How involved were you in the surgery planning?

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#1 Post by **Daveyboy** » Fri Feb 15, 2008 4:09 pm

Hi Everyone,

Before I start, just for info, I do trust my OS's ability 100% but had a weird situation last week and any advice would be much appreciated.

I'm due to have lower advancement in about 4 weeks time, and had a "planning" consult meeting with my OS.
I was expecting to have new X-Rays done (the last ones were over 3 months ago) and then to sit down with him for half an hour at least, and go through exactly what my issues (medically speaking

) are and what he plans to do during surgery.

Instead, I ended up simply getting impressions taken so that they can make the splint.. and all of 1 minute with the OS simply for him to say - got any questions... then feel free to call me on my mobile!

Does this sounds really weird to anyone?

What and how much information were you given as to what they're going to do? As far as I know, I need lower advancement.. but the other things that haven't been mentioned are things like the midline, will either side be rotated/raised or lowered etc?

I am going to schedule another appointment with him, because I won't go ahead with the surgery unless I know what i'm having done.
But any advice on how much information you had (and what type - Xrays/diagrams etc) and how involved you were with the planning of the surgery would be much appreciated.

I know I need more info, but am a bit confused as to how much you would normally expect to be told?

Any replies are much appreciated!!

Cheers
Dave

#2 Post by **ohmyjaw** » Fri Feb 15, 2008 11:28 pm

I had several discussions with my surgeon and ortho about the surgery. I had three meetings with the surgeon - initial, interim, and final consultations. We talked about what would be done and he answered my questions. We didn't go into every single little detail, but he showed me on the x-ray where he would cut. He told me my upper lip was too flat and that he was going to put bone grafts underneath to fill it out, and I told him I wanted no such thing - just fix my bite, thank you very much. I don't remember how much time it took, exactly. But I do remember being at his office for quite a long time at my final consult - maybe a couple of hours. But that included x-rays, molds, measurements, photos, talking, etc. Some was with the surgeon and some was with assistants.

It's hard to get access to surgeons - they are always so busy and sometimes tend to rush through things, because they have done this all a hundred times before, and forget how monumental it is for us patients. If you feel you need more information in order to feel comfortable about the surgery, give it a try. It never hurts to ask, and hopefully he will have the time to meet with you.

#3 Post by **Arvensis** » Fri Feb 15, 2008 11:37 pm

I know I need more info, but am a bit confused as to how much you would normally expect to be told?

I suspect I may be an oddball in my expectations, but I approached this whole thing with the attitude of "it's my mouth, you tell me what I want to know and I'm happy with it, or I'm walking and going to another surgeon".. You can EXPECT to be told everything about your surgery and recovery, etc. YOU are the patient and YOU have a right to know anything you want about your procedure. What strikes me is that something in your OS's attitude or discussion made you uncomfortable.

I was ridiculously involved. I saw the models of how it would look afterward, discussed distance to be moved and expanded (upper), whether he was still considering the lower. I told him I wanted him to do all he could to only do the upper, and we discussed if there was a minor imperfection from just doing uppper vs. doing both upper and lower if I'd want what. I was VERY involved, probably to the point that I drove him crazy. He certainly thought I was trouble (until he met my medical power of attorney god mother - who stayed with me in the hospital - who had a PR background and a masters in public health master degree).

I should also mention that I edited the standard contracts at the hospital, cutting out (1) the part that says they can do whatever they want during surgery (I said they could do what the want but only if it was discussed in advance with me, and if they want to add anything during surgery they have to get it approved by my medical power of attorney who was waiting in the waiting room), and (2) the part that said they could use any photos or documents about my surgery for learning, instructive, etc purposes. Basically anywhere in the contracts that said they could do whatever they wanted I edited to say "if godmother medical power of attorney approves."

#4 Post by **Arvensis** » Sat Feb 16, 2008 12:08 am

Everything in the standard contract can be opted out of. Just cross it out, write your own clause, put your initials down next to it, and sign it. The hospital staff usually doesn't bother to check that you opted out until it's past time they could change it.

I cross out things and write my own clauses everywhere and all the time;)

If the doctor really objects (or realizes you've crossed something out) then they could hypothetically refuse to do anything unless you sign a non-edited document, but this is v. v. v. rare and I've never heard of it being done (indeed my godmother with her masters in public health who I learned all this from has been doing this for 20+ years and never had a doctor or hospital argue with it).

