Patient responsibility in surgery- You and I are a team

You and I are a team.  When you pick me to be your surgeon, we become aligned.  Our goal is for you to have a successful surgery. 

I will treat you to the best of my knowledge and ability.  I will get to know you.  I will meet with you- not a nurse, or a care coordinator, or a patient coordinator.  It will be me.  I will try to understand what is bothering you and what we can do to fix it.  I will advise you of all the good and bad, risks and complications.  I will not candy coat or give false expectations.  I will educate and educate and educate.  I will include “do nothing” as a real option.  I will show photos.  I will do my best to do great surgery. As they say in other fields, I will “measure twice, and cut once.”  I will try to make pretty scars.  I will see you frequently after surgery.  If you are ever concerned, I will be available by phone and email and come in to see when needed.  And if heaven forbid you have a complication, I will be there even more.

We are a team.

But I need you to take responsibility too.  In thinking about this blog, I googled patient responsibility.  I found a contract posted by the NIH.  I found it an interesting, and it got me thinking….  What would be in my contract? Simple things:

• Be honest with me, your doctor.  I am not your mom.  I am not here to evaluate your lifestyle choices.  But I need to know the truth.  If you smoke.  If you have any medical issues.  If you have had prior surgery.  What medication (including herbals and vitamins) you take. 
• Listen to me.  When I tell you not to exercise, or wear a bra, or lift heavy things, it is for a reason.  I am trying to protect you and have you heal well.
• If something feels off/funny/wrong/bad, CONTACT ME.  I know some doctors are not approachable, with layers of nurses and staff between you and the doctor.  I am not that kind of doctor.  Surgery is a unique experience.  I don’t expect you to know what is “normal” or not.  Anxiety will only make your post operative course worse.  Please contact me.
• Scars.  I will try to make scars as hidden, hairline, flat and pretty as possible.  I show my photos at 6 weeks on purpose to show you what scars look like.  I cannot guarantee a perfect scar.  There are some things out of my control.  Certain genetic types scar poorly.  If you have darker skin, you can form hyperpigmentation.  If you get a minor infection, blister from the tape, spit a stitch, or clothing  irritation (bra/garments/clothes), your scar will be worse.  I have lots of lotions and potions for scarring, depending on what the issue is.  Many help.  We should try.  Occasionally, cutting out the scar and redoing it may be the best option.  
• If you are unhappy about anything, talk to me about it.
• Keep your appointments.  I cannot be your doctor if you do not come in.  Particularly if something is worrying you, do  not wait.  Some issues are much better treated when done early. 
• Do your part.  If you have a scar starting to elevate, massage your scar and put on the scar creams.  If you have liposuction, keep up your diet and exercise regimen. 
• Be realistic.  I am blunt.  All of my patients comment on it.  I do not candy coat because I strongly believe this is your body and you should know what you are getting into and the realistic typical outcome.  I cannot control everything.  A complication can happen. 

I am on your team.  I became a doctor because I love surgery and I love my patients.  My goal is your happiness. 

From the NIH:
In the spirit of working together toward a common goal, our patients (and their parents, guardians, and surrogates) have responsibilities as partners in medical research and as patients at the Clinical Center.

You have the responsibility:

1. To provide, to the best of your knowledge, complete information about your current medical condition and past medical history, including current illness, prior hospitalizations, current medications, allergies, and all other health-related matters;
2. To discuss your protocol (study or treatment plan) with the research staff before indicating agreement to take part in it by signing a consent;
3. To inform the medical staff about your wishes regarding treatment plans. You may provide for a duly authorized family member or spokesperson to make medical decisions on your behalf in the event that you become unable to communicate;
4. To comply with your protocol, to cooperate with hospital staff, to ask questions if directions or procedures are not clear, and to participate in your health-care decisions. You may withdraw from the study for any reason, but it is desirable to discuss your concerns with the attending physician before taking that action. Parents of pediatric patients have the responsibility to indicate if and how they want to be involved in their child’s plan of care;
5. To refrain from taking any medications, drugs, or alcoholic beverages while participating in the protocol, except those approved by an NIH physician; >
6. To adhere to the no-smoking policy of the NIH;
7. To report on time for scheduled procedures and to keep all clinic appointments. If unable to do so, you have the responsibility of notifying the protocol physician and canceling and rescheduling the appointment;
8. To report promptly to the medical or nursing staff any unexpected problems or changes in your medical condition;
9. To inform the appropriate staff or the patient representative of any concerns or  problems with the care and treatment that you feel are not being adequately addressed;
10. To respect the property of the US government, fellow patients, and others; to follow NIH rules and regulations affecting patient care and treatment; to respect the rights of other patients and hospital staff. This includes the responsibility of respecting the privacy of other patients and treating information concerning them as confidential;
11. To pay all medical or laboratory expenses incurred outside the Clinical Center, except when you have received written authorization on the appropriate NIH form to have such expenses billed to the NIH;
12. To obtain medical care and medications from your own health-care provider for all conditions unrelated to the protocol in which you are participating, except while being treated as an inpatient at the Clinical Center;
13. To provide your own transportation to and from the Clinical Center and to pay living expenses except when all or part of these expenses are covered by the protocol or authorized by the responsible NIH physician; to advise accompanying escorts or others who travel to and remain in the Bethesda area that they must pay for their travel and living expenses except when designated by NIH as a guardian for you when your expenses are covered;
14. To provide complete information, so that contacts and communications to schedule visits and monitor health status can be maintained. This information should include: (1) your current address and phone number; (2) the names, addresses, and phone numbers of next of kin or persons to be notified in the event of an emergency; and (3) the names, addresses, and phone numbers of physicians responsible for your ongoing care, including your family physician and the physician(s) who referred you to the NIH;
15. To return to the care of your own health-care provider when participation in the protocol is completed or stopped and your medical condition permits.