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If surgery has been recommended to you, I think a second (or even a third) opinion is an excellent idea. Very few things in medicine are black or white, there are many different approaches, many shades of gray in evaluating and judging what is best. In the present managed care environment, many doctors will not take the time to fully discuss your situation with you. They may not have the extra training needed to offer the best option or a minimally invasive procedure. For most doctors, if they do not know how to perform a procedure, they simply will not discuss or recommend it to you.
When a new patient comes to see me for a second opinion, we ask them to bring all the pertinent medical records including all the notes from previous doctors’ appointments and any relevant test results. If an ultrasound or MRI has already been performed, I prefer to look at t he films myself so that I can come to my own conclusions about the diagnosis.
We begin with a consultation and a review of the records, then we proceed to a complete examination, then we go back to my office to discuss the findings and answer any questions that you might have. Medical care should be collaboration between patient and doctor. Together we discuss how best to approach your particular diagnosis. I often use illustrations, diagrams and 3 dimensional models to demonstrate what the problem and potential solutions might be. At this point I make a list of one or more possible diagnoses and outline the treatment options available for each problem. To be complete, I often include even those treatments that I advise against, and the reason. Together we collaborate and determine which choices on this list best meet the individual needs of each patient, seeking choices that are both medically sound and personally acceptable to the patient.
Family members or friends are welcome to join you and this is often helpful to make sure all of your concerns are addressed and to help you remember what is said as we cover a lot of material. It is a good idea to then digest the information in the comfort of your own home to decide what is best for you. Women are always welcome to call me with any additional questions they might have or for any clarification they might require.
If you decide that surgery is right for your situation, you will need to choose the doctor to perform your surgery. There are a number of factors that should influence your decision. The first is to choose a doctor who will perform a procedure that fits your particular situation and problem. In most cases you should have more than one option to from which to choose.
The next concern is the skill of the surgeon. How many procedures does the doctor perform in a month? How many procedures like the one you are requesting? How many of these procedures have they performed in women with problems like yours? How many and what kind of complications has the doctor had? Studies show that experience makes a surgeon better. Surgeons who perform procedures frequently have lower rates of complications. But many surveys show that many gynecologists perform less than one or two major operations a month. Choose your surgeon carefully.
It is also important to feel comfortable with your doctor. Do you get an opportunity to ask questions? Are they answered to your satisfaction? Is the doctor available by phone? Will the doctor be available after your surgery for follow-up and questions as well as support?
If you decide to have surgery, another visit should be scheduled with the doctor you have chosen to go over the specific details of the procedure you are planning. Again, it is nice to have someone accompany you. Once a decision has been made we have a conversation called the “Informed Consent”. At this time we go over what you should expect from surgery. It includes the details of the operation to be performed, the specific risks of the procedure, the alternatives to the surgery, and the possible consequences if no surgery at all were performed. Basically, this is the time you will hear about all the possible risks and complications that may occur during and after your surgery. This can be difficult and may feel as if it’s the last thing you want to hear, but ultimately it will be quite helpful to you.
We are certainly not trying to erode your confidence at this point, but we are legally and morally bound to tell you about things that could happen that might influence your decision to have surgery. Most people’s emotional reaction to this is some fear, which is understandable. Just remember to be sure and hear the optimism in the fact that there are options available to help you.