Bobbie Colgan visited her doctor 13 years ago because she was constantly fatigued and left the appointment disappointed at the perplexing recommendation: gastric sleeve weight loss surgery.
At 310 pounds, she was able to easily lose 20 pounds and change her lifestyle habits. Ms. Colgan initially rejected the suggestion of surgically shrinking her stomach. Over subsequent visits, her doctor persisted and used her young son and the fact that her insurance would cover the procedure to convince her it was right for her.
“My blood pressure was starting to get higher. Anything I told her about stomach issues, acid reflux, and stuff, she would just say, ‘It’s because you’re fat,’” Ms. Colgan said. “She said it could be considered abuse if I wasn’t taking care of myself, and if I’m a single mom, why don’t I care about my son enough to take care of me?”
Conflicted and worn down, she caved to the advice for her son’s sake and had an event-free surgery—one that’s now considered safe enough to be performed on children. From the outside, she appears to be a picture of better health, but she traded pounds for problems that were never fully explained. Since then, her stomach symptoms have worsened and multiplied.
Communication Is Critical in Surgical Care
An extensive section in the peer-reviewed book “Vignettes in Patient Safety,” notes that doctor-patient communication has become more collaborative and patient-centered. However, authoritarian styles in health care are plenty—and it’s associated with increased medical errors. One report blamed lack of communication on more than 60 percent of adverse events.
But communication is more multifaceted than simple transparency—as pointed out in “Vignettes of Patient Safety.” Subtle nuances in communication help patients identify physician biases and red flags.
It begins with the setting of communication—whether it’s poorly lit, full of distractions, or conducted online or with anyone other than the surgeon. Other red flags are surgeons who block conversation by offering advice or reassurance, explain distress as normal, change the topic, ignore the emotional toll of a condition or decision, and jolly patients along, as the authors explained.
They further described barriers in patient education that can include medical jargon, monologues with little attempt to understand the patient, time restraints, language barriers, and limited understanding of health literacy.
Communication Is a Surgeon’s Responsibility
While there are patients who prefer to leave all decisions up to their physicians, it’s up to doctors not to assume that and approach each situation objectively. This is done with communication that’s clear and understood, as well as giving patients time to make up their minds, according to “Vignettes in Patient Safety.”It’s the doctors’ responsibility to discern if “internal noise” is interfering with communication, including whether they or the patient are fatigued, hungry, or angry. That’s what makes feedback vital; surgeons should be rephrasing what patients said for confirmation to assure total comprehension on their end.
“Though it may take time, once shared decision is made, the process will be long and compliance will be total,” the article stated. “Research has indicated that those who use these tools consistently have not only gained clarity in their communication but they improve the physician-patient relationship and outcomes as well.”
The Toll of Regret
Consulting other surgeons—or even other types of providers such as naturopaths or functional medicine doctors—can help patients get another perspective, slow down the decision-making process, and gather more certainty around their decision.Surgery is irreversible, including organs that are permanently removed, new conditions that could result from the operation, and a chance of other adverse events or even errors. As such, the decision demands a more contemplative approach.
Dr. Doughty said it’s common for surgeons to downplay the importance of the appendix and so see little issue with removing it, even if they aren’t sure it’s the problem.
“It’s a good guess,” he said.
Understanding Your Risk Factors
Still, second opinions are a good tool—and even required in some cases—to examine the necessity of surgery. Dr. Doughty said it might be particularly beneficial to get an opinion from someone who doesn’t have a financial incentive to steer you toward the operating room.“The question is, ‘Should I be seeking an opinion from some other doctor who has a different toolkit?’” he said.
Assessing Competent Surgeons
It can be complicated to navigate the murky waters of how competent your surgeon is, but it’s an issue that’s attracted some attention. Some believe doctors should also be subject to occasional assessment.The article noted that the number of practicing physicians older than 65 in the United States has increased by more than 374 percent since 1975. In 2015, 23 percent of practicing physicians were 65 years old or older.
“Research shows that between ages 40 and 75 years, the mean cognitive ability declines by more than 20 percent, but there is significant variability from one person to another, indicating that while some older physicians are profoundly impaired, others retain their ability and skills,” the authors wrote.
Basic cognitive testing could be misleading when medical students with little experience are ranked above surgeons with years of practice, according to a statement from Columbia University Irving Medical Center.
Uncommon Questions to Ask
You can become your own advocate by arming yourself with as many questions as you need. The internet is also filled with lists of what to ask before any specific surgery.- Do you double-book surgeries? This is a common practice that’s sometimes abused. It’s important to know what part of your operation will be handled by your surgeon and what part might be done by attending physicians.
- Will you see me post-operatively? Due to reimbursement, Dr. Dewan said many delegate this responsibility to physician assistants or trainees.
- What bills will I get after surgery? Your surgeon should be able to help you understand the overall cost of your surgery beyond the operation including use of the facility, anesthesia, implants, equipment, etc.
- How often do you do this surgery?
- What is your success rate with this surgery?
- Can I delay my surgery?
- Have you ever canceled a surgery because you were mentally or physically unfit?
The biggest regret she has is not taking a longer list of questions to her doctor.
“I thought I asked a lot of questions. There’s so much more I wish I would have asked ahead of time,” Ms. Colgan said.
She’s seen many doctors since her surgery in an attempt to resolve the same issues, as well as new food sensitivities that have worsened since her operation.
While her doctor no doubt had good intentions, the fact remains: Surgery is a serious intervention and should remain a last resort for most people.
10 Questions to Ask Before Surgery
Dr. Parrish, a naturopath and certified functional medicine provider, has compiled 10 questions to ask your doctor about surgery.- Is surgery the best option for my condition?
- What are the potential risks and complications associated with this surgery?
- What is the success rate of this procedure for my condition?
- What is the expected recovery time?
- What are the short-term and long-term effects of this surgery on my overall health?
- What are the anesthesia options and associated risks?
- How experienced are you in performing this procedure?
- Are there any lifestyle changes I should make before the surgery?
- What can I expect in terms of pain management and discomfort after the surgery?
- What is the cost of the surgery and what does it include?