Be Informed: Learning more about your operation will help you make better decisions about your health care.

Are you facing surgery? You are not alone. Millions of Americans have surgery each year. Most operations are not emergencies. This means you have time to ask your surgeon questions about the operation and time to decide whether to have it, and if so, when and where. This brochure does not apply to emergency surgery.

The most important questions to ask about elective surgery are why the procedure is necessary for you and what alternatives there are to surgery. If you do not need to have the operation, then you can avoid any risks that might result. All surgeries and alternative treatments have risks and benefits. They are only worth doing if the benefits are greater than the risks.

Your primary care doctor-that is, your regular doctor-may be the one who suggests that you have surgery and may recommend a surgeon. You may want to identify another independent surgeon to get a second opinion. Check to see if your health insurance will pay for the operation and the second opinion. If you are eligible for Medicare, it will pay for a second opinion. You should discuss your insurance questions with your health insurance company or your employee benefits office.

Overview

This booklet provides 12 questions to ask your primary care doctor and surgeon before you have surgery-and the reasons for asking them. The answers to these questions will help you be informed and help you make the best decision. Sources are listed at the end of this booklet to help you get more information from other places.

Your doctors should welcome questions. If you do not understand the answers, ask the doctors to explain them clearly. Patients who are well informed about their treatment tend to be more satisfied with the outcome or results of their treatment.

1. What operation are you recommending?

Ask your surgeon to explain the surgical procedure. For example, if something is going to be repaired or removed, find out why it is necessary to do so. Your surgeon can draw a picture or a diagram and explain to you the steps involved in the procedure.

Are there different ways of doing the operation? One way may require more extensive surgery than another. Ask why your surgeon wants to do the operation one way over another.

2. Why do I need the operation?

There are many reasons to have surgery. Some operations can relieve or prevent pain. Others can reduce a symptom of a problem or improve some body function. Some surgeries are performed to diagnose a problem. Surgery also can save your life. Your surgeon will tell you the purpose of the procedure. Make sure you understand how the proposed operation fits in with the diagnosis of your medical condition.

3. Are there alternatives to surgery?

Sometimes, surgery is not the only answer to a medical problem. Medicines or other nonsurgical treatments, such as a change in diet or special exercises, might help you just as well-or more. Ask your surgeon or primary care doctor about the benefits and risks of these other choices. You need to know as much as possible about these benefits and risks to make the best decision.

One alternative may be "watchful waiting," in which your doctor and you check to see if your problem gets better or worse. If it gets worse, you may need surgery right away. If it gets better, you may be able to postpone surgery, perhaps indefinitely.

4. What are the benefits of having the operation?

Ask your surgeon what you will gain by having the operation. For example, a hip replacement may mean that you can walk again with ease.

Ask how long the benefits are likely to last. For some procedures, it is not unusual for the benefits to last for a short time only. There might be a need for a second operation at a later date. For other procedures, the benefits may last a lifetime.

When finding out about the benefits of the operation, be realistic. Sometimes patients expect too much and are disappointed with the outcome, or results. Ask your doctor if there is any published information about the outcomes of the procedure.

5. What are the risks of having the operation?

All operations carry some risk. This is why you need to weigh the benefits of the operation against the risks of complications or side effects.

Complications can occur around the time of the operation. Complications are unplanned events, such as infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have an increased risk of complications because of other medical conditions.

In addition, there may be side effects after the operation. For the most part, side effects can be anticipated. For example, your surgeon knows that there will be swelling and some soreness at the site of the operation.

Ask your surgeon about the possible complications and side effects of the operation. There is almost always some pain with surgery. Ask how much there will be and what the doctors and nurses will do to reduce the pain. Controlling the pain will help you be more comfortable while you heal, get well faster, and improve the results of your operation.

6. What if I don't have this operation?

Based on what you learn about the benefits and risks of the operation, you might decide not to have it. Ask your surgeon what you will gain-or lose-by not having the operation now. Could you be in more pain? Could your condition get worse? Could the problem go away?

7. Where can I get a second opinion?

Getting a second opinion from another doctor is a very good way to make sure having the operation is the best alternative for you. Many health insurance plans require patients to get a second opinion before they have certain non-emergency operations. If your plan does not require a second opinion, you may still ask to have one. Check with your insurance company to see if it will pay for a second opinion. If you get one, make sure to get your records from the first doctor so that the second one does not have to repeat tests.

8. What has been your experience in doing the operation?

One way to reduce the risks of surgery is to choose a surgeon who has been thoroughly trained to do the procedure and has plenty of experience doing it. You can ask your surgeon about his or her recent record of successes and complications with this procedure. If it is more comfortable for you, you can discuss the topic of surgeons' qualifications with your regular or primary care doctor. (For more information about surgeons' qualifications, see page 10.)

9. Where will the operation be done?

Most surgeons practice at one or two local hospitals. Find out where your operation will be performed. Have many of the operations you are thinking about having been done in this hospital? Some operations have higher success rates if they are done in hospitals that do many of those procedures. Ask your doctor about the success rate at this hospital. If the hospital has a low success rate for the operation in question, you should ask to have it at another hospital.

Until recently, most surgery was performed on an inpatient basis-patients stayed in the hospital for one or more days. Today, a lot of surgery is done on an outpatient basis in a doctor's office, a special surgical center, or a day surgery unit of a hospital. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room

Ask whether your operation will be done in the hospital or in an outpatient setting. If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery-or just the opposite, recommends outpatient surgery that is usually done as inpatient surgery-ask why. You want to be in the right place for your operation.

