Sizing Up Surgery

Thousands of Americans face surgery each year, often with fear and doubts about whether the right step is being taken. And not knowing what's involved may mean putting yourself through as much grief as the procedure intends to do away with. Whether you are undergoing surgery for the first time or the tenth, understanding why you need it, the risks involved, available alternative treatments, and the aftereffects will help you make the right decisions and deal effectively with the outcome.

The Value of a Second Opinion -- Is Surgery Necessary?

The practice of medicine is not an exact science and, consequently, physicians do not always agree. This does not mean they are incompetent or unconcerned about their patients' well-being. It simply means there can be differences of opinion about the best way to treat a medical condition. A second opinion is a time-honored practice in the medical profession that public health authorities believe better enables people to weigh the benefits and risks of surgery against possible alternatives to surgery.

In the case of a middle-aged patient with gallstones, for example, Betsy Ballard, M.D., a surgeon in Silver Spring, MD, explains that the initial recommendation for surgery might be made based on the premise that someone that age would not be satisfied with spending remaining years on the strict diet needed to manage the disease. There also might be the danger of a recurrence or complications, such as pancreatitis, if the dietary restrictions did not successfully treat the disease. A second opinion, however, might reveal that the patient for whom surgery poses a risk or who refuses surgery would be a candidate for medicines or other procedures that can dissolve gallstones. In either case, a second opinion helps the patient make an informed decision about the best treatment for his or her condition.

Arno Albert Roscher, M.D., a clinical professor of pathology who specializes in diagnosing cancer at the Granada Hills Community Hospital in California, says that, like patients, health professionals often find it necessary to seek additional viewpoints as well. For example, some forms of cancer pose controversy for even the most skilled professionals in the field.

"A certified pathologist can generally identify 85 percent of regular tumors," Roscher says, "but if there is a glandular difference, tumors are difficult to diagnose and often require second and sometimes third opinions." He adds that even with the small number of unrecognizable tissue growths, specialists need the availability of additional resources to confirm or dispute their findings and recommendations, such as through the California Tumor Tissue Registry, a network of qualified professionals that was created for such specialized second opinions.

There are, however, instances when emergency surgery is necessary in order to sustain life, such as when the diagnosis of acute appendicitis is firmly made. In this case, surgery must be done quickly and efficiently, and would not warrant a second opinion.