• Ronnie Shalev, MD

Part 1 Series: What questions should I ask before having a procedure or surgery?

You should ask your doctor questions before any procedure

Many of us have seen a specialist and been told that we need a procedure or a surgery to fix a medical problem. After the shock wears off, what’s next? A lot of patients blindly schedule the procedure without asking the right questions or even knowing which questions to ask.

This is a two part blog outlining what kind of questions to ask your doctor and what to ask regarding your bill.

Taking control of your health and becoming an informed and engaged healthcare consumer will change the course of your life. Learning about your medical condition and doing independent research about treatment options for your medical condition will prevent you from getting unnecessary procedures, endless visits to the doctor, and even save you money.

After your specialist has determined that you need a procedure, here are some important questions to ask your physician.

Are you board-certified and in which field?

This seems like a no brainer, but you would be surprised at how many physicians are not board certified or are board certified in one field but not in surgery. You might be getting a surgery consultation from a doctor who is board certified in family medicine but not in surgery. Knowing about your specialist’s credentials is important. If you feel like this is too confrontational or you are uncomfortable asking this, you might be able to find this information on the physician’s website or ask their office staff.

Is my procedure medically necessary?

This is a very important question. Some procedures are performed electively to improve pain, improve quality of life, and for cosmetic purposes. If the procedure runs smoothly AND there are no complications, then great! However, if there is an unforeseen complication, then your quality of life may decline dramatically, you might experience more pain, and possibly need multiple hospitalizations to deal with the fallout.

Another important thing to note, is that not all doctors will agree that a certain procedure is medically necessary. This is why a second opinion from a similar specialist is recommended prior to having any invasive procedure. A recent Mayo Clinic Study found that 88% of patients who visited the Mayo Clinic for a second opinion were found to have their initial diagnosis changed or modified as a result of a second opinion. Only 12% of the patients in the study left the clinic with the same diagnosis. It never hurts to hear someone else’s opinion, especially when your health is on the line.

What are my other options?

Before getting cut open or being put to sleep for a procedure, consider that there may be alternative non-invasive options available. One of my patients suffered tremendously from uterine fibroids and her gynecologist recommended a hysterectomy. This is an invasive surgery that would have taken 6 weeks to recover from if everything went according to plan. However, when she researched other treatment options, she found another less invasive procedure called uterine fibroid embolization. This procedure treated the fibroid problem and she only had an 8 day recovery that was significantly less painful. Her gynecologist did not offer this treatment to her as an option because she didn't perform this specific procedure.

Which facilities do you operate out of?

Finding out if the facility is in-network is important. You doctor might be in-network, but if the facility is out of network, then you could be stuck with a bill for $10,000 or more. I will cover more on this in next week’s blog.

Also, if you learn that your physician only operates out of one surgery center, but you didn’t have a good experience there in the past, then you might consider finding a different physician who operates out of multiple facilities.

How long will the procedure take?

The length of a procedure is good to know so you and your family can set your expectations for the day. It is also nice to know when you need to arrive and when you can expect to be home.

Can I drive after the procedure?

After having anesthesia, sedation, or pain medication, you cannot drive home ,and you need to plan your transportation before the surgery so you can get home safely.

How long is the recovery time?

When learning about your procedure, you want to know how many days or weeks you will be out of work, have limited mobility, or might need extra help getting around so you can plan accordingly.

When can I go back to normal activity after the procedure?

It’s good to know when your life will return back to “normal”. Setting expectations is very important, especially since mindset plays an important role in recovery. You’ll want to know when you can return to your normal activities.

What are the potential complications?

Before any procedure or surgery, the physician should discuss potential complications. If they don’t offer this information, then you need to ask. As an informed patient, you need to know what could possibly go wrong and prepare for any potential problems. A patient of mine had recently undergone a breast augmentation which quickly became infected. She subsequently required multiple surgeries to remove the implants and the surrounding infection. She ended up with severely scarred breasts and regretted having that elective surgery altogether.

How many of these procedures have you done?

When choosing your surgeon, the number of procedures they have done will determine their proficiency and dexterity. If they have done thousands of procedures, they are likely highly proficient and can predict any negative outcomes. With vast experience, surgeons can oftentimes avoid mistakes and complications through pre-surgical planning and maneuvers that they mastered.

What is your complication rate? What is the expected complication rate?

Complications are inevitable. You don’t want to go to a surgeon that has more complications than his or her colleagues. As an informed patient, you would feel reassured that your physician’s complication rate is less than his or her peers’ complication rate. In other words, do they have more complications than someone else, less, or about the same?

What happens if I have a complication?

Once you know what could possibly go wrong, you need to have an action plan about what to do if something goes wrong. This should be discussed with your specialist before the procedure. For example, what do I do if I have a fever, a rash, start bleeding, or if my wound opens?

As an ER doc, I typically see patients who are suffering from a subsequent complication from a procedure. Many times they have not even called their specialist who performed the procedure! The first thing you should do is call your specialist. The office might not be open, but they will have an on-call doctor that will guide you and advise you about what to do next.

The other issue I see often is that patients will go to an ER at a different hospital from where they had the procedure. If you are seeking medical care after a procedure, go to the hospital that your surgeon or specialist is affiliated with. When doing that, the physician can care for you at that hospital and be involved in your care.

These are a lot of questions and can seem overwhelming. If you don’t know where to start, MediBookr can help! You can log into the MediBookr app to find out about your physician’s credentials. MediBookr has created a VALUE SCORE that analyzes various physicians, using quality metrics and cost, and can optimally match you with the right specialist. The MediBookr patient advocacy team can help you research your specialist even before you make your appointment! Go to www.medibookr.com to learn more.

-Dr. Ronnie Shalev is a board-certified emergency medicine physician and is the Chief Medical Officer for Medibookr.