Second Opinion is the definitive resource for any of the 15 million people each year who are told they need surgery. This is the one book to turn to when you are sorting out whether or not to have surgery. Dr. Eric Rose and his collegues provide patients a reassuring arsenal of approaches and alternatives so they can participate fully in this important process to assure the best possible outcome. You'll want to bring Second Opinion with you for note-taking, list making, references, and support. It will help you be your own best advocate.
Other features include:
*45 of the most common operations described in detail
*Full illustrations
*Reasons to have the operation
*What can happen if you don't
*Possible complications
*What to expect after surgery
*Extensive, unbiased resources for getting a second opinion
*Patient's worksheets, notes, and rights
Second Opinion is the definitive resource for any of the 15 million people each year who are told they need surgery. This is the one book to turn to when you are sorting out whether or not to have surgery. Dr. Eric Rose and his collegues provide patients a reassuring arsenal of approaches and alternatives so they can participate fully in this important process to assure the best possible outcome. You'll want to bring Second Opinion with you for note-taking, list making, references, and support. It will help you be your own best advocate.
Other features include:
*45 of the most common operations described in detail
*Full illustrations
*Reasons to have the operation
*What can happen if you don't
*Possible complications
*What to expect after surgery
*Extensive, unbiased resources for getting a second opinion
*Patient's worksheets, notes, and rights
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Overview
Second Opinion is the definitive resource for any of the 15 million people each year who are told they need surgery. This is the one book to turn to when you are sorting out whether or not to have surgery. Dr. Eric Rose and his collegues provide patients a reassuring arsenal of approaches and alternatives so they can participate fully in this important process to assure the best possible outcome. You'll want to bring Second Opinion with you for note-taking, list making, references, and support. It will help you be your own best advocate.
Other features include:
*45 of the most common operations described in detail
*Full illustrations
*Reasons to have the operation
*What can happen if you don't
*Possible complications
*What to expect after surgery
*Extensive, unbiased resources for getting a second opinion
*Patient's worksheets, notes, and rights
Product Details
| ISBN-13: | 9781466890909 |
|---|---|
| Publisher: | St. Martin's Publishing Group |
| Publication date: | 02/10/2015 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 448 |
| File size: | 3 MB |
About the Author
Columbia-Presbyterian Medical Center is one of the largest hospitals in the nation. Located in New York City, it is the first and oldest medical center in the country.
Dr. Eric Rose is Chair of the Department of Surgery at Columbia-Presbyterian Medical Center. He has been named as one of the country's best heart surgeons.
Dr. Eric Rose is Chair of the Department of Surgery at Columbia-Presbyterian Medical Center in New York City. He has been named as one of the country's best heart surgeons.
Read an Excerpt
Second Opinion
The Columbia Presbyterian Guide to Surgery
By Eric A. Rose
St. Martin's Press
Copyright © 2000 The Trustees of Columbia University in the CityAll rights reserved.
ISBN: 978-1-4668-9090-9
CHAPTER 1
Understanding Your Medical Problem, and Its Surgical Solution
No one ever wakes up one day and says, "Gee, I'd really love to have an operation." Everyone wants to feel better, look better, live longer, and stay disease-free, but no one wants to be cut open, endure discomfort, and put normal activities on hold.
Yet it's a prospect that faces millions of people each year. Surgery is not inevitable, but it is quite likely that you or someone you care about will someday have to consider it as an option.
How you do react when surgery is recommended? With a sense of relief that there's help for your problem? Or with a denial that you even have a problem? Are you hit by an overwhelming desire to have the operation right now? Or do you just go numb, letting the doctor's words float out of your consciousness?
There are as many ways to react as there are types of surgery. No matter how you first react, try to make the effort and take the time to find out why an operation is recommended, what it entails, and how your health will improve.
If you decide to have surgery, it should be for a very specific reason: you are convinced that it is the medical alternative that supports your best interest.
It helps to recognize a point that can get buried in the emotions aroused by the word surgery. When you hear your diagnosis, you are not just a patient in a doctor's office—you are also a consumer buying a very important service.
It may seem a strange concept at first, especially for those who grew up in an era when the doctor gave the orders and the patient did as told—no questions, no options. But it isn't crass to question your doctor. Nor does it imply disrespect to professionals who have studied and practiced for years. If you are concerned about offending your doctor, remember this: doctors expect you to ask lots of questions, perhaps get a second opinion, and possibly end up following a different strategy than the one they originally recommended.
