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Questions you must ask

MagazineApril 1994 (Vol. 5 Issue 1)Questions you must ask

The prospect of surgery is very distressing and worrying for anyone, and you're not likely to feel at your strongest at these times

The prospect of surgery is very distressing and worrying for anyone, and you're not likely to feel at your strongest at these times. There will also be a natural tendency to trust the surgeon implicitly and to opt for keyhole surgery if it is offered.

Nonetheless, it's important that you satisfy yourself on the following questions (support of family at this time will be invaluable):Is surgery really necessary? Probably the most important question of all, and one to be asked early in the process rather than when you're lying in a hospital bed. A survey at the Leicester Royal Infirmary, England between August 1990 and January 1991 revealed that 78 of the 190 admissions for surgery, or nearly half, were "inappropriate". Of these, 29 per cent needed neither a surgical admission nor surgical opinion; 26 per cent needed an admission, but to a different specialty; 24 per cent needed an opinion in the accident and emergency unit; and 18 per cent a routine or outpatient appointment. Three per cent could have received advice over the phone.

Is surgery going to help? A question you need to consider in liaison with a professional practitioner of some kind who might be able to suggest a more benign treatment. It's worth pointing out that frighteningly few surgical procedures are ever tested for their efficacy and safety.

The most common unnecessary operations, as listed by Stephen Fulder in How to be a Healthy Patient (Headway) include:

Appendix removal. (Three quarters of all appendices removed in Germany have been found normal.)

Back operations. (The Lancet has said 60 of all back operations are unnecessary.)

Biopsy. (If it is for cancer, it may spread it.)

Breast removal. (A review of 8000 cases revealed that the removal of the breast does not increase the chances of survival.)

Heart bypass. (Patients do not tend to live longer unless blockage is severe; 50 per cent of operations are unnecessary, according to JAMA. See also WDDTY, vol. 4, no 2.)

Gall stone removal. (One in 30 elderly patients die from the operation; safer ultrasound method is available.)

Heart/kidney transplants. ("Russian roulette," says Stephen Fulder.)

Hernia. (Four times more dangerous to have the operation than to go without.)

Hysterectomy. (Only one in five are clinically justified in the US.)

Is keyhole surgery the most appropriate course? If you are satisfied that surgery is necessary, do not be bedazzled by keyhole surgery for its own sake. Standard open surgery can be safer for appendix removal, for instance, and can be a better option for cancer surgery as there is less risk of other infection.

Is the surgeon experienced in keyhole surgery? A vital question, but one that may be difficult to put directly to the surgeon (or at least to get a straight answer back). But try and find out from nurses, juniors and helpers. Don't be a guinea pig. Also try and find out the success rate at the hospital. Reports back from regional health authorities around Britain for 1990-91 revealed that you are six times as likely to die after general surgery at some hospitals compared to the safest ones.

Is there sufficient aftercare support? One of the great benefits of keyhole surgery is the short time you have to stay in hospital. The emphasis therefore falls on aftercare support, both from the hospital and your own family. If you live on your own, it is one factor that has to be seriously considered.


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