Patient and His Surgeon

No greater tribute can be paid any man than to entrust him with the life of another. To be worthy of this trust the surgeon must make a constant effort to provide the best possible care for each patient. The surgeon takes the life and health of the patient in his hands. It is his knowledge, judgment, and integrity which de­termine the outcome of his care for the patient. These three qualities are desirable traits in any physician, but a necessity in the surgeon.

The surgeon must make a constant effort to increase his knowledge. He must acquire ade­quate training in preparation for his calling and he must be well informed of all the basic sciences, with a thorough understanding of physiology, pathology, and anatomy. His knowledge must include keen dexterity and alertness, yet calmness of character.

The surgeon must be endowed with critical judgment. His knowledge must be so applied as to anticipate the results from whatever scheme of treatment he elects, and he must preclude complications by foresight. The master surgeon knows when to operate, and when to alter his treatment plan. This is called surgical judgment.

Integrity of character is a vital trait of the surgeon. His conscience must not let materialis­tic gains influence his decisions, and his philos­ophy must be dominated by a devotion to man­kind. The surgeon must be aware of his own limitations and utilize the services of his col­leagues when needed; he should invite a spirit of co-operation within the profession. In no other profession is so much entrusted to one man; he must be faithful to his patient, to his profession, and to himself.

This seems a rather idealistic picture of the surgeon, but actually it is not difficult for the surgeon to attain these qualities. The man who embarks on the long trail to become a good sur­geon must be eager for knowledge in order to reach his goal; once having become a surgeon, the present system of keeping him informed is thorough. There are numerous journals regularly published which present the latest in surgical therapy. The surgeon subscribes to these, and a few hours’ study each week will keep him up to date. Knowledge and surgical judgment are further enhanced by the hospital conferences and teaching programs, where special cases are reviewed and discussed. County, state, and na­tional medical societies, medical schools, and specialty associations are constantly promoting advanced teaching by conferences and conven­tions which provide the surgeon with a wealth of the latest material.

Integrity of the surgeon is seldom questioned, as this trait seems to be innate in the man who devotes his life to the care of others. There is little competition in the surgical fields, so sur­geons have little temptation to jeopardize their esteem. Physicians in a community are neces­sarily familiar with each other’s abilities and qualities; without integrity the surgeon would soon fall into disrepute with his colleagues.

Thus, the patient can be sure, in almost every instance, that his surgeon has the necessary basic traits—knowledge, judgment, and integrity.

Many patients will wonder whether their sur­geon is qualified for the surgical procedure that he is about to perform. This can be answered very simply. In all hospitals approved by the various hospital associations, the staff is care­fully and continually scrutinized. There are com­mittees of physicians appointed who pass pro­fessional judgment on the surgeons’ work and establish the limitations of their surgical abili­ties. The committees establish surgical privi­leges for each member of the hospital staff. These privileges state specifically what each surgeon is qualified to do, and they limit him to that scope. If the surgeon anticipates an operation, the patient can be certain he is qualified to do it; otherwise, he would not be allowed to per­form that operation in the approved hospital.

Therefore the patient need have no fear that the surgeon is qualified; the hospital professional staff controls this very well indeed.

RELATIONSHIP OF PATIENT TO SURGEON

The role the patient plays in his own course of treatment is important to the outcome of that treatment. The most vital part of the union of patient and physician is confidence. The sur­geon must do all he can to inspire confidence, and the patient must attempt to demonstrate confidence. The proper frame of mind in the patient is of major import. When the patient feels that the treatment is going to be success­ful, this is a great adjunct to any therapy the surgeon may render; when there is doubt about any phase of the treatment, the entire plan is handicapped. With confidence, all instructions will be carried out by the patient accurately, medications will be taken faithfully, a better history of the symptomatology will be given, and fear is precluded; without confidence, there will be laxity in these aspects of the relation­ship.

Never fail to confide any symptoms or facts to your surgeon. Too often a symptom is kept secret because of modesty, and in many cases the delay means prolongation or even failure of treatment. All facts of your illness are held in complete trust by your doctor. Anything you tell him or his nurse is held in strict confidence. The physician’s code of ethics inhibits him from betraying the confidence of a patient, and even the courts of law in most states do not require a physician to divulge medical facts given him in confidence. No case is discussed with any­one, not even the patient’s spouse, without the permission of the patient. Timidity in relating complete medical history and modesty in exam­ination are unwarranted hindrances to rapid re­covery. The patient must have confidence in his surgeon, who will not betray the confidence.

