time to ask questions 5.11.11
It’s not unusual to get a writing assignment that calls for a list of questions people can ask their doctors. I never realized how useful a list like that could be until my mother needed surgery.
How it happened
My mom fell on an icy ski run (a double black diamond as she recalls) this March. At first it looked like she had a broken right shoulder — that’s what the doctors in the emergency room told her. The following week, a doctor back home told her she’d also fractured her left clavicle. Not only that, the two pieces of her broken shoulder were moving apart instead of together. Welcome to the medical establishment, Barker family.
The surgeon drew this picture of Mom's fractured shoulder right before he reattached the two pieces with screws.
Within days, Mom had surgery on her shoulder. Before the operation, her doctor drew a picture of the break for us and explained how he would use screws to re-attach the two pieces of bone. Then it was time for me to leave and spend the day holding my breath. My sister and I consider ourselves lucky to have an athletic, smart-aleck mother who does what she wants and stays out of danger, most of the time. The contrast between her stubborn independence and the idea of her under anesthesia was hard to take.
But all went well, the surgery went without a hitch, and I got to take her home that evening. We started counting the weeks of her recovery. A week later, her doctor told her she might need another surgery. Now the two pieces of her broken clavicle seemed to be moving apart. Her first surgeon referred her to a second surgeon, explaining that reattaching her clavicle would be more complicated, in part because the fracture is so close to her heart. Time to ask questions.
What now?
Most surgeries are not emergencies, according to the Agency for Healthcare Research and Quality. This gives people time to ask questions, including whether the surgery is really necessary. In an online video, the agency’s director, Dr. Carolyn Clancy, provides a number of questions you can ask before surgery. She suggests, for instance, asking why you need surgery, if there are any alternatives, and what would happen if you chose not to have surgery.
No less important, we wondered if the recommended surgeon was really the best guy for the job. I couldn’t stop thinking about The Checklist Manifesto, Atul Gawande’s excellent book on how serious medical errors can slip past even the best medical teams. Well-educated, competent, overextended medical teams. This terrified me.
The fact that Mom’s first surgeon referred her to someone else gave us some confidence. Repetition builds experience and the second surgeon had reportedly repaired a great number of broken clavicles. Mom’s first doctor was smart and confident enough to know she’d be better off in another doctor’s hands. Hats off to him for his humility and caution.
Questions for the surgeon
We came up with a list of questions about the procedure itself, safety and risks, and the expected recovery period. I provide them here for any family that wants to use or adapt them.
Procedure
- Can you describe the procedure?
- Is this procedure necessary?
- What are the pros and cons of waiting?
- How long will it take?
- Will mom have to stay in the hospital overnight?
Patient Safety
- What are the risks of this procedure?
- How will you minimize the risks?
- What is the hospital’s track record with infection?
- How well does your team work together?
- How experienced is your anesthesiologist?
Recovery
- How long will it take to recover after the surgery?
- Is there anything Mom can do to heal faster?
- What things should she absolutely not do and for how long?
Happy ending, we hope
In the end, we didn’t ask any of these questions. The surgeon talked to my mother, asked her to move her arm as much as she could, and said he didn’t want to operate on her, at least not right away. If he did, she wouldn’t have use of either of her arms. Mom, my sister, and I all nodded in agreement. The two pieces of her clavicle might still mend on their own, though possibly imperfectly. She may have a bump where the two ends of the bone form an imprecise union, but that doesn’t sound bad compared to the alternative. We’ll find out in a few weeks, when she goes back for a reassessment.
More resources
I’m embarrassed to say I’ve done a better job figuring out how to research hospitals for this blog post than I did before meeting Mom’s potential second surgeon. Turns out, it truly is harder to think and act intelligently when a loved one is sick or injured. I did look the suggested physician up on HealthGrades, along with the hospital where he performs surgery. His ratings for quality and patient safety were quite good, though patient reviews ranked him average for communication, an observation that didn’t reflect our positive experience with him at all.
Later I found numerous web sites that raise questions about HealthGrades’ hospital profiling procedures, including some notable gaps in their list of best hospitals. The best advice I found was on the Annenberg School for Communication & Journalism’s Reporting on Health Blog. This post, which is addressed to health care reporters, suggests looking at a number of sources to form a picture of a provider’s quality and safety record. Specifically, the post suggests the U.S. Department of Health & Human Services’ HospitalCompare, The Leapfrog Group, the Dartmouth Atlas of Healthcare, and yes, HealthGrades.
When it comes to health care quality, there may be no one source you can rely on for the full story but a number of sources can give you pretty good idea. If Mom does need clavicle surgery, I’ll be ready to dig deeper.
