Questions To Ask Your Surgeon

[NancyRN 1]

<TABLE style="MARGIN-LEFT: -10px" cellSpacing=0 cellPadding=5><TBODY><TR><TD vAlign=top>

<TABLE style="BORDER-COLLAPSE: collapse" borderColor=#cccccc cellSpacing=0 cellPadding=4 border=1><TBODY><TR style="BACKGROUND-IMAGE: url(/shared/images/gradient-e7eef6.gif); BACKGROUND-REPEAT: repeat-x; BACKGROUND-COLOR: #e7eef6"><TD style="PADDING-LEFT: 4px" align=top>Hi all (especially Penny Merrick),

I've seen several versions of "Questions to Ask Your Surgeon" lists. I integrated Sandy R's list of questions and the post by Dr. C (on www.obesityhelp.com) with posts by Penni Merrick and in the section on weight loss surgery on lapbandtalk.com. (The spacing is weird, because the format in which I wrote it didn't transfer properly to this site.) Would you review this and let me know what you think? A couple of possible problems: it's very long, and I don't know where it should be posted to help the most people. Any ideas? I hope to post it on both this site and lapbandtalk.com.

NancyRN

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Your Initial Consultation: Finding Out the Key Information Necessary to Decide on Weight-Loss Surgery

Note: Ask the surgeon the following questions.

About The Surgeon’s Recommendations:

1.Which weight loss procedure is best for me? Why? (Write down the exact name of the surgery if you think you may not remember it.)

2.What are its benefits and risks?

3.What is your success rate?

4.What is the likelihood my problem will return after surgery?

5.Can this surgery be performed by laparoscopy?

6.Am I a good candidate for surgery, even if I have one or more other health conditions related to my obesity?

7.What do you consider a successful outcome?

8.What is the typical excess-weight loss?

9.What is the typical improvement in associated health conditions?

10.Tell your doctor your preference for treatment, if you already know.

11.Tell your doctor the results you expect from the surgery. What outcome would you consider a success?

12.Discuss your biggest concerns about the surgery.

13.Are there other options I should consider? I want to be sure to consider all of them.

14.(If you are unsure what treatment is best for you), tell the doctor you’d like to get a second surgical opinion. (This is a common practice. The surgeon should not be threatened by it. It’s wise to get a second opinion even if you feel sure about the surgery you want. )

About Your Surgeon:

1.How many Lap-Bands have you done?* (Most important. Bands only, not bypasses too. Should be at least 50, preferably 100.)

2.How many have converted to open?* (If more than a handful that's a problem)

3.What is your skin-to-skin time on an average case?* (Skin-to-skin means from the first skin incision to the skin closure. If it's over an hour that could imply poor laparoscopic skills.)

4.How many band patients have you reoperated on for slips, erosions, or port problems?* (If more than around 5% run!)

5.Are you board-certified in this area?

Cost

1.What is the complete cost of the surgery? (In addition to the surgeon’s fee, you will be charged for use of the operating room, anesthesia, tests before, during, and after surgery, and hospitalization. Your surgeon should be able to give you a ballpark total cost. If he or she says it depends on what care is given – which is true – ask the cost for the typical patient.)

2.What is your contracted rate with my insurance company? (Health care professionals commonly bill at an inflated rate, because they know the insurance company will automatically pay only part of the bill. The professional should have a rate at which he or she contracted to provide the care. This amount varies from one insurance company to another. What you need to know is the amount that is the rate at which the surgeon contracted with your insurance company. The amount your insurance company will expect you to pay (your share of the charges) will be based on this number.

3.What does that fee cover? Only the operation? Preop visits? Post-op visits?

4.What are my options for payment?

5.Will anesthesia be billed separately?

6.Do you contract with a group of doctors to provide anesthesia? (If so, you will be billed separately for the anesthesia.)

7.Do you contract with a group of doctors to provide anesthesia? If so, what are the name and phone number of the group?

8.Do you have information about other surgical costs? If not, who does and how do I reach them?

Partnering With Your Doctor

1.Tell the doctor your expectations of the relationship with him or her. (Do you want a collaborative relationship? Or do you prefer to know as little as possible about what will be happening?)

