What ?s should surgeons be asking their patients?

Hernia Discussion Forums Hernia Discussion What ?s should surgeons be asking their patients?

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    • #10591

      Dear All,

      My name is Dr. Jake Greenberg and like Dr. Towfigh, I am a hernia surgeon excpet in freezing cold Madison, WI instead of sunny Beverly Hills! Additionally, I am a hernia patient as I had bilateral inguinal hernias repaired several years ago. I am curious to know what questions you as patients feel that we surgeons should be asking our patients about groin hernias. Most of the time we tend to ask questions about pain, discomfort, and changes in bowel or bladder habits. I suspect this leaves many patient complaints and concerns poorly addressed. Do you have any issues that weren’t addressed by your surgeon? Are there other questions we should be asking? I would love to hear any ideas you all may have. All to often in medicine we fail to listen to our patients and I think forums like this provide an excellent opportunity for that to change.

      Thanks for your time and I look forward to your responses.

      Sincerely,

      Jacob A. Greenberg, MD, EdM

    • #12755
      JPaterso
      Member

      What ?s should surgeons be asking their patients?

      Hi Dr. Greenburg,

      I think it is fantastic that you are taking the time, and have the interest to ask these questions!

      For me, what I appreciate the most in a doctor or surgeon, is for them to allow me the time to tell my story – when my pain began, what lead up to it, the history of the affected area, how I am feeling now, what I believe may have caused the pain, etc. I am a patient of Dr. Towfigh’s and what I really appreciated about her is she took the time to really listen to what I had to say, without interruption and she believed me. I had seen five other surgeons previous to seeing Dr. Towfigh, and four out of those five were distracted, dismissive of what I had to say, rushed and did not have the time or seem to care about hearing my story. This was very frustrating and scary to me, as a patient. Of course I understand that doctors, especially good doctors are very busy and have only a certain amount of time to spend with a patient, however, in order to make an accurate diagnosis, I believe it is important for the doctor to really listen to the patient. It was also really disturbing and upsetting when some doctors did not seem to take my pain seriously, or even to really believe me, saying things like ‘I would need to learn to manage my pain’ or that ‘perhaps I needed an injection’. I knew there was something wrong inside of me, despite there being no bulge or outward appearance of a hernia. That was the reason I was visiting those surgeons!

      I am so thankful for doctors such as Dr. Towfigh, and you that really do care about their patients, take the time to listen and use their expertise, combined with the information gained from the patient to investigate, accurately diagnose and fix the problem. I hope that this is helpful to you.

    • #12760
      drtowfigh
      Keymaster

      What ?s should surgeons be asking their patients?

      Hi all. Please welcome Dr Greenberg. He is a friend and colleague of mine and I respect all of his expertise.
      So glad to have you on board, Jake!

    • #12790
      groundfaller
      Member

      What ?s should surgeons be asking their patients?

      Thanks for asking this question. I think this a great way for doctors and patients to connect better with each other.

      I wish my doctor would have asked questions about what, if any, activities my hernia is causing problems with. It seems like that would establish a baseline for the severity of the problem and, given that pain is relative, it might be a good indicator of my tolerance as well (albeit a subjective measure still).

      I also would have liked it if my doctor had asked questions about what I expect to do after the surgery in terms of activities. I realize it is impossible to say if one can return to their normal activities but I might have taken more time to consider whether or not I would have gone through with the surgery had I known that I might be considering selling all of my bicycles like I am now because I am not sure I can ride them again. At least before the surgery I could ride.

      I also would have liked the doctor to ask me during my initial exam if I wanted to know about the surgery which would have initiated more Q&A on my behalf and made my decision more informed, especially since I could go home and research with some knowledge.

      Right now given all of my complications I feel like I didn’t seize on enough questions. Dialogue is so important.

      Thank you for being thoughtful enough to seek out this information.

    • #13454
      Beenthere
      Member

      What ?s should surgeons be asking their patients?

      It looks like Dr. Greenberg has not been on the forum for sometime but wanted to put my two cents in on this. With you being specialist in hernia surgery and as a hernia patient, I would hope that you should cover most if not all the questions I would ask as a patient, since this is one of the most common surgeries. When I do hear all the information from you and your staff than I can formulate my questions and the these would than be answered honestly and completely.

    • #13456
      groundfaller
      Member

      What ?s should surgeons be asking their patients?

      Wow! I was surprised to have been brought back to this post but here I am. My surgery was nearly two years ago. The first year after the surgery was a absolute hell. I was not prepared for the difficulty. I was also not prepared for the lack of support.

      Ultimately, almost 18 months after the surgery, I found a physical therapist who was willing to put in the time and energy to help me as well as install a sense of confidence that I can be helped. He was great.

