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| From Fangirlsarewe.com |
So I really did mean 'Witch' in this case :) Kind of-
We had this discussion in the office just a few days ago, and we all though it might be a good idea to get the word out on procedure choice and some of the pitfalls we have experienced lately.
But first a story about my neighbor. No she didn't have weight loss surgery. But she did closely resemble the "Wicked Witch of the West" - but in appearance only. She was a very nice lady and a long time great neighbor.
I remember when I was a little kid , and after watching the Wizard of Oz I mentioned it to my Mom and I was surprised at her abrupt and negative reaction when I compared the two of them.
I think she thought I meant how she acted..not how she looked like her. Seeing this picture again only reinforces what I first thought. It still is true! I wonder what my Mom would say if I mentioned it to her again? Might take that walk down memory lane this weekend...
Anyways - Which Bariatric procedure for which patient?
As I said, we had a discussion in the office about this very topic recently.
Historically, the patient comes in to the office with a general idea of which procedure they are intending on having (Band, Bypass or Sleeve), and when the Surgeon meets with them, they review the patient's history and fill in any gaps in the patient's knowledge about the other procedures, how they work, and complications - and they work together to decide on their surgical procedure, "tool" if you will.
The issues that started the discussion recently, was that a new patient met the Surgeon for the first time with a very limited view on surgical options, based on one of their Physician's recommendations about either which one they had to have (and be cleared for), or limited the patient by which surgery they couldn't have.
Both Physicians in question were long time providers of care to their respective patients, and the Surgeon, new to them, had a hard time fully discussing both risks and benefits, as well as real world implications of their limited choice of one procedure over another one.
There now certainly is more information and experience out there with all health care providers, due to the explosion of cases of Bariatric Surgery in the general population. And there certainly are many "grey area"subtleties, and nuiances that exist among the different procedures that we do, especially as taken in context with an individual patient's presentation and needs / comorbidites, age, mobility, etc..
Although there still is not hard and fast data that steers us easily and unequivocally to match up a certain patient demographic and medical characteristics to guarantee 'success' with a specific procedure type for a specific patient, there are some general time-proven principles that we can experientially apply to patients that we see in the office before surgery. The patient's Surgeon usually speaks to that over two visits pre op, and those discussions have real merit and potential consequence.
Unfortunately, every now and then, a well-meaning PCP or specialist will short-circuit that discussion with a previous discussion that can close the mind of a patient and lead them to suboptimal results down the road.
However, don't get me wrong - the patient, generally in discussion with his or her Surgeon, arrives at a decision for surgery, and the patient's final desire for procedure type is always what is done.
I just know that recently, one of our Surgeons felt a bit shut out of the benefits of a full discussion about what procedure may be best for a couple of patients, seemingly due to the directive from their PCP or specialist who had a bias about what procedure to have done, and it was very difficult to change that patient's mind because of it.
Frustrating, but we do the best we can do.
So, keep those referrals coming, but try and leave open the final discussion about which procedure for which patient mainly between the Surgeon and their new patient.
Thanks!