You can compare the situation to any major purchase. The stakes are very different, but wouldn't you expect to put at least as much effort and ask as many questions about an operation that could alter your life as you would about buying a car?
You want the medical system to work to your advantage. After all, you are buying into a treatment package—physicians and staff, medical center, type of operation, recovery plan—that will make a difference in the quality, even the length, of your life.
I urge you to establish from the outset that you have a big role to play. Be proactive. You can break your responsibilities down into these ten steps:
1. Choose medical professionals who are caring and knowledgeable.
2. Gather the facts of your medical condition through testing and discussion.
3. Obtain a clear description of your diagnosis and treatment alternatives.
4. Put that description into the context of what it means for your everyday life.
5. Create a support team of friends and relatives.
6. Confirm your diagnosis and treatment options through a second opinion.
7. Evaluate the risks and the benefits of your options.
8. Understand what happens to you during the operation, in recovery, and post-operatively.
9. Form realistic expectations of what an operation can accomplish.
10. Decide whether or not to have surgery.
Of course, if there is a medical emergency and your life—or the way you live it—is in immediate jeopardy, you may have to have surgery on the spot without going through this sequence. When there is a choice, however, try to use these steps to help you make the best choice.
Taking the time may be tough, given the risks of surgery, the expense, the immediate impact on your lifestyle, the demands it places on your family, and the rigors of the recovery process. But it is worth every ounce of effort you put into being a proactive consumer in the surgical process. Understood and used properly, surgery can provide powerful benefits for you.
In some cases, the decision is fairly easy to make. You're clear about what you want and the medical data confirms your best option. In others, the decision will take a lot of probing, discussing, and researching to answer the question: "Do I need this operation?"
Surgery can be daunting, but it need not be shrouded in mystery. It is a process that includes finding out what's wrong and repairing it. It's common to get stuck on images of the operation itself in which you appear as an unconscious body on an operating table while the surgical team—gloved, gowned, and masked—uses a formidable array of instruments on you.
No wonder people anticipate an operation with concern, if not terror. What an ultimate act of trust! You see yourself as giving up all control to a surgeon who is going to have to subject you to trauma without question. In return, you expect to gain better health and a longer life. It is an agreement that no reasonable person enters into lightly.
Your participation in the decision-making process of surgery can lead you to enter into that agreement wisely. You exercise control beforehand so you can feel safe in the operating room. But your role in treating your medical condition doesn't mean you have to operate! You are not expected to pass the scalpel, advise the surgeon, or monitor equipment during the operation. That would be absurd.
But it is also unthinkable, unless you are in an emergency, that you would end up in an operation without knowing who is operating on you, why you're there, and what benefits will result from it.
Your intention to get the best information possible and your belief that the decision is yours to make will lead you to a realistic goal: to have the data in your hand and the feeling in your gut that having that particular surgery performed by that specific surgeon is the best option for you. Being wheeled through the operating room doors is not the beginning of surgery; it is the culmination of the process.
Collaborate or abdicate?
Just because a procedure is doable doesn't mean it should be done on you. Your best approach is to view the process from the start as a collaboration between you and your doctor, not as a predetermined course from which you cannot veer. You and your physician need to listen to each other to understand what is relevant to create an outcome that best suits your needs.
What, then, can you bring to the discussion? Doesn't the doctor, with his experience, data, and presence of mind hold all the cards?
No. You have the critical pieces that complete the puzzle of how to proceed:
• What is important to you?
• Can the result of surgery make your life better?
Even in a medical crisis, the answers to these questions are an indicator of whether the solution to your problem is surgery, alternative treatments, or doing nothing at all. The level of medical intervention should be a reflection of what fits the way you want to live your life.
For example, perhaps you have a condition called claudication, which is debilitating pain in your leg(s) when you walk due to blockages in the arteries of your leg(s). The choices of treatment range from medication and exercise to placing balloons and stents in the arteries to an operation to bypass them. How do you choose?
You'd start by thinking about your lifestyle in the context of the medical problem at hand. If your favorite activity is running six miles a day and you've had to give that up because of the pain, the level of treatment you seek is more likely to be at the high end of the spectrum than if you are a couch potato who rarely walks more than a block at a time.
The many other questions you'd ask, including whether you could lose the limb in an extreme case, are more meaningful if you see the interrelationship of your lifestyle with your treatment options.
