There are a multitude of issues surrounding medical care. Anyone who has undergone a medical procedure is somewhat attuned to the idea of "informed consent." An article published by the National Institute of Health (NIH), titled Informed Consent, defines this as:
"Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention."
In the years I spent litigating workers' compensation and medical malpractice cases, this was a frequent subject. Patients ultimately make decisions about their care. The point is that they need to have sufficient information about that care and its risks in order to make valid choices.
Unfortunately, there are untoward outcomes from medical care. But there are miracles as well. In our modern world, we see news stories of miracles that are fantastic: vaccines, robot surgery, targeted medications. See Cleveland Clinic overview for details in recent years.
Unfortunately, there are also tragic instances in the news. A plastic surgeon here in Paradise was arrested after a surgery patient died in the midst of a procedure. There was another example recently in Nashville. These are extreme examples, but there are various potential complications of surgery. VeryWell Health provides a list that is similar to others on the internet:
- "Postoperative Pain, Swelling, and Bruising"
- "Anesthesia Reactions"
- "Intraoperative Injuries"
- "Bleeding Problems During Surgery"
- "Blood Clots Caused by Surgery"
- "Nerve Damage From Surgery"
- "Postoperative Infections"
- "Postoperative Pneumonia"
- "Delayed Healing After Surgery"
- "Scarring After Surgery"
- "Poor Results After Surgery"
- "Death Due to Surgery"
Suffice it to say that there are many potentials worthy of consideration. Over the course of many years, I have seen various patients or their families complain of each of these listed.
Despite the risks "Globally, a staggering 310 million major surgeries are performed each year; around 40 to 50 million in USA and 20 million in Europe," according to an article published by the NIH. That is a great many operations, and in each, the patient was purportedly thoroughly informed and educated in order to facilitate an "informed consent."
I have seen informed consent in various settings. Some doctors deliver information verbally with a member of her/his staff witnessing/documenting. Some provide written materials listing and explaining the various potential outcomes and risks. Others have videos that describe and even demonstrate surgical procedures as well as the potential risks and challenges. The point, through whatever means, is that patients must realize what they are to undergo and what the potential risks may be.
This is sound practice. It makes sense that patients understand risk and make informed decisions. In doing so, patients use an economic analysis that is called a "cost-benefit analysis." Too often, that is seen as a purely economic tool. Those who make this mistake perceive "cost" as a purely financial element. The fact is, that "cost" can be any detriment.
So, if I will be unable to walk for some period following surgery, then that is a "cost" (I like to walk, and I do so daily, thousands of steps). If I won't be allowed to eat certain foods or will require so many hours of physical therapy after surgery, those are "costs." If the surgery may cause me pain for some period, that is a "cost." The idea here is clear. The downsides have to be measured against the upsides and then an informed decision can be made.
Thus, as Hamlet alluded to Horatio so long ago, however,
"There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.”
Hamlet, Billy Shakespeare, 1599.
It is prudent to consider the known costs and benefits. Will the procedure provide the relief or restoration that is sought? Will any of the untoward outcomes listed above by VeryWell Health occur? If the surgery is to correct the fact that one of my eyebrows is higher than the other, or that one of my ear lobes is lower than the other, and there is a probability of a complication like death, my cost-benefit analysis has to consider that. Am I willing to risk death to even my ear lobes?
We all would like to be prettier. Let's face it, Madison Avenue and Hollywood have done a pretty solid number on most of us. There is a consensus that we all could use a little work, whether it is body rebuilding or just a little Bondo and paint. We are persistently being told we could look better (I have a mirror, you didn't need to tell me), and our society celebrates you pretty people while not supporting folks who look like me so much.
Over time, it is possible that we might be affected by all this. We might come to see our body as needing work. In a recent story by the British Broadcasting Corporation (BBC) there was description of
"body dysmorphia, a mental health condition where a person sees a flaw in their appearance no matter how others see them. The impact of the condition can be devastating."
Thus, there are people like me who really could use a makeover and there are people who perceive flaws in themselves that either don't exist or are overemphasized. And, for some reason, there is a tendency to turn to surgery (see above re plastic surgery tragedies). The BBC article describes a young lady who wanted to be taller. Not "NBA" taller. She sought to go from 5'2" to 5'5", a three-inch increase.
The outcome? She had complaints of incredible pain following the surgery. She required additional surgeries to correct the placement of metal implants. She suffered through having legs of different lengths, which she says altered her posture and caused curvature of her spine. The outcome?
"Eight years on from the initial surgery Elaine says she is still recovering from her mental and physical scars."
The costs, perhaps, outweighed the benefits there. The potential benefit was to spend 50 thousand pounds ($64,000) and be three inches taller. The risks? Well, they are listed above.
This is an extreme example of some of those coming true. There are many people every day who undergo surgical procedures. Some have far fewer complications or complaints, and some have none at all. For some the benefits prevail, for others the risks.
It is highly personal; that your aunt Gertrude had no complications with her ear lobe lowering does not mean you will not. Just because your cousin George got an infection after his appendectomy does not mean that you will. The risks and benefits are possibilities, not certainties. As they used to say, "your mileage may vary."
So, if I need my appendix removed, it needs to go. People can die from a ruptured appendix. There is a health risk to foregoing that surgery. Having surgery, I risk death (see above) and not having surgery, I risk death. The analysis is challenging. However, if I don't have my ear lobe lowered, the risk is people may stare. Is that risk sufficient for me to take the risk of surgery (see above)? It is a cost-benefit analysis that is personal and complex, but above all should be informed.
In the course of litigation following the leg-lengthening surgery noted by the BBC, there are two perspectives. There is the disappointed and disfigured patient who claims damages. There is the surgeon who voices, essentially, "She knew the risks."
The point is that both the benefit and the costs/risks are potentials that bear consideration and weighing in making that "informed consent" to undergo the care.
How much information? The answer is "enough," and that will depend on the risks, the benefits, and the overall circumstances. The patient, ultimately, should be diligent and thorough in the decision because it is the patient who faces risks.
