How to Choose a Hospital and the Surgeon Before Surgery?

Undergoing surgery can be a life-changing event. No one would like to bear pain unless the risk versus benefit suggests a significant betterment in the quality of life. How to choose a computer and printer is readily available, but little is available as a checklist regarding what patients should or must ask their surgeons. Do most patients know about how to choose a hospital for surgery? The answer to that question lies in the fact that even in advanced countries, the third most common cause of death in admitted patients is a medical error by hospitals and their employees.

Following are the things which I think every patient should ask before she or he decides to undergo surgery. Likewise, I feel this information should be made available to patients when requested.

First Is the Primary Physician or Medical Specialist:

This is from where the patient is referred for surgery. It is the responsibility of the medical specialist to diagnose the disease and evaluate the realistic chances of success of medical treatment in a said patient. Also, if surgery would be required, refer to a competent surgeon. He or she is supposed to make sure that it is not too late or advanced to make surgery complicated, risky, and sometimes even useless.

Following are the questions that I think every patient should ask the physician or medical specialist, irrespective of surgery as an option for treatment or not:

1. What are my health issues?
2. What about the other diseases that I have and other medicines that I take?
3. What are the options available to treat these?
4. What is a realistic outcome with each option?
5. What will be the side effects, precautions, dietary changes required because of these treatment suggested?
6. Is there any permanent or long-term solution to my problem?
7. Which solution will offer me the best quality of life?
8. Will I be able to afford the expenses till my treatment is complete?

Second Is the Surgeon:

Both the qualification and the training of a surgeon is very important. But even more relevant is his or her experience in the specific surgery that the patient requires. People need to understand that most surgeons qualified with a specific degree are interested in only a handful of surgeries permitted by that degree and perform it well. But there is no publicly accessible database of these 'surgeon preferred operations,' and no way of swapping patients so that there is the best match between the needful patient to the most interested and competent surgeon. Thus, most surgeons attempt to do whatever they can safely, for the patients that visit them. So as a patient one should try to get the following information:

1. What are the different types of treatments and surgeries possible for my problem?
2. What are the pros and cons of each option, and how are they applicable to my case?
3. Will I be completely cured after the surgery? Will I need further therapy or follow-up like chemotherapy, radiotherapy, etc.? Are those facilities available in the same hospital? In the case they are required, what is the sequence of the various therapies which will offer me the best chances of a cure?
4. Which option is the best for me? Tell the doctor to explain the procedure in layman's term.
5. Of all the options, which one are you and your hospital most comfortable conducting?
6. Is this the latest surgical option available? Ask for what training that surgeon underwent? And what are his or her results with this particular surgery?
7. Ask about possible complications with the specific surgery suggested and the expected hospital course.
8. Exact probability of each complication, including hospital infection rate and if applicable ICU infection rate.
9. Can those complications be managed at the same center?
10. Do they have the emergency backup facilities like a 24-hour blood bank, ICU, radiology support, an ambulance with trained professional to transport, if required?
11. What is the usual post-operative course expected in such a procedure?
12. Does the hospital follow evidence-based Enhanced Recovery After Surgery (ERAS) protocols? And WHO (World Health Organisation) patient safety checklists?
13. If the surgery is done in a laparoscopic or robotic manner, will the hospital provide a short video clip of the surgery, if requested? Or a few operative pictures?
14. Who will process the pathology of a medical specimen taken out? Does the surgeon personally know and trust the pathologist (especially in the case of a cancer diagnosis)?
15. Would there be any requirement of blood? Is the blood bank checking for infections that can be spread by blood, including HIV and hepatitis?
16. How long will be the expected hospital stay, and how many days of work will be lost?
17. If the patient had prior injuries or surgeries, ask if there will be any issues because of that?
18. Ask about effects of this surgery on your diet, fertility, and sexual lifestyle.
19. If a daycare procedure (same day discharge as the day of surgery) is planned, the patient should ask for what kind of family support and transport logistics can be required in the middle of the night?
20. How much will be the total expected cost if everything is normal and also if one of the top three most common complications occur? Also, confirm the exact coverage of your medical insurance.

Third Is the Anesthesiologist:

The anesthesiologist is usually consulted after the surgeon and before the actual admission in the hospital for surgery. If the procedure is to be conducted under local anesthesia, then it is the surgeon with whom the patient should have this conversation. For all other types of anesthesia, an anesthesiologist is involved.

1. What are the possible anesthesia options for me? Which one do you feel is best for me?
2. What can be the problems associated, and whether there can be any long-term complications?
3. How can the other diseases and medications affect my stay in the hospital after this surgery?
4. Is it safe for me to undergo this procedure right now or will I be better if I try to make some lifestyle modification, change some medication that I take, or observe some measures to decrease my risk (if the situation allows that)?
5. What are the post-operative pain management options available in my case?
6. Does the hospital follow evidence-based Enhanced Recovery After Surgery (ERAS) protocols?
7. What are my chances of requiring an ICU?

If I am a patient and have the opportunity, I would like to know all of the above before undergoing major surgery at a specific hospital. Neither this list nor any such list can be absolute. It is just to help you choose wisely. For the doctors, I believe a voluntary generation of these statistics, and disclosure of all that information will not only contribute to reducing the confusion in patients mind and build trust (thus decreasing litigation). It will also go a long way in weeding out the quacks and sub-standard treatment practices, thereby improving the outcomes for both the patient and the hospital.