Wednesday, September 19, 2012

Something To Add, Part 2 (1-14)




I just got the October issue of Reader's Digest in the mail. On the cover is an actor in scrubs, with a surgical mask hanging down, cheap latex gloves like they wear at the food court in the mall, making the 'shhhh!' gesture and looking the camera in the eye. 50 Secrets Surgeons Won't Tell You!

I couldn't resist! Shall we go for it?

Readers Digest Says:
They slice us open, remove tumors, reshape our thighs, and give us new hips and kidneys. Yet despite the fact that surgeons have our lives in their hands, most of us know more about the folks who cut our hair than those who cut our bodies. Did you know, for instance, most surgeons are paid based on how many operations they do or that it's better to have surgery on a Tuesday than on a Friday? Use these insider tips to become a savvier, healthier patient.

Reiki Doc Says:
We are going to spill from insiders? Yeah, right. Pull up a chair and sit right next to me... ; )


Choose the Best Doc

#1
 Reader's Digest Says:
"To know which doctor is good, ask hospital employees. Their word trums an Ivy League degree, prestigious titles, and charm."

Reiki Doc says:
Better yet, ask an anesthesiologist, perfusionist, scrub tech, or O.R. nurse. PACU and Pre-Op nurses know too. They work with these surgeons every day. They know their ability, their temperament, and how well their patients do. Don't ask just anybody at the hospital.

#2
Reader's Digest Says:
"Ask about their complication rate. If they don't have one, they're hiding something or haven't operated enough to have one. No one is immune to complications."

Reiki Doc Says:
I stratify my complications like a traffic light. The green light ones are the little things that aren't that bad, are common, and go away on their own, like a sore throat after a general anesthetic. The yellow light ones are less common, such as dental trauma or a hoarse voice after a general anesthetic. The red light ones are the ones you worry about that keep you up all night. Fortunately, they are rare. At a teaching hospital, with very busy operating rooms, we get maybe one case like this a year, and usually it is someone with a problem so serious they would probably die anyway with or without the surgery. Going on the freeway onramp is a risk you take every day, but it is a controlled risk. Much is the same with surgery.

#3
Reader's Digest Says:
"If an airline told you that their pilot is the best one they have but he's not FAA-certified, because he failed the exam, would you get on the plane? For the same reason, always check to see if your surgeon is board-certified in his specialty. Many are not."

Reiki Doc Says:
This is true. Be wary of plastics procedures. There are ENT-trained plastic surgeons, and Plastic Surgery-trained plastic surgeons. Would you want someone who does primarily breast work giving you a face lift? And many dermatologists and other physicians go to a weekend class to learn plastics procedures and do not have the board certification and training you might expect.

#4
Reader's Digest Says:
"Don't assume your primary care doctor's recommendation is best. Referrals may be politically motivated or be given because the doctors work within the same multi-specialty group."

Reiki Doc Says:
This is true. Know your insurance. If you have a PPO, try to stay in network, but ask an O.R. staff for a recommendation and go to them for a second opinion. Never let anyone cut on you without talking to two or preferably three different surgeons in a non-emergency setting.

#5
Reader's Digest Says:
"Ask if you can talk to former patients. It's like getting a references for a babysitter."

Reiki Doc Says:
Use caution and what resonates with you. My talking with a patient who had pituitary surgery before me freaked me out. She had every complication, went on and on and on, and would not shut up. I had to hang up the phone on her, and she was my mother-in-law's best friend!

#6
Reader's Digest Says:
"Some surgeons won't mention procedures they don't know how to do. I'll see patients who were told they needed an open hysterectomy, even though it could be done laparoscopically. That's one reason it's good to get a second opinion."

Reiki Doc Says:
Painfully true. I used to work at a place that pioneered robotic prostatectomy. Impotence rates and blood loss were markedly less. When I left to work in private practice, laser vaporization of the prostate and open prostatectomy were done for three more years before the robot came to the facility. Even now, we are still on the learning curve.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Questions to Ask Before Any Surgery
Reader's Digest Says:
Why do I need this procedure now?
Who is going to be doing it, and how many times has he/she done it before?
What are the most common complications, and how do you deal with them?
What will the recovery be like?

Reiki Doc Says: ASK YOURSELF
What does your intuition tell you about this surgeon? Are they money-driven or mindful?
Would this person have your back if there was a huge complication of walk away?
Would this surgeon recommend this to their mother? Their child?
Do I feel safe with this person?
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Before You Go Under the Knife

#7
Reader's Digest Says:
Always ask "Who is going to take care of me after surgery?'. You want to hear 'I will see you on a regular basis until you have recovered fully.' Often it can be residents or physician assistants. Sometimes it's not anybody, especially after you've been discharged from the hospital.

Reiki Doc Says:
I have worked in both academics and in private practice. In academics, there is a team of residents, that is supervised by a Chief Resident. You have many eyes following you, being led by one ready to graduate. As long as it's not July you are going to be okay. (July is when all residents 'move up' a level in training). An attending surgeon will see you once a day, and write a note. It's the law, per Joint Commission. In private practice, you may get the P.A., but really in all cases, you have a nursing team and/or resident team on the front lines in constant communication with the boss, your surgeon. Don't expect a busy, successful surgeon to sit at your bed and share stories. If you thought the office was busy--why should the busy stop in the hospital too? You are going to be fine! Don't worry!