If physicians were treating only the disease process, their job would be a lot easier. But they are treating the whole person and they need to know your thoughts and concerns to map out a plan with you. When one person hears that a lump that's been discovered in his thyroid is benign, he may be so relieved he's ready to fly out of the office. Another person may be so fearful of having any lump at all, that he could only live happily if he has it removed.
It is not responsible for the surgeon to follow a treatment course simply because you, the patient, want it, if he thinks you can be harmed by it. Nor is it his job to predict what you want; it is your job to tell him as clearly as you can.
A breast surgeon determined that the cancer in a young woman could be successfully treated by the standard method of removing the lump and the lymph nodes along with radiation. However, the woman insisted she only wanted the lump removed, nothing else. Rather than do an operation he considered substandard, the surgeon referred the woman to a radiologist and an oncologist so she could find out more about the impact of making that choice.
Of course, you can also opt out of this whole process and let the doctor decide. You can say, "I don't want to hear anymore. I'm too upset about this. Just go ahead. I trust whatever you want to do." Such autonomy dumping, as I've mentioned, is an option. It's quick and easy. But most people, when they consider the consequence of handing over a decision that could have a major impact on their lives, think better of it. At the very least they may say, "I trust what you're going to do. Tell me about how you'll do it and what the outcome will be."
In some cases the patient is mentally impaired, too young, or too old to make the decision for himself. You may be called upon to go through all the steps of the decision-making process for this loved one. The question remains the same: given the set of facts and the lifestyle needs of the person who is depending on you, is surgery in his best interest?
In answering the question of whether or not to have surgery, you may find that the process of collaboration by its very nature leads to some disagreements. Feel free to speak up—as well as to be challenged in turn. It's the give and take that leads to clarity, different perspectives, and finally a consensus. As long as you and your physician treat each other with mutual respect and are open to new insights, you're on the right track.
How do I begin?
You should not be daunted by the prospect of learning about disease and surgical repair. Like all big efforts, you start with small steps. You do not need to know every nuance, every last detail. You do not need to acquire the same level of knowledge as the physician. What you do need is to get the information that will allow you to feel comfortable about making a decision.
"Doctor, what's wrong with me?"
It may happen that you arrive at the doctor's office for routine tests or an evaluation of symptoms. And you leave with a recommendation for surgery. You should expect to get the following information from the doctor with whom you're consulting:
• An opportunity to describe your symptoms, ask your questions, and express your concerns.
• An understandable, coherent explanation of the disease or injury you have.
• A description of its specific implications for you and for your quality of life.
You need to hear your physician describe, in plain English, the basics of your medical condition. If it helps you understand better, ask for pictures and diagrams along with a verbal explanation.
As one woman who had surgery put it, "If I ask the questions, I get the answers."
Imagine discovering you have a heart condition called aortic stenosis. An ideal dialogue between you and your doctor would be the following:
What is aortic stenosis? It's an abnormality of the aortic valve that guards the left ventricle. The valve is located at the spot where blood leaves the major pumping chamber of the heart.
What does that valve do? When the valve is normal, it lets blood flow freely out of the heart and keeps blood from leaking back into it.
What's wrong with my valve? It's gotten so narrow that it's difficult to eject blood from the heart and to prevent blood from leaking back into the heart.
How do I experience this? You could have shortness of breath, chest pains, or fainting episodes. Or you may have no symptoms.
Adapted to your condition, these questions are your opening salvo for understanding any medical problem and deciding how to treat it. In more general terms, this is what you're really asking:
• What part of my body is diseased or injured?
• What does it do when it's operating normally?
• What's it doing in my case?
• How does this affect me?
How can I tell if I've had enough tests for an accurate diagnosis—or if I'm having too many tests?
There are many types of tests for most medical conditions. The question to ask your doctor is: "Will the information obtained from this test help us make a meaningful decision about my problem?" If not, then the test is not necessary.
A doctor feels comfortable with the thoroughness of the testing process when he has enough information to establish a definitive diagnosis and to exclude reasonable alternative conditions.
When your doctor provides his diagnosis and explains how he reached it in a way that makes sense to you, you can be assured that the testing process was thorough and complete.
Given my medical condition, what will surgery do for me?
There are two main reasons for recommending surgery:
• To prevent death or a catastrophic illness.
• To relieve symptoms.
It may sound simplistic but remember, no operation will make you feel better if you aren't suffering from symptoms. If your heart valve isn't working properly, but you don't have shortness of breath or chest pain, you won't experience improvement in how you feel after the operation. What you will experience is the knowledge that you've substantially reduced your chance of dying from a heart attack in the near future.
