Surgeons, How To Talk To Your Patients

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bookjp

Well-known member
Joined
Jan 17, 2009
Messages
166
Location
Flint,Michigan
Is it a law that a surgeon has to tell you the mortality rate of a certain surgery and also the complication rate????They wonder why patients are scared to death.Even if it is a law they could easily make the patient feel better.Here would be my speech to me.Mr. Purdy by law I have to tell you the mortality rate for your operation is 5% to 7% but now that I've told you FORGET THOSE NUMBERS .You're fairly young(56) no other health problems and My team and I are the best in the business so don't worry we're going to get you safely through this surgery.You have my word on that.Wouldn't you feel better to hear that from your surgeon.So come on docs, jeezz install a little confidence in your patients!!!!!!!!!1
 
Funny...... Both of my OHS, I was not afraid I would die. I was afraid I would not.

I had far more fear of having a stroke during surgery or some other debilitating event which would leave me less than intact post op.

I was afraid I might have wished I died.

I know this is probably an off the wall way of thinking about it when facing surgery but our minds all roam off in our individual directions. The odds of either happening to an otherwise healthy youngish person are very, very, very small especially for a first timer. (A second, third surgery increases the risk a tiny bit.)
 
Luckily, my surgeon used similar words to what you want surgeons to say...he had to tell me the mortality rate was 4% in my case but asked me not to think about it and that he would be my surgeon for many long years! he reassured me that I am healthy and in good shape and when I asked about other issues; his reply that all will improve once the valves are functioning better.
 
On the same subject of how doctors need to talk to us, I do not know about others, but my bad experience was with my cardio who is now fired...he needed to choose some right words to tell me about me needing the surgery...I went alone that day happy that I lost weight, dropped my cholesterol, etc...he dropped the news of the surgery and I felt like bomb shell hit me...he did not give me any advice or even assure me this is a routine procedure these days, etc, or refer me to any website! He asked me to return in six months and he will refer me to surgeons then!! ...I asked him what will happen if I do not have the surgery, his asnwer was: you shall disappear. He left me in that small room in a shock...This is a harvard top notch graduate with many years of experience!! I burst into tears when I reached my car and cried and sobbed while driving home confused whether to tell my sister and hubby or hide the news from them until I checked with someone else! Since that incident, my hubby accompanies me all the time.
 
On the same subject of how doctors need to talk to us, I do not know about others, but my bad experience was with my cardio who is now fired...he needed to choose some right words to tell me about me needing the surgery...I went alone that day happy that I lost weight, dropped my cholesterol, etc...he dropped the news of the surgery and I felt like bomb shell hit me...he did not give me any advice or even assure me this is a routine procedure these days, etc, or refer me to any website! He asked me to return in six months and he will refer me to surgeons then!! ...I asked him what will happen if I do not have the surgery, his asnwer was: you shall disappear. He left me in that small room in a shock...This is a harvard top notch graduate with many years of experience!! I burst into tears when I reached my car and cried and sobbed while driving home confused whether to tell my sister and hubby or hide the news from them until I checked with someone else! Since that incident, my hubby accompanies me all the time.
Eva it seems like some of these Doctors need to take another class on how to relate to patients.I don't think they realize how high 5% to 7% sounds when you're that 5 to 7 percent.
 
Personally, I refused to watch any pre-surgery movies until they found me one that only showed the parts of the hospital and rehab, but not the surgery itself. I had NO interest in seeing -- or hearing about -- exactly what they were going to do during surgery. I DID want a hospital tour, like the kind I had before giving birth, but I guess they only do that for pregnant women, probably because most of us could pretty much have our babies anywhere, so they want to sell you on how great their hospital is.
 
When I saw my surgeon the first time in December 2004 (he only had my echo reports from another hospital at that time), he first explained that people with my profile either died or HAD TO have the surgery within 10 years. When I asked him about the risks, he said 1% (I'm assuming he was speaking about mortality risks and that it was his personal statistics) and then went on and said "For you, 0%"!!! I'm smart enough to know that there is no such thing as 0%, but the fact that he said it made me feel better, and I never really worried about dying during the operation. Like Jkm7, I worried about complications.

Oh, on the surgical report, the surgeon put something like "I explained to the patient that the risks were about 5%..." I never head that!!!!:eek:
 
Like Jkm7 I wasn't in the slightest bit worried about dying, if I died then I died, I wouldn't know anything about it. The surgeon told me the risks of the surgery and my response was "And without surgery I definitely die, yes?" So why worry, I was dead without it and probably/hopefully with surgery I wouldn't be dead. I was quite surprised to wake up, my first thought was "So I woke up then".

