3. Are there other ways to do this surgery? Why have we chosen this variation?
This question will get a bit technical and some may prefer not to worry about it, but there are many ways of surgically achieving your goal.
Clinical trials help provide us with some answers as to which way is the most likely to be effective, but also provide an insight as to what can go wrong.
For example, to revisit shoulder dislocations, there are two surgical approaches most commonly used: the Latarjet procedure or an arthroscopic bankart repart.
There is now a solid amount of research indicating a higher rate of return to sport and a lower rate of recurrence of dislocation with a Latarjet. However, it is also associated with a slightly higher risk of adverse effects, so the decision is not always cut-and-dry.
Similarly, with and ACL reconstruction, choice of graft (hamstring, quad, patellar etc), tunnel location, single or double bundle, nerve block used can all effect outcome. Many factors influence the surgeons decision, and they will undoubtedly offer the best solution in their opinion. While you do no need to have personal knowledge on any of the above, we think it’s a good idea to obtain this information and understand WHY they have made the decisions they have.
It’s a good idea to write this down too as the technical terms are usually hard to recall.
4. How many of these procedures do you perform a year?
There is a body of research regarding total knee replacement operations and ACL repairs that consistently associates higher yearly volume (how many a year the surgeon performs) with fewer infections, shorter procedure time, shorter hospital stays, lower rate of transfusion, and better outcomes in the long-term. Research on other procedures is less available, but it’s safe to extrapolate that experience matters, just like any other profession.
If the surgeon has a relatively low yearly volume, it doesn’t mean that they will do a bad job as they will have undergone may procedures in their training and education.
Likewise, certain procedures as less commonly performed (e.g. repair of a complex bone break) so a high yearly volume is not feasible.
In any case, it’s worth asking how often they perform the procedure. If they perform a low number annually (<10 on a common procedure such as TKR), you could consider politely inquire if they have colleagues that specialize in this procedure and perform it more often.
With something as serious as a surgical procedure, you are always entitled to a second opinion. A good surgeon will have the self-awareness to know when they are and are not the right person for the job. If they can confidently assure you they have the necessary skill-set and experience, then you leave the consult knowing you are in safe hands.
5. Always ask YOURSELF, do I understand the diagnosis and/or the proposed solution? Test this by trying to summarize the information to you surgeon before you leave.
It’s a simple place to finish but make sure you fully understand what your surgeon has told you in the first place as errors in communication are so common in this situation.
The true test of this comes when you go home and try the “family/friend test”. If you can explain your problem well to family/friends, then you probably took the information in effectively. However, if it makes perfect sense in your head at the time, but you struggle to explain it later then you may not have understood it as well as you thought.
To ensure you pass the” family/friends test’, I recommend people try and perform a summary at the end of their consult, e.g.:
“So, if I understand correctly, my problem is that……and the proposed solution would fix this by…….all going well I should expect……but it may take as long as……..”.
This way, your surgeon will be able to highlight and correct anything that got lost in translation on the first occasion.