#5 Post by **Arvensis** » Sat Feb 16, 2008 12:13 am

Oops just reread your post, Meryaten. Yes, it was in the standard hospital contract. So I opted out:)

#6 Post by **dubnobass** » Sat Feb 16, 2008 4:28 am

I took an interest and ask them what they were planning, but let them get on with it.

I look at this this way - they are a team of highly trained, very experienced professionals, who have chopped and shopped literally hundreds, if not thousands of patients before me. They know what I 'should' look like, and know what needs to be done for an optimal result. I'm just me, not an orthodontist or a surgeon, with only my own scientific knowledge (I'm a pharmacologist by profession) and what I've read on the internet, for information. I am more than happy to leave it in their hands - why should they involve me? What can I add to the consultation process?

The only part where I had any input was they offered me the choice of just correcting my overbite, or also trying to correct my assymetry, slightly gummy smile and lip incompetence. The former would have involved just BSSO, the latter, the lefort as well. Seemed like a no-brainer to me, and I went for both procedures. Beyond that, they've talked over my head, and I'm quite satisfied with that. I did attend a fairly lengthy planning meeting where 7 people stood around me in the chair and talked about me - but not to me. I think some people are freaked out by this, but it seems natural to me.

#7 Post by **loulou123** » Sat Feb 16, 2008 5:37 am

Hi daveyboy

im in the uk and felt in a similar postition to you. my surgeon didnt really include me that much in what he was doing and i went into surgery not knowing 100% what i was having done

but i felt i could trust his judgement as hes obviously the proffessional and would do what was required.

As for the midline, raising lowering aspect i didnt think to ask, as far as i was concerned they were breaking my jaw and i didnt really need all the details.

If your concerned tho, you should make another appointment, or give the surgeon a call.

#8 Post by **Arvensis** » Sat Feb 16, 2008 11:55 am

I am more than happy to leave it in their hands - why should they involve me? What can I add to the consultation process?

Dubnobass, if I had done this at 15 and just let them do what they wanted to do, I would have had AT MINIMUM one more surgery, if not two. They told me I was done growing (I wasn't). They told me I couldn't breath through the nose because my jaw only (that wasn't true, the nose was the problem, but no one listened or took my complaints seriously enough to find this).

Yes, they're professionals, yes, they usually know what they are doing, but I disagree that we should just assume they will do the right thing for us. They are only human, and humans aren't perfect and don't always know what is best for us as individuals. There are plenty of good surgeons who have been involved in lawsuits for operating on the wrong leg, etc.

Having input does not mean telling them how to do their job, it's knowing how they arrived to their decision and any factors involving your particular case. You know your body and your experience better than they do, no matter how professional etc the doctor is.

#9 Post by **Arvensis** » Sat Feb 16, 2008 10:19 pm

Once the homework's done and you are assured in your own mind that you want to proceed with surgery, with the surgeon you've seen, and with the general plan, then is when she's talking about leaving the rest to the expert.

I guess what I am saying is that I never considered that my homework was never, ever done. I was prepared to walk at a moment's notice, knew who my backup surgeon would be, etc, if they didn't explain everything or if I wasn't fully comfortable with how the planning for everything was going. I didn't let go and allow them to do their job literally until the day of surgery. But keep in mind that this is the 2nd time I've gone through the planning phase and the last time no one asked my opinion or involved me on anything, and I refused to have surgery then because I disagreed with their prognosis (ie done growing, everything wrong related to surgeon's area of expertise vs. actually looking at problem) so I fully admit that I might be on the extreme end of patient involvement.

#10 Post by **Brandyleigh35** » Sun Feb 17, 2008 12:29 am

I was very involved with my surgery plans. I had two pages of questions for him which he answered very kindly. I was able to email him or call the office if I thought of anything else I wanted to know, and did so 3 or 4 times. He always got back with me and was very thorough with his responses. I never felt like I had any questions about what was going on, and if I did, I didn't hesitate to ask someone, or have it explained to me.

I think its hugely important for people to manage their medical care to a large degree these days. I researched my procedures to death, did investigative work on my surgeon, and even talked to previous patients of his, asking many questions. It helped me tremendously as I felt at ease with what was being done to me, AND trusted my doctor implicitly. I think he respected my interest and knowledge regarding what was being done.

If there is stuff you are not comfortable with, or unsure about. Ask about it. It's your jaw........be informed and be at peace with it all by knowing what is going on.

