(Plus 4 "Bonus Biopsy” Questions)
Have you or a loved one ever faced the prospect of surgery and been at a loss for what questions to ask?
It’s a very common scenario and unfortunately, most people (and even a lot of physicians!) who meet with their surgeon (or gastroenterologist, or pulmonologist, or that nice young doctor in the hospital) often feel overwhelmed. I often hear how “there were a lot of words spoken and I still have no idea what’s happening.”
Patients and their families are often left to decide whether to let this physician open them up based solely on their personal impressions, opinions of friends or family, recommendations from trusted physicians, or even from the internet (with its own series of biases, inflammatory comments, etc). As all of us are quite aware by now, all of these evaluations don’t answer the fundamental question: “Am I in good hands?"
Fortunately, even if you or a loved one feels overwhelmed, there are a definite series of questions that you can ask your surgeon that should help to give you a lot more information with which to make a truly informed decision, and to allow what I call truly informed consent.
Note: if any physician ever refuses to give you this information, chastises or dismisses your questions, then take a good long pause to question whether you will want to trust your own or your loved one’s health to this physician.
Medicine is a tough and critical profession, and with great power comes great responsibility. Responsible physicians should know these numbers: surgeons in particular usually have many of these metric tracked. The great ones will do so even on their own.
Without further ado, I present the list. Feel free to suggest your own as I am always looking for feedback.
11 TOUGH QUESTIONS EVERY SURGEON SHOULD ANSWER*
* (or any physician wanting to perform a procedure)
(1) How many of these have you done?
(2) What is your personal complication rate?
(3) What is the expected outcome of this procedure?
(3A) Might I have to have this procedure again?
(3B) If “yes,” in what time frame and under what circumstances?
(4) Will this (procedure, biopsy, surgery) be definitive? Or is this simply a temporizing procedure?
(5) What are the possible negative outcomes or complications?
(5A) How often do they happen?
(5B) How often have they happened to YOUR patients?
(6) What kind of preparation is necessary for the procedure?
(7) Will I experience any pain after the procedure?
(5A) If so, how much and for how long?
(5B) How will my pain be managed?
(8) What other things (complications, limitations, dressing changes) can I expect to encounter after the procedure?
(9) What is the WORST thing that can happen as a result of this procedure?
(10) How long will my recovery time be?
(11) ❗️How will your office deal with any complications, need for pain control, etc - especially if they occur after hours or on the weekends?
4 BONUS BIOPSY-SPECIFIC QUESTIONS (getting a tissue sample)
All of the above questions, PLUS:
(1) How DIFFICULT will this biopsy procedure be?
- How EASY is it to get an accurate sample?
- How MANY biopsy samples are needed?
(2) How many FALSE POSITIVES occur?
- This means that a biopsy is deemed to be positive that actually is negative for the condition being tested for.
- Example: a biopsy determines that someone has breast cancer but it turns out that the patient never did have the cancer after all.
(3) How many FALSE NEGATIVES occur?
- This means that a biopsy is deemed to be negative that actually is positive for the condition being tested for.
- Example: a biopsy determines that someone does NOT have prostate cancer but it turns out that the patient DOES have cancer.
(4) PROSTATE BIOPSIES: What happens if the biopsy is NEGATIVE but my PSA keeps INCREASING?
That’s it! I hope that you find this useful. Appreciate any feedback.
Warmest regards,
Peter Cashio, MD MS
__________
❗️This is a very important topic. In my time in the ER, I have seen so many patients dumped to the ER after hours or on the weekend because the surgical office cannot get in touch with the surgeon. Now, depending upon your complaint (wound problem, etc), the ER may be the best place for an evaluation. It’s best to have this clarified before undergoing the procedure.
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