Deciding About Surgery

When your doctor recommends surgery, you should take an active role in deciding whether to go through with it. Your values and beliefs are often a key part of choosing surgery versus exploring other types of treatment as a road to better health. Surgery can be risky and difficult, but sometimes it's clearly the only way to go. Other times, alternatives to surgery are the wisest choice.

Learning to ask the right questions -- and getting the right answers -- is vital to helping you decide whether or not surgery is right for you. Being a responsible health care consumer starts with getting involved in decisions about your health. That way, you're more likely to feel calm and confident about whatever course of treatment you choose.

Deciding Which Option is Best

When you have a health condition that may involve surgery, it is scary. That's why doctors seldom perform elective surgical procedures -- those a person can choose to have or not have. (Elective surgeries relieve conditions that are basically harmless or are causing only minor symptoms.)

So how do you decide about surgery? The first step is to find out whether the surgery your doctor is recommending is nonelective or elective.

Nonelective Surgery

When surgery is needed to save a person's life (such as to remove a ruptured appendix) or must be done immediately to prevent permanent disability (such as to surgically repair a badly broken bone), it is considered nonelective. That means there is little or no choice but to have the operation or risk serious consequence to a person's future health. And there is probably no time to explore other options. Fortunately, few surgical procedures are truly nonelective.

Elective Surgery

Most surgical procedures involve some degree of choice for the patient. In some cases, alternatives to surgery exist, such as medications or other ways of dealing with the problem. In other cases, surgery may be the only option for correcting a particular problem, but the symptoms don't merit the risk of surgery. For example, many people who have gallstones have no pain, discomfort, or other symptoms and do not need treatment. Surgery is appropriate when it is needed to:

• Relieve or prevent pain

• Restore or preserve normal function

• Correct a deformity

• Save or prolong your life

Even if surgery is appropriate, it may not be the only choice of treatment. It's always best to investigate all other options before choosing surgery.

Make an appointment with your doctor to discuss the questions to ask before surgery listed below. Write down or record the answers. If you feel anxious or nervous, take a friend or relative along for moral support. Then assess the information and decide what you want to do.

Make sure it's your own decision. Don't let yourself be pressured into having surgery.

Asking for a Second Opinion

Getting more information can help when you're deciding about surgery. One way to do this is to get a second opinion, also called a "review of treatment".  A second opinion can help you make a more informed decision. Some health plans require second opinions before they will cover certain procedures, but others may not cover it. Check with your health insurance to learn weather a second opinion is covered.  

Although a second opinion isn't needed in every instance, you would be wise to seek one if:

• The procedure is experimental or high risk, such as an organ transplant

• Your symptoms aren't severe and the outcome of surgery isn't clear

• The procedure has a reputation for being performed when not absolutely needed

Don't Be Timid

You might feel uncomfortable asking for a second opinion, but most doctors today are used to this and are very cooperative. A doctor who responds with anger or refuses to cooperate with such a request may not have your best interests at heart.

To find a second surgeon, ask your primary doctor, your health plan, or your local hospital for a recommendation.

Avoid the expense of repeating tests and procedures; bring your medical records and x-rays, if any, along with you. If this is not possible, you can have them sent to the second surgeon before your appointment by signing a records release form.

If the second surgeon disagrees with the first, find out why. You may find that one surgeon's philosophy and reasoning fit with your own more than the other's.

Questions to Ask Before Surgery

Name and Procedure

• What's the operation called?

• What will be done?

• How is it performed?

• How long will it take?

• How serious is it?

Reason

• Why is this surgery recommended?

Results

• How will this procedure help my condition?

• What are the benefits?

Alternatives

• What other treatment options are available?

• Is outpatient surgery an option?

• What will happen if I don't have the surgery?

• Is no treatment an option?

Timing

• How soon should I have the surgery?

• How soon must I make a decision?

• What will happen if I postpone the operation?

Risks

• What are the risks involved?

• What percentage of patients die from this procedure?

Complications

• What complications may occur?

• Which complications are common for my age and state of health?

Postoperative Information

• Are there any side effects of anesthesia?

• Will I have tubes, catheters, or dressings after surgery?

Recovery

• What's the typical recovery period?

• How long will I be unable to care for myself?

• When can I return to work and my normal activities?

Experience

• How often do you perform this procedure?

• How often is this surgery done at your hospital?

Cost

• How much is this surgery likely to cost?

• What are your fees?

• What's the average hospital charge?

• What will be covered by my health plan?