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Is it Time for Surgery?

Before we talk about surgery, I have a disclosure to make- I am a surgeon and I enjoy performing surgery.

Having said that, I am a selective surgeon. I do not rush to offer surgery except in emergencies. I try not to offer surgery during the first visit with the patient-even if the patient had been specifically referred to have surgery done- unless it is clearly indicated and all other options had been tried and failed before. This approach serves two purposes: First, it helps to make sure that all valid options have been considered. Second it allows some time for the patient and me to get to know each other better.

I consider surgery a partnership between myself and my patient. To this end, I aim to build a patient-doctor team whose job is to have a clear understanding of the problem, determine what outcome is sought, and what it takes to meet it.

I consider my role to be as follows:

  • Educate the patient about the condition and treatment plan.
  • Help the patient get ready for it.
  • Do a good job.
  • Monitor and guide recovery following the surgery.

The role of the patient is two-fold:

  • To understand my part of the plan and what to expect later on. A knowledgeable and informed patient is a happy patient.
  • Be ready for the plan. This starts with setting a realistic goal. Setting the goal above what may be achievable is a recipe for frustration. The patient needs to understand and be ready for the risks that may come with surgery, and be willing to handle them should they happen.
  • To actively participate in the plan. After all, it is a partnership. The patient’s responsibility is to get ready for surgery, to follow post-operative instructions, to participate with rehabilitation protocol, and to comply and respect restrictions and time frames as determined by the specific surgery performed.

Once the patient is comfortable with the above, and once he/she is ready to commit to surgery and the care to follow, he/she is asked to sign the surgery agreement (Informed Consent) to start the process leading to the surgery day.

Steps Taken Before Surgery

Depending on the nature of the planned surgery, the setting where the surgery will be done, and the health status of the patient, the patient will have to go through predetermined steps to insure a safe and successful outcome for the surgery.

  • Agreement to have surgery: As discussed above, discussing the surgery, and understanding the risks and benefits, followed by signing an informed consent form is the very first step and the one that starts the process. It may not be a bad idea for the patient to go home, take some time to think about the options, and then come back with questions and a decision.
  • Authorization and Scheduling: This is taken care by my office. The date of surgery is determined based on how urgent it is, and what operating room time slots are available.
  • Medical Evaluation: This can be done in my office, or can be arranged for with your primary care doctor depending on your health status. We usually order all necessary labs and tests and send them to your doctor for review. We ask him in return to send us a full history and physical with a statement of medical clearance. It is extremely important to have this available well in advance to avoid losing the surgery time slot.
  • If you are currently taking blood thinners such as baby aspirin, coumadin, warfarin, Plavix, and Pradaxa, we may ask you to get permission from your medical doctor to stop them the week leading to your surgery. Several orthopedic surgeries cannot be safely and effectively done if you are on blood thinners and it is important to know about them.
  • Anesthesia Evaluation: This is done at the hospital. The anesthesia provider will evaluate you and discuss your anesthesia options and educate you about their risks and benefits.
  • Pre-operative Visit: This is your last stop. I will see you one last time during the week leading to your surgery date. During this visit we will go over your condition, make sure no major changes has happened since I have seen you, review you data ( x-rays , MRI, CT scan, nerve tests,…) as well as any test results and the note for your primary care doctor. I will go over the surgery itself and remind you of the benefits and risks.
  • The day of Surgery: All patients going to surgery should have had absolutely nothing to eat, drink, or use tobacco products drink starting the midnight before. Failing to do that jeopardizes your health and will result in rescheduling the surgery.

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