If I had to have OHS again next week I still wouldn't worry about dying, I either will or I won't. I would be more concerned that the house is a mess and it will be quite a lot of work for someone to clear up. :)

When I was about to have my angiogram the nurse read aloud to a group of about eight of us all having one that day, she told us of all the possible risks and things which could go wrong but said that if any of these things happened we were in the best place to have them dealt with, she was legally obliged to tell us but not to worry. I think we were more concerned with trying to pee uphill and without breaking wind! :)
 
When I was about to have my angiogram the nurse read aloud to a group of about eight of us all having one that day, she told us of all the possible risks and things which could go wrong but said that if any of these things happened we were in the best place to have them dealt with, she was legally obliged to tell us but not to worry. I think we were more concerned with trying to pee uphill and without breaking wind! :)

I have been through enough medical procedures in my lifetime, that I jokingly refer to the caveats that doctors tell you as the CYA speech.

Some years ago, I met a woman who was a social worker. She worked in a medical school, teaching young would-be doctors "bedside manner". At the time, she said that this hospital had the first program of that type. I sincerely hope that the idea has spread in the interim.

I think that it is so important that doctors learn how to gauge their patients' emotional states, and talk to them with empathy. I do believe that how a problematic medical issue is presented, may make a difference in how the patient deals with it.
 
5% would be high for a simple replacement. I've got to think they're using a generic number, which includes people in their eighties, and people with other, concurrent lung and organ diseases. It wouold make it easier for them if they kept a sliding scale to show relative risks by age.

The percentage for an other wise healthy individual in the 50s would run about 1%- 2%, like your doctor mentioned.

Certainly the other doctors mentioned were not good with patients. I see no excuse for them.

On the other hand, I can be a handful as a patient. I wouldn't know what to say to me. I don't know what it's like to deal with people when you tell them this, even if you do it in a reasonable way. I have to assume a percentage get belligerent, some burst into tears, some try to blame the doctor, and ...well, people do just about anything...

I agree that there is a lot of poor delivery going on out there, and it needs to be improved greatly in some cases. In fact, it ought to be grounds for suit for those that are awful at it. On the other hand, I can't imagine being in the doctor's position either.

Best wishes,
 
Bob,

In response to your : "5% would be high for a simple replacement. I've got to think they're using a generic number, which includes people in their eighties, and people with other, concurrent lung and organ diseases"

The percentage of mortality as explained to me does not depend only on the health of the person,..they also take into consideration other factors even though they are prepared for them...I cannot recall now as I was in another world then...maybe those with some medical background may mentione them...I slightly remember if anything goes wrong with a lung machine, electricity, ..... I personally focussed on the positive results.

Bookjp, as I said above, my surgeon was perfect the way he talked to me...my problem was the way my cardio spelled the news to me.
 
I had surgery 550 miles from where I lived. My Cardiologist recommended the surgeon. I had wanted to use Dr Cooley but he was booked for 2 months. Met my surgeon face to face the day before surgery. I had talked with him on the phone a couple times before. He explained the risk but also said I was in excellent health and had everything in my favor. He was concerned about using a mechanical valve since I had a history of severe bleeding duodenal ulcer. But he still recommended mechanical due to me being 55.

Like some of the others, as for as the surgery it didn't worry me or about death. I had known for ten years that someday I would have to have the valve replaced. They said most people went home within 5 days so I was ready to get the show going. Had I known what was in store for me I would have been more concerned.
I had complications the first night after surgery. The next morning the surgeon told my wife I was in a very sick man but he would save me. He kept his word.
 
I had surgery 550 miles from where I lived. My Cardiologist recommended the surgeon. I had wanted to use Dr Cooley but he was booked for 2 months. Met my surgeon face to face the day before surgery. I had talked with him on the phone a couple times before. He explained the risk but also said I was in excellent health and had everything in my favor. He was concerned about using a mechanical valve since I had a history of severe bleeding duodenal ulcer. But he still recommended mechanical due to me being 55.

Like some of the others, as for as the surgery it didn't worry me or about death. I had known for ten years that someday I would have to have the valve replaced. They said most people went home within 5 days so I was ready to get the show going. Had I known what was in store for me I would have been more concerned.
I had complications the first night after surgery. The next morning the surgeon told my wife I was in a very sick man but he would save me. He kept his word.
Olefin,this came out of the clear blue sky for me.I had people write me that they had no symptoms either.Than in the next sentence they tell me that they are out of breath walking up a flight of stairs.I would call that a symptom.I was playing basketball two months ago with no problem.Now my surgeon says I not only need a valve but a new ascending aorta and possibly an aortic arch. If I need the arch he said they lower your body temperature to 64 degrees and have app. 45 minutes to fix the problem before brain damage I assume.I am having a hard time coming to grips with the fact that I have no and I mean no symptoms at all and I going to be clinically dead on the operating table with I suppose the possibility of brain damage if things go bad.How can you not think of that possibility!!!
 
