Going for Surgery? What You Need to Know

My Dad had heart surgery this year (he’s doing very well) and while many people felt like he was SO lucky to have me (future heart surgeon) in the family, I did not share that sentiment. I used to think that it would be a relief to be so well versed in the operation my Dad was going to have, but in fact it was terrifying. Being in heart surgery means that I see the full spectrum of outcomes, the operations that go really well, the in between and those that unfortunately go horribly wrong. What I will say is having a loved one go through heart surgery has broadened my perspective on how I interact with my patients.

In this post I will share some of the nuances of going for surgery and being admitted to a hospital that I wish my Dad had known before being put under the knife.

What is informed consent anyways?

This is such an important topic and I believe a very misunderstood topic. Let me ask you - have you ever signed a consent form with questions remaining? Or have you ever signed a consent form where the physician spent < 5 minutes with you? If I had to guess, informed consent was not actually obtained.

I speak to patients all the time who are coming for surgery who say something along the lines of "just do what you need to do doctor, I trust you." Now, I am not trying to say that you shouldn't trust us, but I would encourage everyone to take ownership of their decisions, because ultimately you are the one that has to live with it.

"The doctrine of informed consent ensures the freedom of individuals to make choices about their medical care. It is the patient, not the physician, who ultimately must decide if treatment — any treatment — is to be administered." - CMPA

Medicine is often compared to aviation or other high risk industries but I would argue that we are far different. If something goes wrong in an airplane, the pilot is going down with everyone on board. Generally speaking if something goes wrong on the operating room table, the surgeon walks away but the patient may not be so lucky.

So what is informed consent anyways? Well first off, consent needs to be valid. Now what that means is it needs to be 1. voluntary (family members cannot decide for you if you should have surgery, we as physicians cannot tell you to have the procedure), 2. the patient must have the capacity (whole other topic, but essentially someone who is capable of understanding) and finally the patient needs to be 3. informed.

The last part there is what I would like everyone to pay attention to. Informed means that you are informed enough to make a decision. In surgery, that means we as surgeons need to provide an explanation about the operation we are offering and the expected outcomes including the risks associated with the operation. This also means that we need to tell you as the patient about the alternatives even if the alternative is NOT operating and the risks associated.

Many of the diseases we treat in cardiac surgery are mechanical problems and mechanical problems, like a leaky valve, blocked pipe etc. require mechanical solutions, which often means without surgical intervention the likelihood is a fatal outcome. Speaking from experience, there are often worse things death and that is why I am emphasizing the need to listen to all the risks, not just whether or not you are going to live or die.

Consent should be taken by the surgical team member. Preoperatively, patients are often spoke to by nursing, medicine (cardiology for example), their family physician, social workers etc. All of these team members are very knowledgeable in their own right but they aren't the ones who are going to be cutting you open, they will serve as a supportive role but the information surrounding the procedure should come from your surgical team.

Here are my top 5 tips to consider before going under the knife.

Tip #1. When you're listening to the risks, pay attention to the COMMON risks. Let's take cardiac surgery as an example. There is ALWAYS the risk of dying, stroke and heart attack. Those are the scary ones, but if you are an average risk patient then they are less common.

The way more common risks are, but not limited to, infection, delirium, and atrial fibrillation, and they SUCK. I wish I had done a much better job at preparing my Dad and my Mom for those risks because they can make a patient feel awful and they are often overlooked in the consent because they are considered "more minor."

Tip#2. Ask about what you can expect after surgery. There is seriously no such thing as a dumb question. For example, what am I going to look like? What am I going to feel like? How much pain am I going to have?

I say this because the more prepared you can be before you go into the operation, the less surprised you are going to be after. The cardiac ICU can be a scary place, the patient probably won't even remember their time there but for the family members it can be a shock. Our patients will have IV lines, big central lines coming out of their neck, arterial lines to monitor blood pressure, and many of them will be still be asleep with the breathing tube in when they first arrive in ICU. Our patients will also have chest tubes coming out with blood inside. It is good to have a mental picture in mind before you see your loved one.

Tip #3. Hospitals can be a scary place, especially in the ICU. There are so many unusual noises that you aren't used to hearing. Whether that be the monitors that are in your room, IV poles that become jammed and start beeping or honestly other patients. When my Dad was waiting for surgery, his roommate had a code blue, which means their heart stopped. That scenario is chaotic and we do a bad job as health care providers to check in on the patients who witness these events. We are so focused on the patient who is having the code blue that we forget to check in. Now, that is obviously an extreme, but the noises were something in particular that bothered my Dad and I figured I should mention it. Consider bringing headphones and something you enjoy listening to or watching to help make you feel more at home.

Tip#4. Be your own advocate. If you have questions, ask them. If you haven't seen a doctor in a while, say something. One of our mandates as physicians is patient advocacy but there is a huge spectrum on physicians and what that means to them, so as patients advocate for yourself. PLEASE do not take that as I am telling you to complain, I am simply recommending that if you feel in the dark about your care, or there is something that doesn't feel right, speak up, and tell someone.

Tip#5. When you leave hospital, the most important thing to remember is you are leaving because we as your surgical team believe you are safe to leave. My tip for you is to stay compliant with your discharge plan and be proactive about your care. Call your family doctor, call your surgeon's office. If you really aren't feeling well then go to your local ER, or ideally go to the ER where they did your surgery. There is no point when you are fresh from surgery that we wait at home when there is a concern. I can guarantee you, we would much rather see you unnecessarily than see you at a point of no return.

If you take anything away from this blog post, please remember the following - we as your surgical team swore an oath to do what we believe to be in your best interest but ultimately it is your body, your life, your choice. We should not make decisions for you, we should only provide you with the tools to make the decision for yourself.