Surgery: Before, During and After
Who will be taking care of you and your surgery, other than your surgeon?
Once the patient and the surgeon agree that surgery is the best treatment option, a lot of things go in to the patient's surgical experience, and ultimately the OUTCOME. You probably are not aware of how many people are involved in ensuring a good surgical result for you, but if you're interested to know, read on.
In our society, the surgeon is presumed to take ultimate responsibility for the patient's care and surgical results. However, in reality, there are a great many individuals, not directly under the surgeon's control, that will also affect the patient's surgical result. Some of them you'll meet along your 'surgical journey,' many of them you'll never know existed. It is important, however, to realize that any one of these people can have an impact, good or bad, on your surgical experience and final outcome.
These people have varying levels of education, expertise, attention to detail, motivation, and standards of excellence. The point is, choose your doctor well, but also hope that the supporting staff that works with you are also upholding the same level of care provided by your doctor. In short, it's not just the doctor you need to worry about.
The following list is in chronological order, starting from the first people involved in your surgical journey, to the last people involved when your care is completed. If any one of these individuals is not giving their full, undivided attention to your care, (and sometimes even if they are) you could experience a complication/bad outcome. Your surgeon will likely be assigned the blame, but read on to see who all are really involved. Your surgeon doesn't supervise or interact with most of these people. As you'll see, other than your surgeon, there are more than thirty (30) people who impact you.
Before your surgery:
Pre-operative nurse- This person will do your initial screening before surgery and assess your health risks for anesthesia. If they detect some risk factor, they may send you to your PCP for further screening.
Your primary care physician (PCP) - Depending on your age, your PCP may be asked to provide a note stating that you are in as good of medical condition as you reasonably could be - in anticipation of your upcoming surgery. Often they will order some blood work.
The phlebotomist - This person draws your blood. Poor technique can contaminate your blood sample or cause infection from the needle.
The laboratory technician - If you have any blood work or labs ordered by your doctor, the lab tech must process the blood properly and give accurate results.
The nursing secretary - This person takes the doctor’s written medical orders in your chart and enters them into the computer, including medication types and dosages.
The radiologist -This doctor reviews your X-rays, ultrasound and MRI, and determines the official result.
The radiology/MRI technician - This person is the individual who actually does your MRI, and sets all the parameters for your study. The doctor is NOT usually present during this test.
The EKG technician - This tech sets up this test to determine if your heart is beating properly.
The surgeon's staff/medical assistants/nurses - They will complete your paperwork with you, and give you your prescriptions and instructions.
The day of your surgery:
The pre-surgery holding area nurse - After you check in, this nurse will get you 'prepped' which will include putting in an IV catheter in your arm, and possibly shaving the area of the surgery. Poor technique can lead to infection.
The nurse anesthetist - This person will get you ready for anesthesia and be administering most of your anesthetic medications. Needles will be used and medication vials will be opened. They will also determine how much 'gas' you get. They will be with you throughout the surgery, but they often rotate to give each other breaks. Therefore, you may have 2 or 3 nurse anesthetists attending to you while you are asleep. They are also responsible for checking to make sure your body is in a padded and protected position throughout the surgery. Poor technique can lead to death or permanent functional damage.
The anesthesiologist - This doctor will supervise your nurse anesthetist by occasionally coming in the operating room to 'see how things are going.' They will be present at the beginning and end of your surgery. The anesthesiologist also confirms that the position of your body (sitting up, laying on your side, your back, or your stomach) should be safe for your surgery. Poor technique can lead to death or permanent functional damage.
The scrub nurse - This person will be handing the instruments to the surgeon, and assembling all the gadgets that the surgeon uses. These individuals often rotate, and in a hospital setting, may have no experience with orthopaedics or with the surgeon's techniques. Improper techniques can lead to infection, broken implants, delaying the surgeon and incorrect devices implanted.
The circulating nurse - This person walks around in the operating room, recording the medications given, the time things happen, and hooking up different types of equipment for the surgeon's tools. They may have to open sterile equipment and also prepare sterile materials/solutions that will ultimately go into your body. Improper techniques can lead to infection, delaying the surgeon and incorrect devices implanted.
