WHEN A SURGEON BECOMES THE PATIENT

I recently surpassed the six month “anniversary” of my open heart surgery for a congenital defect. I’m very happy to share that the surgery was a success, and I’ve been back at work for five months now and feel as good as I did the day I walked into the hospital. Ironically, I felt completely normal the day before my surgery as well. I was actually in the best shape of my life and faced with the recommendation to have surgery only after a very caring and persistent internist insisted that I see a cardiologist to evaluate a heart murmur that he heard during a routine physical exam. True to the stereotypical physician-as-terrible-patient mold, I initially objected to pursuing a seemingly unnecessary test. I eventually agreed as I realized that he certainly knew more than I about heart murmurs and, more to the point, I reflected on how I react when my patients resist my recommendations.

Once I discussed the diagnosis with my family and accepted that surgery sooner rather than later was the best option, I began the search for a surgeon. It was certainly interesting to start asking questions from the other side of the exam room. Which surgeon did I want with my future quite literally in his hands? Which hospital has the best cardiac unit? Should I request a specific variation of the procedure that I read about online? Can I pick a specific anesthesiologist recommended by a friend?

I then thought to myself, do my patients contemplate these same questions as they sit across from me contemplating upcoming knee or shoulder surgery? Do I provide them with satisfying answers and address all their concerns? The role reversal took me by surprise, but I could not help exploring this train of thought each step of the way.

For a number of reasons, I met with three different surgeons; ironic since I routinely counsel friends and family to avoid the confusion of too many opinions. As it turned out though, after meeting Dr. Hillel Laks at UCLA, my wife and I looked at each other and said “we’re done looking.” Dr Laks’ calm and professional manner immediately put us at ease. He listened intently and then explained, in very clear detail, his plan of attack. Without even waiting for me to ask, Dr. Laks answered every question I had. By the time he finished making his recommendations, I very clearly understood what exactly he planned to do, why he preferred to approach the problem in this particular way and what I could expect throughout recovery. He did not dwell on the risks of surgery, but he did explain those he thought were important and further explained how he planned to minimize them. My wife actually commented as we walked out of his office, “I’m not even nervous about your surgery anymore.”

Both before and after surgery, Dr. Laks and his phenomenal assistant (of two decades) Tess were always available to answer questions and guide me through unfamiliar surgical territory. I said goodbye and thank you to both of them months ago, though I have not stopped thinking about them. The whole experience has been much easier than I anticipated on so many levels, and I attribute this to their caring nature and Dr. Laks’ expert hands.

Why am I sharing this story so publicly? This experience has been an unexpected learning experience for me. Despite recent questions about the importance of preventive medicine, I am a firm believer. There is no doubt that as a society we overuse some aspects of health care and sometimes rely on too many expensive “tests” that don’t provide that definitive answers we are looking for. However, I believe that a yearly visit to an internist with attention to health maintenance and disease prevention is a worthy expenditure for all of us. A physical exam by a physician with a keen intellect, perceptive senses and a caring heart will forever remain the best and most inexpensive test we have. It’s easy to believe that nothing can possibly go awry in our bodies when we are young and feeling invincible, but you certainly cannot find what you are not looking for. I will continue to listen to my doctor and urge my friends, family and patients to listen to theirs.

The unexpected diagnosis and need for surgery has also taught me a great deal about how I deal with my own patients. I am proud of the practice I have built over the past ten years and particularly of my relationships with all of my patients. However, being a patient and observing my own interactions with Dr. Laks from “the other side” highlighted many important aspects of the surgeon-patient relationship for me.

While I’ve grown accustomed to recommending surgery to repair knees and shoulders for years now, open heart surgery seemed like a much “bigger deal.” As I progressed through the patient learning curve though, I came to realize that this procedure was relatively routine for Dr. Laks. Nevertheless it wasn’t routine for me. That’s when I realized that even though the most straightforward of knee surgeries is routine for me, it is NOT routine for the patient. Fears of pain, disability, loss of work, inability to exercise and play actively with children apply equally to me as to the patient who has placed his or her trust in me to reconstruct a knee or shoulder injury. Dr. Laks recognized all these issues without me having to bring them up. He remained patient in answering any questions, thorough in describing the procedure and recovery and, perhaps most importantly, inspired confidence for my family before, during and after surgery.

Now that I’m back working, feeling as strong as the day I walked into the hospital for surgery, I carry all these lessons with me as I speak to my own patients. I’m thankful to all my physicians, not only for taking great care of my heart, but also for teaching me how to care for my patients with greater heart.