      I want to emphsize a couple of points. First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.” It can be deadly. I am not exaggerating when I say that I felt hopeless and the idea of suicide crossed my mind as I wasn’t recovering.

      Secondly, someone, somewhere, somehow needs to develop a comprehensive physical therapy/rehabilitation program to recover from this kind of surgery. This is one of the most common major surgeries which has a high incidence of complications. Professionals, please, I beg you, consider a better after care process. I can’t stress this enough. Don’t let people sit and waste away.

    • #13463
      Beenthere
      Member

      What ?s should surgeons be asking their patients?

      HI Groundfaller,

      I hope things are better for you. What you describe sounds very much like my experience. As soon as my condition worsened about 7 weeks post surgery I found out the truth about my quote expert hernia surgeon who supposedly performed a large number of hernia surgeries with less than 8% total side effects and complications prior to mine. Afterward when I got worse, I was told the surgeon had no idea what was wrong since he performed so few hernia sugeries. Six years post surgery I just found out he had done a whopping 2 hernia surgeries(just days before my operation) before mine in the previous 18 months. What is also shocking he is now posting online as a surgeon at a Hernia Clinic. And according to a report I received if accurate he did not perform one hernia surgery between 2011 and 2015.

      When my problems started it was me that was the problem and was bounced from different specialist to different specialist but when questioned they had no real expertise in this matter unlike the moderators on this site. I finally got new insurance and paid out of pocket to go to one of the real hernia experts to be fixed. Less than a week after corrective surgery I was without the previous pain, walking normally and even spent 11/2 days spectating at an auto race, meaning I was walking the whole day.

      I agree with your “First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.”” statement.

      I firmly believe that every hernia patient should be given this website address, Dr Goodyears website address and be given a copy of the book Unaccountable before surgery unless an emergency. This would give the patient a much better understanding and true picture of what is to come.

      Next there should be a complete checklist that both the Dr. and patient need to check all of the boxes on all aspects of the surgery before the informed consent.

      Than the patient should be given a complete copy of all presurgical visit notes and the agreed upon surgical treatment plan to take home and review to make sure it is accurate and complete. I thought I covered all the bases with my surgeon and his staff prior to my surgery, but when reviewing my medical history post surgery I found they failed to note any of the agreed upon treatment plans and none of my history was accurate and no notes by the doctor on the location of my hernia. Here is one example: The doctor agreed that he would locate all three nerves and preserve them. Post op notes states only the inguinal nerve found and preserved. When asked about why the other two nerves were not noted in the post surgical report it was stated that the other two nerves were not in the surgical field of vision on an open procedure.

      Informed consent should be given at the last appointment before surgery to be taken home and read at ones own time frame and reviewed by a lawyer if so desired. Instead of being given seconds before you are being wheeled to the operating room.

      Again I hope everything is better.

    • #13464
      otzi
      Member

      What ?s should surgeons be asking their patients?

      quote :

      Wow! I was surprised to have been brought back to this post but here I am. My surgery was nearly two years ago. The first year after the surgery was a absolute hell. I was not prepared for the difficulty. I was also not prepared for the lack of support.

      Ultimately, almost 18 months after the surgery, I found a physical therapist who was willing to put in the time and energy to help me as well as install a sense of confidence that I can be helped. He was great.

      I want to emphsize a couple of points. First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.” It can be deadly. I am not exaggerating when I say that I felt hopeless and the idea of suicide crossed my mind as I wasn’t recovering.

      Secondly, someone, somewhere, somehow needs to develop a comprehensive physical therapy/rehabilitation program to recover from this kind of surgery. This is one of the most common major surgeries which has a high incidence of complications. Professionals, please, I beg you, consider a better after care process. I can’t stress this enough. Don’t let people sit and waste away.

      Can you detail what physical therapy regimen has assisted you in your recovery?

      I have found an online physical therapy protocol for sports hernia type injury, which may be relevant to some patients of other types of groin pain and perhaps even groin surgeries.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273884/

      I know that Shouldice clinic in Canada encourages near immediate post-surgical minor activity, walking, and they have pool tables set up which obviously forces people to bend at the waist a bit. Similarly, when you hear about professional athletes being sidelined by surgery, they always have rehab and recovery for 6-12 weeks. There must be something to it.

      Perhaps some sort of protocol should be standardized and recommended for all patients?

    • #13465
      otzi
      Member

      What ?s should surgeons be asking their patients?

