Surgery, Should I or Shouldn’t I

“Doctor, is this really necessary?”

What are the risks?

What are other options?

What happens if I do nothing?”

These questions outlined by neurosurgeon, Christer Mjåset, should be part of every dialogue between doctor & patient in shared decision making for intervention.

If the doctor doesn’t prompt this conversation, the patient should.

Also ask, “what is the: best case, worst case, & most likely outcomes.” Sometimes people do not know what to ask after being told they would benefit from a procedure. A good doctor asks, “do you have any questions?” A great one will help the person identify their own values & bring context to the decision in relation to the individual’s desired objectives.

As Atul Gwande says, doctors must identify the goals of their patients. These conversations are sometimes lacking in treatment decision making. He says we should ask ourselves & our patients, “what is the goal? Are we fighting a disease for focusing on improving quality of life?”

We cannot allow ourselves to be a win at all costs profession. Inevitably we lose the battle if prolonging life is the only focus. We must draw our attention, & our patients’, to what brings them satisfaction in life & ways to more fully experience that in the face of their obstacles.

One response to “Surgery, Should I or Shouldn’t I”

  1. I wish this article could be sent to surgeons and physicians periodically. Having had several major surgeries, I’ve encountered surgeons who have explained the procedure recommended, and initiated questions related to the procedure, as well as recovery and prognosis. I’ve also encountered surgeons who barely explained the procedure, and were not willing to discuss options, treatment plans or answer any questions. I once had a prominent surgeon at The Cleveland Clinic respond to what I think was a fair, intelligent question relating to a rare and major surgery I was facing, by replying “I’m not answering any questions.” Do I ask you how you do your job”. Needless to say I did not choose him as my surgeon, and in fact decided not to have the surgery. I hope at some point he realized the damage he caused that day. Facing surgery, especially those that can be life changing, need to be discussed, sometimes at length, and all reasonable questions answered. I fully understand that there may not be enough time when the patient is sitting in their office and the physician may be behind schedule, etc. However, then perhaps a reasonable alternative should be offered, such as speaking to a PA or assistant, scheduling a phone consult, or offering the option of submitting a list of questions to to the physician., for him to respond at a later date. There should always be communication between the patient and surgeon for a successful surgery and outcome to occur.

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