I would say I had no symptoms other than being short of breath a few (3) times in the past 9 months. I attributed that to trying to keep up with my 20 -30 y/o workers! I was ok with the way the first cardioligist told me and I felt the second opinion cardio was relieved that he didn't have to talk me into the surgery. As someone said previously, without the surgery we die so what choice do we really have. I also am more afraid of not dieing and loosing something to " complications"

Mikeb
Awaiting surgery date
 
The problem is for a lot of us the symptoms developed over years so you really never notice it. Some chalk it up to getting older, maybe a bit rundown from work, etc.
Thats my problem Dyna.Just before my routine physical I was playing basketball with a group of guys in there early thirties(I'm 56) with no problem keeping up with them.You would think that if i'm in that bad of shape that I would feel something.Some people tell me that I'm lucky that I don't have any symptoms but I beg to differ.How can I subject myself to this profound of an operation without some kind of awareness that something is truly wrong!!!!!
 
Olefin,this came out of the clear blue sky for me.I had people write me that they had no symptoms either.Than in the next sentence they tell me that they are out of breath walking up a flight of stairs.I would call that a symptom.I was playing basketball two months ago with no problem.Now my surgeon says I not only need a valve but a new ascending aorta and possibly an aortic arch. If I need the arch he said they lower your body temperature to 64 degrees and have app. 45 minutes to fix the problem before brain damage I assume.I am having a hard time coming to grips with the fact that I have no and I mean no symptoms at all and I going to be clinically dead on the operating table with I suppose the possibility of brain damage if things go bad.How can you not think of that possibility!!!

Justin was able to play soccer the night before his surgery when he was 10 (they let him finish the season) and didn't think he had symptons, but after recovery he had so much more energy (and a growth spurt) since the valve slowly gets worse your body compensates which is why you might not notice it. The reason I'm writng is Justin had the lowerred temp for his 2nd surgery, I know it sounds scarey but the experienced surgeons (and anesthesia) do this pretty often and know the safest ways to cool and bring you back to temp. Did you ask how many he has done and the success rate?
 
I guess I'm different then most others (which really isn't a big surprise :rolleyes:). I'd rather have the doctor be blunt than to try and sugarcoat the statistics. I think most people who weren't expecting the news that they needed surgery would be in shock as well as have a range of emotions from anger to despair regardless of how the doctor broke the news. I actually asked my surgeon what the mortality statistics were for the Ross Procedure before he had the chance to tell me. Then I asked what his personal mortality rate was for patients he performed the Ross Procedure on. Then I asked him what his personal statistics were for re-ops on his patients that he performed the Ross Procedure on. I wanted it all laid out on the table so I could come to grips with what I was facing.

Bob,

I agree with approximately 99.9% of your comments. :D But I have to disagree with this statement you made in your post:

I agree that there is a lot of poor delivery going on out there, and it needs to be improved greatly in some cases. In fact, it ought to be grounds for suit for those that are awful at it.

Maybe you were exaggerating to make a point, but no doctor should be sued for having a lack of tact...especially surgeons. Since they normally don't have a chance to bond with most of their patients they tend to get right to the point of what needs to be done and what might happen if things don't go right. That's like saying a mechanic should give you a hug and let you cry on his shoulder after he breaks the news that your transmission is shot. :D
 
Justin was able to play soccer the night before his surgery when he was 10 (they let him finish the season) and didn't think he had symptoms, but after recovery he had so much more energy (and a growth spurt) since the valve slowly gets worse your body compensates which is why you might not notice it. The reason I'm writing is Justin had the lower temp for his 2nd surgery, I know it sounds scary but the experienced surgeons (and anesthesia) do this pretty often and know the safest ways to cool and bring you back to temp. Did you ask how many he has done and the success rate?
Llnw thanks for writing I haven't heard of anyone on this forum having this done.Some have wrote about a bentall procedure but from what I read its not the same.Hell I was gonna ask for some extra blankets during surgery.I guess thats out of the question now!!!!1
 
Llnw thanks for writing I haven't heard of anyone on this forum having this done.Some have wrote about a bentall procedure but from what I read its not the same.Hell I was gonna ask for some extra blankets during surgery.I guess thats out of the question now!!!!1

I'm not sure but I think he was saying he had the bentall (valve+root+ arch) and that involves the lower temp.(HCA) let me look here is a thread about HCA http://www.valvereplacement.com/forums/showthread.php?t=18963&highlight=HCA
 
I'm not sure but I think he was saying he had the bentall (valve+root+ arch) and that involves the lower temp.(HCA) let me look here is a thread about HCA http://www.valvereplacement.com/forums/showthread.php?t=18963&highlight=HCA
Llnw thanks for that link.It makes you feel a little reassured that other people have had this procedure done.The 2% sounds a whole lot better than 5% to 7%.With my health I figure I'm down to maybe one half of one percent.Thanks again for getting me out of the funk I was in for the last two days!!!!!
 

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