      [quote]HI Groundfaller,

      I hope things are better for you. What you describe sounds very much like my experience. As soon as my condition worsened about 7 weeks post surgery I found out the truth about my quote expert hernia surgeon who supposedly performed a large number of hernia surgeries with less than 8% total side effects and complications prior to mine. Afterward when I got worse, I was told the surgeon had no idea what was wrong since he performed so few hernia sugeries. Six years post surgery I just found out he had done a whopping 2 hernia surgeries(just days before my operation) before mine in the previous 18 months. What is also shocking he is now posting online as a surgeon at a Hernia Clinic. And according to a report I received if accurate he did not perform one hernia surgery between 2011 and 2015.

      When my problems started it was me that was the problem and was bounced from different specialist to different specialist but when questioned they had no real expertise in this matter unlike the moderators on this site. I finally got new insurance and paid out of pocket to go to one of the real hernia experts to be fixed. Less than a week after corrective surgery I was without the previous pain, walking normally and even spent 11/2 days spectating at an auto race, meaning I was walking the whole day.

      I agree with your “First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.”” statement.

      I firmly believe that every hernia patient should be given this website address, Dr Goodyears website address and be given a copy of the book Unaccountable before surgery unless an emergency. This would give the patient a much better understanding and true picture of what is to come.

      Next there should be a complete checklist that both the Dr. and patient need to check all of the boxes on all aspects of the surgery before the informed consent.

      Than the patient should be given a complete copy of all presurgical visit notes and the agreed upon surgical treatment plan to take home and review to make sure it is accurate and complete. I thought I covered all the bases with my surgeon and his staff prior to my surgery, but when reviewing my medical history post surgery I found they failed to note any of the agreed upon treatment plans and none of my history was accurate and no notes by the doctor on the location of my hernia. Here is one example]

      It would be nice if statistical information about surgeons, their procedures, numbers, and their outcomes, as well as anonymous patient info were public data, so this type of situation could possibly be avoided.

      It may be helpful for you to share the name(s) of the providers who ended up assisting you in correcting and recovering from your first unsuccessful surgery, if you are comfortable sharing that information.

    • #13466
      Beenthere
      Member

      What ?s should surgeons be asking their patients?

      I hope this is not breaking any rules of the forum. My first searches and information came from I think the forum herniawebmd and than Dr. Goodyears website. From the people who had the same problems many names came up multiple times. I started contacting them: Dr. G in Cleveland he spoke to me at least twice(maybe 2 hrs) in the evening going over multiple issues and was very helpful and never a charge, seemed more concerned with helping me than his time or money. Dr Peterson in Vegas I had contact with but was I think he was no insurance. On the list but I never contacted were Dr.s Amid, Chen, our host, Billings in Seattle and a couple more.

      When I found out my insurance was changing I narrowed the search to Dr. Yunis, Ramshaw and Goodyear. Spoke to all three at length and than spent the time and money to meet with all three in person. All were excellent and made the choice harder. Hate to say it but it came down to my in laws had a place within 1 hour of one of the Dr.s so I could spend over a week recovering and see the Dr. before returning to home. I think any the list I described would be excellent choices.

      Before my insurance changed it was a complete CF or SANFU. After finding out about my original quote expert I was not about to be screwed over again. I referred toat least five quote local experts and found they all were just general surgeons without any special training or experience with correcting post surgery pain and discomfort from hernia surgery. One supposedly a leading hernia experts, had a total of 75 hernia surgeries and when it came to triple neurectomies and mesh removal surgery he had performed none. Another again with no triple neurectomies or mesh removal surgery done but stated it would be an easy surgery to perform without any supervision from a true expert.

      Make sure you ask very specific questions and if you have any doubt ask again and again. If you still have that gut feeling something is not right find another Dr. Your health is too important. Also in a teaching hospital get it in writing that the expert surgeon will perform the entire surgery and read the informed consent very carefully and redact any item that does match the agreed upon treatment with your surgeon. This is the fall back and out for the Dr. and hospital that you were fully informed and signed this contract.

    • #13468
      sngoldstein
      Member

      What ?s should surgeons be asking their patients?

      As a surgeon, this is very interesting reading. Having been a patient and having dealt with the medical system with my elderly parents on several occasions, I know how frustrating it can be dealing with doctors and the medical system, especially when you don’t have 10-20 years of education in medicine. Unfortunately, our system is a business, and rapidly becoming a big business and many doctors are pressured to generate income. Patients with difficult problems take a lot of time for which the doctor is not reimbursed.

      Hernia surgery is significantly more complex than most people imagine, and just like with any complex procedure, outcomes are dependent on skill and volume. I agree with all of you that there should be transparent data about surgeons and their volume and outcomes. The establishment has been talking about quality measurement for years but the best they have been able to come up with is how well we do at checking boxes on computerized forms.

      At this point the best anyone can do is talk to their friends and find a surgeon who did good by them. Fortunately, and despite the stories in this feed, most hernia patients do quite well. Also, most doctors really are trying their best to make you better, it’s just that our system is not ideal and the information both the patient and doctor need to provide the best care is simply not available.