HOW TO HELP YOUR SURGEON HELP YOU

The role of the patient in the doctor-patient relationship is not entirely passive. There arc numerous ways the patient may contribute to the success of his treatment. Too frequently re­covery is delayed by some minor neglect by the patient himself, and, although most of these are quite obvious, it seems wise to mention a few of the ways you may help your doctor help you. These are applicable not only to surgical patients, but also to all.

Co-operation with the doctor is paramount. You have sought his advice, and he has outlined

a plan of therapy for you. It is doubtful that he can help you if you fail to comply with his directions. Medications are labeled in a precise manner for maximal benefit in your case; taken any other way the effect will not be the same. Dietary instructions play a major role in many instances; these must be followed. In some cases certain activities may be curtailed; do not ra­tionalize that you are a better judge of your case than your doctor. Specific instructions must be executed specifically.

Tell your doctor all your symptoms. He will ask you questions about symptoms in every sys­tem of your body, but you may have a com­plaint not brought out in the interview, or a new symptom may develop at any time during the course of your treatment. Even though a symp­tom seems insignificant to you, it may be im­portant. A minor pain in your leg after an op­eration, called to your surgeon’s attention, may prevent a serious clot formation in the veins; or mentioning discomfort with urination may obviate a kidney infection. Some symptoms are significant and others may not be, but let your doctor decide. There are certain minor com­plaints which are related to your illness but are not important except that they keep you uncomfortable. If you have a headache, men­tion it to your doctor—even though he knows it is not alarming or unexpected, he will want to make you more comfortable. Your progress is apt to be impeded if you are needlessly un­comfortable, and complications can be curtailed by early recognition through your symptoms.

Mention all your symptoms, but try neither to exaggerate them nor to minimize them. Your doctor wants to know, as well as you can ex­plain, the severity of each complaint. Many patients exaggerate the symptoms of pain be­cause they fear that it might be disregarded if thought to be minimal. Others will minimize their pain because they do not want to be con­sidered a “complainer.” The exaggerator is apt to be misjudged when severe pain does strike, and the minimizer will suffer needlessly. Describe the severity of each complaint as accurately as you can.

Even though you must call each new com­plaint to your doctor’s attention, and even though you must keep informed of your condi­tion and progress, do not expect a detailed dis­cussion from your doctor to explain each minor or incidental symptom. Often the explanation is complicated and time-consuming, and actually not important to your knowledge of your main illness. If it is necessary for you to know, your doctor will explain the essential facts to you, but the time might better be spent discussing the major illness.

If you have complaints about service in your doctor’s office, he will appreciate your men­tioning it. There is always the perpetual prob­lem of waiting, for which no successful solution has been found. Many physicians try to mini­mize the problem by making appointments, but even this does not solve the situation in many cases. It is difficult to predict the time each visit will take, and often the doctor is called suddenly away, thus upsetting the entire sys­tem. Appreciate this problem and arrange your time so that it will not disturb you. Render any complaints you have in a polite and kindly manner.

Be respectful of your doctor and when you visit his office be courteous. Be considerate of other patients and of the office nurse. Do not be offended if someone is called ahead of you; the other patient may have had an appointment or may be seriously ill. When your turn is called, act promptly. Answer all your doctor’s questions as specifically as you can and freely submit to any examination or test he desires.

When your office treatment is finished, it is always a courteous gesture to show your appre­ciation to the office nurse by thanking her ver­bally or even sending a greeting card. It boosts her morale, and she will remember your appre­ciation on your next visit.

When your doctor calls on you in the hospital or in your home, politely excuse everyone from the room, put away your book, dispose of your cigarette, and give him your undivided atten­tion. Be as respectful of your doctor as he is of you.

When you are attending a social function where a doctor is present, do not seek medical advice from him. He cannot accept you as a pa­tient under such circumstances, nor can he give you advice without a full knowledge of your case, and it is doubtful that you will want to disrobe for examination any place but in an examining room! The doctor cannot mix busi­ness with pleasure any more easily than any­one else, so do not spoil his evening by re­questing a “curbstone consultation.” Try to limit your professional requests to your own doc­tor’s office or hospital.

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