If you're having an operation to keep from getting worse (e.g., preventing the spread of cancer or a heart attack), the questions to ask are: What's the likelihood of preventing death or serious illness if you have the operation or if you don't?
If you do have symptoms, know which ones you're addressing, which will remain, and which will go away. Sometimes people who undergo surgery have a vague sense that an operation will fix a lot of things that are bothering them, although they're unrelated to the specific surgery. If you have chest pain and leg pain, you can expect to eliminate the discomfort in your chest from valve surgery. It will not eliminate the pain in your leg!
Find this out before the operation. You don't want to go into an operation with unrealistic expectations about what is going to change, only to come through it disappointed.
Most decision-making about operations today is based on data from observations of large populations over long periods of time, expressed statistically. Even if you're the type of person who shunned statistics in high school math, try not to block it out when it pertains to surgery. You need to combine an understanding of the scientific data on surgery with your own personal medical history.
You'll undoubtedly hear stories from friends and relatives about how Uncle Joe had the same operation, and did—or did not—benefit from it. Sure, you'll be tempted to get emotional reinforcement from anecdotal evidence. It may be your only personal exposure to that type of surgery to date. And most people are only too willing to share their war stories. But don't get hung up on anecdotes.
These stories are intriguing but are no more than a rough guide to what is going on with you. Medical treatment is a highly individualized process. You are unique and that uniqueness determines which option is best; furthermore, methods and techniques may well have changed since the time of your relative's surgery.
How do I look at risk in deciding whether I should have surgery?
Assessing your tolerance for risk is a concept that's often applied to activities like investing your money, but it's also entirely relevant in a surgical context. Risk permeates the surgical process, including how likely it is you will improve through surgery. For example, if you have back pain and there is a chance that it will recur after surgery, you would want to know if that chance is 2 percent or 30 percent before you decide on the operation.
Looking at the numbers helps you put your medical condition in context of what is likely to happen to you, not what is definitely going to happen. One woman in her mid-forties found out she had colon cancer and a section of her colon was removed. Although she had surgery, her doctor said that in the future she still had twice the chance of getting cancer in another part of her body and ten times the chance of getting colon cancer again than the average person.
Ten years later, when tests showed some abnormal-looking cells in her colon, she was faced with a decision of whether to have surgery to remove them. The doctor said he felt 95 percent sure that the cells should be taken out. She went ahead and had the surgery. No cancer was found. The statistics helped her decide on the need for the surgery; they were not a guarantee of the outcome. She didn't feel her surgery was unnecessary. Given her risk factors, she felt it was a wise decision. Her overwhelming sense was one of relief that all was well.
(Continues...)
Excerpted from Second Opinion by Eric A. Rose. Copyright © 2000 The Trustees of Columbia University in the City. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents
Title Page,Copyright Notice,
A Note to the Reader,
Acknowledgments,
Introduction,
PART ONE: DO I NEED SURGERY?,
1. Understanding Your Medical Problem, and Its Surgical Solution,
2. Getting a Second Opinion,
3. Evaluating the Alternatives,
4. Finding the Right Surgeon,
PART TWO: BEFORE, DURING, AND AFTER: OPTIMIZING YOUR HOSPITAL STAY,
5. Getting Yourself Ready for Surgery,
6. Using Special Services,
7. Planning Your Hospitalization,
8. What to Expect in Recovery,
9. Coping in the Aftermath of Surgery,
10. What You Need to Know About Anesthesia,
PART THREE: WHAT'S GOING TO HAPPEN TO ME?,
11. A Brief Introduction to the Surgical Procedures,
12. Breast and Skin Cancer Surgery,
13. Cardiothoracic Surgery,
14. Endocrine Surgery,
15. Gastrointestinal Surgery,
16. General Surgery,
17. Orthopedic Surgery,
18. Reproductive Surgery,
19. Transplantation Surgery,
20. Vascular Surgery,
Appendix A: Resources,
Appendix B: Sample Living Will,
Appendix C: Sample Health-Care Proxy,
Appendix D: Sample Consent Form,
Appendix E: A Patient's Bill of Rights,
Appendix F: Sample Appointment Schedule,
Appendix G: Checklist of Questions,
Appendix H: Post-Operative Instruction Form,
Appendix I: Prescription Timetable Form,
Index,
Copyright,