TAKING THE RISK IN SURGERY

Abstract

One of the most difficult to accept treatment options by the patient remains surgical intervention. The patient resorts to a wide range of therapies, more or less appropriate, with the hope that he will solve his health problems by non-surgical ways. Only the idea of a surgical treatment triggers a reaction of fear, sometimes going to panic. The patient resorts to the most unusual solutions: natural medication, bioenergy, homeopathy, magnetism, polarized light, acupuncture, and more others just to avoid the operating room. The patient's reaction is natural and is the expression of a preservation instinct in front of aggression. Surgery remains, however, the most radical therapeutic remedy. Whether it is done in a classical way or minimally invasive, the surgical solution brings almost instantaneous resolution of the disease to which it is addressed. The therapeutic outcome, often spectacular, is accompanied by a number of risks that must be accepted by the patient. Hence retention and fear for surgery. The idea of being "cut" accepting aggression on your own anatomy is a difficult obstacle to overcome.
There have been many changes in surgery. Advances have been made rapidly, in line with technological changes: endoscopy, laparoscopy and thoracoscopy, robotics, mechanical sutures, surgical lasers, ultrasonic disks, and so on. But the risks are almost unchanged: anesthetics complications, intraoperative hemorrhages, visceral lesions, eviscerations, postoperative bleeding or peritonitis and so on. How can the patient accept “this list of nightmares”? How can he accept the percentage of 0.1-10% of post-operative deaths, a number which varies according to the extent of the surgery and the patient's biological status? The informed consent cannot cover all possible surgical and non-surgical complications. However, the therapeutic act is inseparably linked and conditioned by obtaining this consent. During a few hours, the surgeon is responsible for the life and the future of his patient. A great surgeon, Robert Soupault, once said that the operator has "plein pouvoir sur la vie". These powers should be used with utmost discernment, with the sense of measure, consistent with the illness being treated and with the condition of the patient. Any exaggeration will, unfortunately, be reflected in the postoperative outcome. Overestimating or underestimating the disease are equally risky. "Better is the enemy of good" is an old saying well known in the surgical world.
Rightly, paraphrasing Iuliu Hațieganu, "surgery is science and consciousness, both heated by respect and love for people.". And then, if things are so, in surgery it's good to think you can, but realize on time when you cannot.