2.What do you expect from me as your patient?

3.Do you like to have well-informed patients asking you questions?

4.Do you have patients who are willing to share their experiences, both positive and negative?

5.May I have the names and numbers of 5 or 6 of your patients? (Then be sure to TALK to them.)

6.What kind of information can you give me to help family and friends understand my surgery?

Once You’ve Decided on Lap-Band Surgery: Finding Out the Details that Will Make Your Surgery a Successful Experience

Note: The following information can usually be learned from the doctor’s handouts and the staff.

The Practice

1.How many doctors are in the practice? (One person can’t be on call 24 hours a day, 7 days a week.)

2.How many BANDED people with PRACTICAL knowledge are on the staff? (Makes a huge difference.)

3.What is your after-hours and weekend policy? (Someone should be available 24 hours a day. If you have a big overfill on Friday, you can’t wait ‘til Monday for an unfill.)

Preoperative Procedures

1.What nutritional support do you provide?

2.Is the nutritionist Band-knowledgeable?

3.What preop tests do you do? Why?

4.What preop diet do you use?

5.Do you have a support group for Band patients only? (Go to a meeting and ask questions.)

6. What can I do to improve the likelihood of success?

The Operation

1.Is banding done in the hospital or in an outpatient surgery center?

2.How long will I be in that facility? (A few hours? Overnight? Two days?)

3.How long will I be in surgery?

4.Will you be performing the operation yourself or will others perform some of it? (In a teaching hospital, a resident may perform part of the surgery, but he or she should be closely monitored by the surgeon.)

5.Will you be using any new equipment during the surgery? If so, have you been fully trained in its use?

6.Will anyone be in the operating room other than the doctors and nurses needed to perform the surgery? (An example would be a person involved in training your surgeon on a piece of new equipment.)

7.How critical is the timing of the operation? Is there any flexibility when it is scheduled? (Be prepared to discuss your scheduling preferences.)

8.What band do you use? (The correct answer is: it depends on the patient’s needs. In the U.S., a surgeon can only use the Inamed band, but there are 3 sizes available. The correct size can be chosen only after the surgeon sees your insides. Beware the surgeon who says he or she only uses one size.)

9.Where do you place the port? Why? (There are several spots possible, and all have pros and cons.)

Anesthesia

1.Who will provide my anesthesia?

2.What kind of anesthesia will be used?

3.When will I meet my anesthetist?

Recovery Period

1.What is normal to expect during the recovery period?

2.Will my activities be limited during recovery?

3.If so, which activities and for how long?

4.What help might I need while I recover?

5.What are the post-surgical signs or symptoms for which I should call you?

Ongoing Postoperative Care

1.How often do you see clients for follow-up? (Monthly is good, to assess progress, continue teaching, review band rules, and so on.)

2.What type of long-term aftercare services can you provide for me? (Examples are support groups and nutrition counseling.)

3.What kind of postoperative diet do you use?

Fills

1.How many fills have you done? (He himself, not his assistants. If the surgeon has a “fill person”, how many has that person done?)

2.What is your policy on the amount of fills? (Run if the surgeon says a certain amount every month. Should be “as needed, individualized amount, any time, etc.”)

3. When do you give the first fill? (Trick question. Should not be “at 6 weeks”. Should be “at 6 weeks IF NEEDED.”)

4.What is your policy on fill fees? (Free the first year? Pay for each fill and unfill? Free the first year, then $800 each the next year? [An actual case – and plenty of fills are needed.])

5.If you or your staff damages the port, what is your policy on port replacements? (The fill person may goof and puncture the tubing during a fill. Even the best can accidentally do this.) Do you replace it for free? For hospital charges only?

6.After a good fill, what is the expected rate of weight loss?

* Identified as top questions to ask a surgeon, by Dr. C, a surgeon performing Lap-Band surgery (from lapbandtalk.com; also at www.TheBandDoctor.com)

Credits: This section is adapted from the contributions of many people. Special thanks to Sandi R. (on obesityhelp.com), and Penni Merrick and Dr. C (on lapbandtalk.com) . Please direct any questions or comments to me on either site or at nancy.holloway@insitutech.com.

NancyRN

6/26/06

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