The surgical assistant tech (SA) - This person assists the surgeon by holding equipment or tools when the surgeon’s hands are full. They sometimes sew wounds closed or may even be asked by the surgeon to operate some of the tools.
The physician assistant (PA)- This person assists the surgeon by holding equipment or tools when the surgeon’s hands are full. They sometimes sew wounds closed or may even be asked by the surgeon to operate some of the tools.
The implant/devices equipment rep- This individual brings in (from their office or the trunk of their car) special devices that will be used on you or implanted in you. They will also instruct the scrub nurse on how to properly assemble these things for the surgeon's use.
The orderly help in the operating room - These individuals help transfer you on and off the operating room table while you are 'out of it.' Forceful movements could damage the surgeon's work, or injure you.
The sterilization staff - These individuals stay in the 'laundry room' of the OR. It is their job to clean, wash, rinse, scrub, and sterilize all the surgical tools. Poor technique can lead to infection or broken tools.
The housekeeping staff - These individuals clean the room (operating room or hospital room) in between patients to decontaminate and remove harmful germs. Poor technique can lead to contamination of your surgery.
The recovery room nurse - This nurse will monitor you while you wake up in the recovery room, giving you pain medication, and checking you for signs of complications from your surgery. He/she will also adjust your sling, brace, splint or cast, and apply an ice pack to reduce swelling. The set-up of these devices can affect your results. Lack of attention here can lead to death or functional impairment.
Recovery room X-ray tech- Often, before you wake up in the recovery room, an X-ray will be taken of your operated area. This person will move you around to position you for the X-rays. Forceful movements could damage the surgeon's work.
The floor nurse - If you stay in the hospital overnight, a nurse will watch over you; usually a different nurse every 8-12 hours. The night nurses are more likely to be foreign graduates.
Your pharmacist - This person is responsible for filling your prescriptions the way the doctor ordered, and checking to see if there might be any bad drug reactions from the medications. Filling this inaccurately can lead to nausea, pain or worse.
After your surgery:
Your family or friends - Depending upon your resources, you may have other people assisting you, giving you advice and impacting your recovery. Unless you live with your surgeon, that assistance or advice may not always be 100% correct.
Visiting nurse - If you have a nurse come over to your house after surgery. He/she will be assisting you, giving you advice and impacting your recovery.
Hospital staff- If you are admitted to the hospital, you'll be meeting some of the above people again; having your blood drawn, orders transcribed, more tests, more interpretations and more nursing care.
The physical therapist- This person will help you move your injured body part around to aid in recovery.
Therapy that is not aggressive enough can lead to weakness, stiffness and a loss of function.
The surgeon's medical/clinical staff/nurse/PA - These people work for the doctor, and they will be returning your phone calls, acting as an intermediary between you and the surgeon, giving you medical advice, calling in prescription re-fills, renewing therapy orders, and filling out forms. Lack of attention to detail here could impact your recovery.
Durable medical equipment rep - This person may fit you with a brace, sling, boot, cast or mechanical medical device to aid in your recovery. The set-up of these devices can affect your results.
Home equipment rep- This person may come over to your house to set up or deliver home equipment to aid in your recovery. This individual transports these items from their office or the trunk of their car. The setup of these devices can affect your results.
Special equipment rep - This person may be called on to set you up with a special medical device, e.g. bone stimulator or oxygen tank, etc. The set-up of these devices can affect your results.
The workers at your insurance company - This institution controls payments for all the above services. If they refuse to pay for your care or grant you the benefits of these services above, it could delay or inhibit your timely recovery.
For a closer look at the outpatient surgical experience, see this link: YOUR DAY IN SURGERY.
Ultimately, you, the patient, can have the biggest impact on your care. IF all these people above (and your surgeon) do their best, and IF you have good fortune, you still have a lot of work to do for your best shot at a great result. You should:
- follow the post-surgical guidelines
- communicate your concerns if some arise
- avoid harmful products like tobacco, alcohol and recreational drugs
- take your medications as prescribed
- complete your physical therapy as prescribed
- do your home exercises
- be patient with yourself
- be optimistic, but realistic
- expect some ups and downs along the way
- make sure you understand 'the plan' for your recovery