#8
Reader's Digest Says:
It's better to have an elective surgery early in the week because lots of doctors go away for the weekend and won't be around to make sure you're OK. If you go in on a Friday, and then on a Saturday or Sunday something icky is coming out of your incision, you're going to get someone who's covering for your surgeon.

Reiki Doc Says:
I think a well-rested surgeon who has a life is a better doc than one who is a workaholic. Doesn't the blogger 'Skeptical Scalpel' who said this KNOW that next weekend YOUR surgeon is going to be the one covering for the one who covered him? Duh! But seriously, the REST of the hospital kind of shuts down on the weekend. Radiologists hire a central location to read all the images from the hospital remotely at night and on weekends. The O.R. shuts down and a team has to be called back in. It works, but it's not wiki wiki.

#9
Reader's Digest Says:
Go to your preoperative appointment with a family member. That reminds your doctor you're not a gallbladder or a bypass or a valve--you're a person who's par of a family.

Reiki Doc Says:
Oh please! What?!? Hello?! Your doctor KNOWS you are a person! Don't fall for this fear porn. However, sometimes with the stress of surgery, especially with a diagnosis like cancer, your ability to understand and retain critical information for your health is not as good as it usually is. Having someone who cares about you with you will help both of your follow instructions and get all questions answered.

#10
Reader's Digest Says:
It's amazing how diligent people can be about searching for the right surgeon but have no idea who their anesthesiologist will be, which is just as important. So ask, 'Who's going to be putting me to sleep?' or ask me who I think the best anesthesiologist is. In some hospitals, you can request that person.

Reiki Doc Says:
This is true. May I add that your surgeon may think someone is the best because they cut the most corners and are therefore the fastest? Or the one who golfs with him or parties on their boat?
Some surgeons won't even work with some anesthesiologists. If you take what is offered at your hospital, and you LIKE that anesthesiologist, take their name, and request them in the future. I function in this capacity as a 'private anesthesiologist' for many of my patients, especially ones with complex surgical conditions that take them back several times. I also am the one most requested by the staff, inside and outside the O.R. I have the reputation for being 'the best'. Just yesterday I got called to L&D for an obstetric emergency while I was between cases in the Main O.R. My boss requested me, he was panicking (he does not do OB anesthesia, and was covering because the one on call had to be two places at one time). I calmed and stabilized the uterine bleeding in teamwork with the surgeon in under ten minutes. We did not have to transfuse or do a hysterectomy. My skills are that important in the O.R.

#11
Reader's Digest Says:
Years ago, a patient sent his slides to three different pathologists and got three different answers. I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab-not just one or two slides but the whole lot--and get a second interpretation.

Reiki Doc Says:
This is excellent advice for something that is not common. Some things are more straight forward, like prostate cancer and breast cancer. Either way, this offers 'peace of mind' for the patient. It may be expensive, though.

#12
Reader's Digest Says:
So often the risks on legal consent forms aren't the things we actually worry about, or there may be one complication we're really concerned about. If you truly want to understand the dangers, ask your surgeon, 'What is the risk that give you the most pause?'

Reiki Doc Says:
I stratify my anesthesia risks. Red light equals serious, permanent, rare, like a stroke or an M.I. Yellow light equals bad, but not life-threatening, like a cap that comes off your tooth. Green light equals common, annoying, unpleasant, but not serious, like sore throat or nausea after surgery. It's kind of expected. That would be another strategy to ask your surgeon about risks.

#13
Reader's Digest Says:
Talk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery. Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there's less chance of reactions.

Reiki Doc Says:
That's a surgeon for you! Do you think going for heart surgery two units of blood down and anemic is safer than having all your red blood cells when you have anesthesia and have an ischemic heart? The donation process takes weeks, and the marrow might not have fully recovered. Yes, it does decrease risk of foreign reaction. But it also carries it's own risks with anesthesia. Family members might have personal habits you don't know about, like needles or unprotected sex. Blood bank will screen their blood and throw it out if it is contaminated. Either way, the process takes weeks in advance of your case. Blood bank blood once is fine. Ask for cell-saver, which collects your blood lost in surgery and gives it back.

#14
Reader's Digest Says:
Residents have to learn how to operate, and it's required that an attending physician be 'present'. But 'present' doesn't mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour.

Reiki Doc Says:
Woo hoo! Is this recommendation an antique or what?!
Effective less than ten years ago, an attending surgeon MUST be scrubbed in and at the wound doing surgery. Those days for residents to be independent are over! And that's not so good a thing. Do you know our surgery residents are all taking fellowships now because they aren't getting enough clinical exposure to really be that safe? With the limited work hour restrictions and the attending doing 'more' their opportunity to learn important skills has been reduced. Be sure to ask, 'how many of these procedures have you done in your career? How many in the last year? And how many complications?'

More installments to follow! Click this link to read up to #50: http://reikidoc.blogspot.com/2012/09/something-to-add-part-2-15-50.html

Namaste,

Reiki Doc



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