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What every patient should know before surgery

Written by Derek T. Cawley
Knowing “when”, “where” and “what to have ready” are key questions before surgery but it is the “why” that is the most important. It is because your operation is designed to help you.

It may be your first time in hospital to have a procedure. For us, your healthcare professionals, this is a job that we have trained for, that we do every day and we want you to trust us to do our best. We must always warn you that no surgery can guarantee success and all types of surgery carry risk. Remember, most importantly, that this is your body and your choice. Yes, we can advise and inform but you always have the option to accept, delay, or decline your treatment plan.

Sometimes the mere mention of risk or harm may be upsetting enough for you to forego the operation. Attending the clinic specifically to discuss surgery has proven to be very constructive and helps strengthen the bond between patient and surgeon (1). A thorough consent process helps us to understand your preferences. This respect for your values is what empowers you to make the best decision.

We frequently find it difficult to strike a balance between providing too much or too little information (2). Adequate time is required for you to reflect, both during and between consultations. Printed colourful booklets about surgical procedures can be a great help.

The meaning of doctor comes from its Latin origin, to teach (3). Receiving information about your operation in a way that you understand and feel comfortable with is key to you to make your decision. The chances of having a side-effect or complication, whilst important to know, may or may not seem relevant to you. Traditionally a surgeon would have recommended a treatment option, whereas it is now more appropriate that together, you and the surgeon would pick the most agreeable option.

Research continues in the field of new technologies to improve diagnosis and treatment, but it is heartening to know that research also continues to find out more about what influences the outcome of an operation (4). The effectiveness of an operation is similar to but not the same as patient satisfaction (5,6). Effectiveness may mean the medical success of an operation. Satisfaction is based on a broader experience. Elements such as the administrative process, the hospital stay, the aftercare and the doctor-patient relationship play an important role. Informing you thoroughly about what to expect is good preparation for what lies ahead. You are most likely to be satisfied when your hospital experience matches your expectations.

With our medical code of ethics in mind (7), you should know before surgery that your healthcare team will act in keeping with your wishes, while endeavouring to avoid harm and with the intention of achieving the best possible outcome. Ultimately, when you look for reassurance and direction post-operatively, this is founded in the trust built pre-operatively.

Get well soon!
Derek T. Cawley


References:

1) Powell JM, Rai A, Foy M, Casey A, Dabke H, Gibson A, Hutton M. The ‘three-legged stool’: A System for Spinal Informed Consent. 2016;1427-1430.

2) Lemaire R. Informed consent--a contemporary myth? J Bone Joint Surg [Br] 2006;88- B:2–7.

3) docere: to teach, Oxford Latin-English Dictionary

4) Black N. Patient reported outcome measures could help transform healthcare. BMJ (Clinical research ed). 2013;346:f167.

5) Mannion AF, Porchet F, Kleinstück FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D. The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice. European Spine Journal. 2009;18(3):367-73.

6) Graham B, Green A, James M, Katz J, Swiontkowski M. Measuring patient satisfaction in orthopaedic surgery. J Bone Joint Surg Am. 2015;97(1):80-4.

7) Declaration of Geneva, as currently published by the World Medical Association. Last edition: 2006: Editorial Revision. 173rd Council Session, Divonne-les-Bains
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