10. What kind of anesthesia will I need?

Anesthesia is used so that surgery can be performed without unnecessary pain. Your surgeon can tell you whether the operation calls for local, regional, or general anesthesia, and why this form of anesthesia is recommended for your procedure.

Local anesthesia numbs only a part of your body for a short period of time-for example, a tooth and the surrounding gum. Not all procedures done with local anesthesia are painless. Regional anesthesia numbs a larger portion of your body-for example, the lower part of your body-for a few hours. In most cases, you will be awake with regional anesthesia. General anesthesia numbs your entire body for the entire time of the surgery. You will be unconscious if you have general anesthesia.

Anesthesia is quite safe for most patients and is usually administered by a specialized physician (anesthesiologist) or nurse anesthetist. Both are highly skilled and have been specially trained to give anesthesia.

If you decide to have an operation, ask to meet with the person who will give you anesthesia. Find out what his or her qualifications are. Ask what the side effects and risks of having anesthesia are in your case. Be sure to tell him or her what medical problems you have-including allergies-and any medications you have been taking, since they may affect your response to the anesthesia.

11. How long will it take me to recover?

Your surgeon can tell you how you might feel and what you will be able to do-or not do-the first few days, weeks, or months after surgery. Ask how long you will be in the hospital. Find out what kind of supplies, equipment, and any other help you will need when you go home. Knowing what to expect can help you cope better with recovery.

Ask when you can start regular exercise again and go back to work. You do not want to do anything that will slow down the recovery process. Lifting a 10-pound bag of potatoes may not seem to be "too much" a week after your operation, but it could be. You should follow your surgeon's advice to make sure you recover fully as soon as possible.

12. How much will the operation cost?

Health insurance coverage for surgery can vary, and there may be some costs you will have to pay. Before you have the operation, call your insurance company to find out how much of these costs it will pay and how much you will have to pay yourself.

Ask what your surgeon's fee is and what it covers. Surgical fees often also include several visits after the operation. You also will be billed by the hospital for inpatient or outpatient care and by the anesthesiologist and others providing care related to your operation.

Surgeons' Qualifications

You will want to know that your surgeon is experienced and qualified to perform the operation. Many surgeons have taken special training and passed exams given by a national board of surgeons. Ask if your surgeon is "board certified" in surgery. Some surgeons also have the letters F.A.C.S. after their name. This means they are Fellows of the American College of Surgeons and have passed another review by surgeons of their surgical practices.

For More Information

Surgery. The American College of Surgeons (ACS) has a free series of pamphlets on "When You Need an Operation." For copies, write to the ACS, Office of Public Information, 55 E. Erie Street, Chicago, IL 60611, or call 312-664-4050. Pamphlets in this series range from those providing general information about surgery to those explaining specific surgical procedures.

Second Opinion. For a free brochure on "Medicare Coverage for Second Surgical Opinions: Your Choice Facing Elective Surgery," write to Health Care Financing Administration, Room 555, East High Rise Building, 6325 Security Boulevard, Baltimore, MD 21207. Ask for Publication No. HCFA 02173.

To get the name of a specialist in your area who can give you a second opinion, ask your primary doctor or surgeon, the local medical society, or your health insurance company. Medicare beneficiaries may also obtain information from the U.S. Department of Health and Human Services' Medicare hotline: call toll-free 800-638-6833.

Anesthesia. Free booklets on what you should know about anesthesia are available from the American Society of Anesthesiologists (ASA) or the American Association of Nurse Anesthetists (AANA). For copies, write to ASA at 520 North Northwest Highway, Park Ridge, IL 60068, or call 708-825-5586; or AANA at 222 S. Prospect Avenue, Park Ridge, IL 60068-4001, or call 708-692-7050.

Pain Control. "Pain Control After Surgery: A Patient's Guide" is available free from the Agency for Health Care Policy and Research (AHCPR). For a copy of this consumer version of the AHCPR-supported clinical practice guideline and for information on other patient guides, write to the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, or call toll-free 800-358-9295.

General. For almost every disease, there is a national or local association or society that publishes consumer information. Check your local telephone directory. There are also organized groups of patients with certain illnesses that can often provide information about a condition, alternative treatments, and experience with local doctors and hospitals. Ask your hospital or doctors if they know of any patient groups related to your condition. Also, your local public library has medical reference materials about health care treatments.

Some of the issues discussed in this booklet are covered in greater detail in a guidebook and video program, "PREPARED for Health Care: A Consumer's Guide to Better Medical Decisions," by J.C. Gambone, D.O., and R.C. Reiter, M.D.,@ 1993, Great Performance, Beaverton, Oregon. For information on obtaining copies, write to Great Performance, Inc. at P.O. Box 91400, Portland, OR 97291-0400.

For further information you may also wish to see "The Savvy Patient: How to Be an Active Participant in Your Medical Care," by David R. Stutz, M.D., Bernard Feder, Ph.D., and the Editors of Consumer Reports Books, @ 1990, published by Consumers Union of U.S., Inc., Yonkers, NY, 10703.

Take this list of questions with you when you go to your doctor to discuss your surgery:

1. What operation are you recommending?
2. Why do I need the operation?
3. Are there alternatives to surgery?
4. What are the benefits of having the operation?
5. What are the risks of having the operation?
6. What if I don't have this operation?
7. Where can I get a second opinion?
8. What has been your experience in doing the operation?
9. Where will the operation be done?
10. What kind of anesthesia will I need?
11. How long will it take me to recover?
12. How much will the operation cost?