December 18, 2017
As an attending cardiac surgeon for more than 20 years, I have performed thousands of operations; I love what I do. A big part of my job is speaking with patients and their spouses, siblings, friends, and spiritual leaders about the operations. In fact, I find my conversations with patients as rewarding as performing their operations.
Those interactions can do so much to help relieve anxiety for the patients and their families. Before each operation, I try to educate my patient by providing detailed information. I believe this helps everyone concerned have a higher level of understanding about what to expect so that they feel more confident and better prepared.
Despite the time that I spend with my patients, I often get the feeling that they haven’t fully grasped everything that I’ve told them. But that’s okay; the effort is always worth it. Let’s face it, when you get your car fixed or your air conditioner repaired, how many of the technical details do you actually understand? That’s when asking the right questions can help. Questions from patients and their families allow me to do a better job of providing “informed” consent that can become “understood” consent.
Here are five questions that I wish patients would ask me:
“What caused this?”
Despite all of the information that may be available, patients don’t always completely understand what caused their problem. However, it’s important that they do. For example, when patients know what caused their coronary artery disease or lung cancer, it may not necessarily prevent them from requiring an operation, but it may motivate patients to change their lifestyles and make different choices, thus hindering recurrence. For this reason, educating patients and “interested individuals” is very important. If a grandson sees his hero grandfather intubated in the ICU because the grandfather was a smoker, then the grandson may think twice about smoking. As Admiral William H. McRaven said, “If you want to change the world, start off by making your bed.”
“Are there any options that would provide long-term results that are equally as good?”
When you consider long-term outcomes, surgical treatments—especially those for coronary artery disease—are often better than nonsurgical options. You may think, “I don’t want bypass surgery.” But if it means a better outcome for years to come, then the long-term approach may be the way to go. Surgeons should emphasize this with their patients.
“What is the likely outcome?”
Discussing the risks of an operation and long-term expectations with patients is important. Risk scores, such as those determined using the STS Risk Calculator, are valuable tools that I use whenever I can. The risk score provides a heart surgery patient’s risk of death or complications, such as long length of stay or renal failure. Most patients want to know as much as possible before their operations, while also understanding that there may be bumps along the way. I always stress, though, that the most likely outcome is complete recovery and, in many cases, symptomatic improvement and prolonged life.
“If I don’t survive, how will I die?”
This question is the elephant in the room that the overwhelming majority of surgeons don’t address with their patients. It is a very uncomfortable topic. Most elderly patients really want to know if dying will be like falling asleep and not waking up or if they will be in pain. I feel that I owe it to my patients and let them know how things could play out. Oftentimes, they are relieved when they learn the answers.
“What would you recommend if it was your mother or your brother?”
I perform a lot of minimally invasive surgeries, which works for many of the diseases that our patients have. In these cases, I would recommend minimally invasive surgery for my mother or brother. However, sometimes there are better options, so I explain in detail all of the treatment possibilities and potential outcomes to my patients. I provide them with as much information as possible, helping them make the most informed decision that they can. For example, when a patient is having valve surgery, I explain the difference between tissue valves and mechanical valves, as well as the choices for inserting that new valve.
If you or a family member have been referred to a cardiothoracic surgeon, keep these questions in mind. There also are lists of questions on each disease page of this website that you can download and bring with you when you visit your doctor. Remember, the more information you have, the better you will feel about your health care decisions.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.
The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.