3 Questions to Ask Before an Elective Surgery
Disclaimer: This article does not replace medical advice from your doctor. Always consult with your healthcare professionals and trusted sources of information around you who personally know you first, before making a medical decision. The tools shared in the article only apply to hospitals and surgeons in the United States.
As a patient safety advocate, I read many health-related articles about patient safety. I recently ran across disturbing data from years ago, results collected by ProPublica’s patient harm questionnaire. One of the most disturbing results that are worth noting for you to know is this: out of 1000+ cases, more than half of the harms were from elective surgeries.
Elective surgeries do not mean they are optional necessarily, a misconception that many will get by the name. These are surgeries like hip and knee replacements, gallbladder removal, and other surgeries that can be scheduled in near future than urgent surgeries like a coronary bypass. They are considered safer than urgent or emergency surgeries by many because they are often less complicated as some are even done in outpatient settings; some of these surgeries require fewer provisions as recovery times are relatively shorter than other surgeries. The graph above, however, should give you an inkling that they are not necessarily safer.
I have gotten to know many advocates who have either loved ones harmed or experienced harms themselves through elective surgeries. The harms that I am talking about include indirect factors from the elective surgeries even though the surgeries have gone well, such as medication adverse effects, medication errors, and even some chain effects from one event to another during recoveries.
Asking serious questions before elective surgery, therefore, is a crucial step to take for your own safety. You may think your doctor may know you well, but that is very far from the truth. Average doctors in the United States see 1,500–2,000+ patients annually and there is a very slim chance that they will remember the details of your medical conditions. Your doctor can only be as good as how much you can “effectively” share about your condition because you are the one who holds the most comprehensive history of your medical conditions and you are the only one who feels the symptoms in you. There are many good articles out there like this one by Johns Hopkins Medical Center on what questions to ask yourself and others.
However, I like to share 3 additional questions that include subtle nuances that you have to consider. The key is that patients have to do their own research and be self-advocate, or consult other advocates to be an advocate for you to protect yourself.
- Is this surgery really for me; what are other alternatives, “seriously”?
Many articles suggest this question but it may not tell you how to go about it. Second opinions are definitely something to consider, to find out whether this is a necessary surgery for you. Stanford Medicine has an online second opinion program that can be an affordable option for a second opinion. This was something unheard of years ago. My father wanted to get a second opinion at my home country, which he never made it, as just getting the second opinion was going to cost him $40,000–50,000 in the United States in 2007: most of the cost being redoing the tests at its facility before the second opinion. Many doctors and hospitals still prefer their own tests that now more healthcare organizations are recognizing as unnecessary and costly. Alternative medicines that many surgeons and traditional doctors may not be familiar with are also options as well in some cases. As much as 80% of patients will suffer from back pain at some point in their lifetime and chiropractic treatments and acupuncture can help to relieve the pain effectively for many cases. Their benefits are increasingly recognized by medical communities and insurances and they have covered services for some insurances.
2. Who will “actually” perform the surgery?
ProPublica's story on LaVerne Stiles is an example that shows who performs the surgery may matter more than the hospital. The surgeon may have determined the surgery has gone well but complications may not get detected until too late. Renowned hospitals don’t necessarily mean they have the best surgeons as illustrated in the article; a small-town hospital’s surgeon may perform better than a surgeon at an academic medical center with an extensive research history. If clinics and hospitals change the surgeon for some reason, do your research again on the new surgeon and weigh in the benefits and risks of rescheduling the surgery with the preferred surgeon as some surgeries may be time-sensitive. ProPublica has a surgical scorecard available on surgeons and hospitals based on 2009–2013 Medicare records. Although it is dated, it can give you a history of the surgeon and the hospital you are considering that can help your decision.
3. What are my risks and benefits and at “what cost”?
Every patient is different, so your risks and benefits can be different depending on other conditions you may have. American College of Surgeons has a surgical risk calculator on their website that weighs in these factors. The cost of surgery may be also hard to find out and the cost surprisingly varies greatly depending on where the surgery is performed. Consult websites like Clearhealthcosts.com or healthcarebluebook.com and your insurance to avoid surprise bills. You may have to find exact current procedural terminology (CPT) codes that will be used for surgeries to contact the insurances and compare costs for yourself. There can be more than one code involved, so check with the surgeon and the facility for thorough information to be provided to you. If you are uninsured, there are facilities that offer flat prices for uninsured patients, so check with each medical facility. Unfortunately, this question has complicated answers, as patients have different insurances, different risks and benefits depending on other conditions that each may have, and different preferences of doctors and hospitals. Also, resources are scarce that directly compare cost, benefit, risk, and quality altogether.
Bottom line: Patients “must” be self-advocates. If you don’t have the capacity to do so, please consider hiring a patient advocate for your own safety. This is even more important with Covid-19.