    • #13475
      drtowfigh
      Keymaster

      What ?s should surgeons be asking their patients?

      Thank you all for sharing your insight. This is exactly the reason why HerniaTalk exists.

      For sure the term “hernia expert” has been thrown around and most are by general surgeons who perform hernias, without expertise in handling complications from these hernias. Hence the importance of such a forum to seek the right information for your needs.

      We try diligently to refer you to colleagues in your neighborhood who are true hernia experts. If you do have excellent experiences with surgeons of your own, please share openly on this forum. Others will learn from you and you can help thousands.

    • #12274
      Beenthere
      Member

      What ?s should surgeons be asking their patients?

      Thanks for the reply’s. What concerns me is a multiple of issues in my long hernia journey. My case should have been I think pretty straight forward, if I had been given a Surgeon according to my very specific requests. I was told by the person who set up my initial appointment that he was a highly trained hernia specialist that performed hernia surgeries all of the time. I just found out that he had performed 0 in the 18 months leading up to my presurgical consult and that it was known that this quote world renowned hospital had a known 25 to 30 percent 1 year post surgery pain rate. Here is some background. My hernia occurred during a bad coughing spell at the site of the surgery for aN open appendicitis operation about 30 years ago. I will use this from another post ” It is just right of midline between my belly button and pubic bone”. My GP’s PA did the initial diagnosis and said it was a inguinal hernia. The quote expert hernia GS did two separate inguinal exams on different dates both lying down and standing and could not find anything and asked where is the bulge and I pointed to the spot described above. In his notes there is no mention of this, his findings or diagram of the hernia location. A couple on months later it was getting slightly worse for protruding and pain, plus when driving the top of the lap belt ran across it. So I decided to go ahead and have it fixed. So here is were this leads to in this post.

      I was told by every staff member of this Doctor by phone or during consults which there were three, how great of surgeon, his current training and knowledge, that he performs them all the time and excellent outcomes at this clinic at 8% or less total problems and/or complication. So after the surgeon and his staff went thru what to expect and was given the little booklet here are my questions to the doctor which I asked.

      When I left the first consult watchful waiting and open surgery.

      This is what I asked to his PA and what I was told. second consult for surgery work up

      How many has he done – performs them all the time since coming to the hospital about 18 months.
      Will he perform the entire surgery – we do not have techs so a resident will only assist. She also stated that the resident would be the only non licensed person in OR. It would only be the surgeons highly trained and experienced team in the OR.
      Gave the name of a class mate that is anesthesiologist that I would not be comfortable with doing the gas – Agreed but not noted in notes plus told the that it would be a highly experienced general anesthesiologist doing the gas.
      Asked about metal-no metal to be used – absolvable sutures were to be used.
      What is there are complications or pain post surgery – we have a world renowned specialist on staff for post pain to resolve the issue.
      Surgery changed to Lap.

      Second consult with surgeon 3rd total. Changed back to open surgery. When I asked why no reason given. But again this is supposedly one of the best hospitals in the nation and being told constantly how great my surgeon is I except this.

      Questions I ask the surgeon.

      How many times have you done this type of surgery – well over 1,000
      Are you going to perform the entire surgery – yes according to their residents exit survey the residents might perform up to 90% of the surgeries at this hospital.
      What about current training – I am up on all current techniques for open hernia surgery
      What or how do you deal with the three main nerves – We agreed he would locate and preserve. When asked after the surgery about why no note in post op about two of the nerves were not reported I was told not in the surgical field of vision.
      What type of mesh to be used – We agreed on lightweight mesh. Heavyweight(PMII) was used and he could not answer why but another PA stated he performed so few since coming to this hospital that he might not have known approved types available.
      Time of recovery – 6-8 weeks to be fully recovered.
      Can I travel by plane in 10 day s- no problem
      Side effects and complications – listed seroma, hematoma and infection as the three main ones. The writer of a study that found they had a 25% post pain issue was in the consult room at the time and said nothing. Also I had two previous surgeries in the general area and never mentioned a possible loss of testicle. Less than a week after the surgery the doctor stated he inserted the mesh a tight as possible
      Pure tissue surgery – no can not be done that way.

      I now know that I forgot to ask two important questions-Why are you recommending open over lap and if doing it open why are you recommending a general over local.

      I think I asked the right questions and was given the answers they wanted me to hear, that led me to consenting but after my surgery and reviewing my history plus what I have found I believe I was intentional missed informed.

      That is why I stated this and Dr. Goodyears forum along with the book unaccountable should be required by consent it obtained.

      Doctor Towfigh if you or the other mediators would like to review my history I would be more than happy to forward them to you.

      Thanks again for all of your time and help you provide to this group

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