#11 Post by **dubnobass** » Sun Feb 17, 2008 8:29 am

Well. I suppose one other important factor to consider here is that in the UK, this type of surgery is covered on the NHS, so I don't think there -are- any private surgeons. 'Private' healthcare is performed here by the same physicians who work for the NHS, they just do it outside their NHS hours. We just don't go through the same routine of shopping around for surgeons. We get what we're given!

I think UK patients are given a very good idea of what sort of treatment they are likely to need, and what the outcomes will be with various options. I was told there was pretty much no point being treated at all unless I was prepared for surgery, but they also explained why, showed me the x-rays, explained where my skeletal problems lay, etc
They didn't just crack on with it all and not bother explaining the rationale for their decision. I trusted them in what they told me, and have trusted them to know what they're doing all the way through. If you decided to handle things differently and exert some sort of control over the proceedings, that's entirely up to you - but that's also perhaps, a 'luxury' that patient choice affords. When you have no patient choice, there really aren't many options for a second opinion!

#12 Post by **ohmyjaw** » Sun Feb 17, 2008 10:44 am

I really agree it's a good idea to do this "with your eyes wide open". Especially after my surgeon told me he was going to do that extra little cosmetic procedure for my upper lip. He didn't ask me, he told me. When I refused, he said ok that's fine, we won't do it if you don't want it.

I guess he didn't write that down, because at my next consult he brought it up again, same as before. Then I freaked out a bit. I told him no, I don't want that, I said that last time. And from then on, I was really on my guard! I started double checking everything.

#13 Post by **Emaciated** » Mon Feb 18, 2008 4:37 am

I didn't find out specifically what was going to be done to me until one week before surgery when I spent the entire day at the hospital taking x-rays, molds, etc.

My surgeon is an excellent surgeon, but as has been mentioned, he's incredibly busy. He had decided at one point he was only going to do my lower, then changed his mind further down the line.

In fact, I'm not entirely convinced he even knew exactly what he was doing until he got a good look at me the morning of the surgery. Kidding... (sort of). I was all wired up in the hospital bed and he sort of trotted in in a hurry. (Friendly and upbeat, but in a hurry nonetheless.) He kind of tossed my chart aside, took a good look at me and said something along the lines of "Hmmmm, all right, let's see what we have here... Oh, right, an open bite... yea, no problem, we can fix that. Okay, I'll see ya in there." he was half-joking but like was already mentioned, he's done so many of these I imagine its second nature.

I know from his assistant that they had already done numerous practice surgeries on models and digital software, etc. so was not concerned. I would've gone through with it regardless of what they had suggested. I wasn't concerned that they wouldn't make me look good, I more just wanted to know WHAT exactly I would look like. And was nervous about the recovery period of course.

#14 Post by **Happysmiler** » Mon Feb 18, 2008 5:24 am

I agree with Dubnobass's comments completely.

In the UK with NHS treatment, we really don't have the option of finding an alternative surgeon without it being a massive upheaval. I also have to add that Consultant Surgeons in the UK are always professionals at the very top of their field - this you can be assured of without really having to research their ability or successes. Yes there may be some that are more 'personable' and will discuss at greater length as to what is to happen, but as with life, there are those who are not forward in giving information.

I'm not sure how it works with choosing a Private Surgeon across the world - ie what experience or qualifications they have etc, but in the UK, whatever their personality, you know that the Consultant Surgeon will be very highly experienced and qualified, so their ability is unquestionable. They also have teams of Registrars and other Consutants working with them for second opinions etc.

This probably sounds very strange to those who are doing research into finding the best surgeon and then selecting the one they prefer, but this just does not happen over here.

I trust my surgeon explicitly, he is not that talkative and quite abrupt at times, (not unpleasantly) but he has been doing this for years and years at the top of his field.

My opinion is, that with Orthognathic Surgery, they are working to ideal measurements of the face. It depends on each case as to whether they can reach those perfect measurements, but where they can't, they just get as close to them as possible, so there should always be an improvement in facial balance.

I like to be fully informed as to what they are planning to do during the operation and I will give my preferences and views - (and they are listened to), but I don't feel it is necessary for me to discuss the finer details of the surgery as I am not qualified to do so.

Hope this gives a bit of an insight into our 'system' over here.

Best Wishes
Happysmiler

#15 Post by **Daveyboy** » Mon Feb 18, 2008 7:38 am

Hi Everyone,

Thanks for the comments and advice. I've emailed my OS with some concerns and asked to meet with him to discuss these before my surgery.

I just think that it's weird that I haven't had an Xray for 4 months, or had him talk me through what they're going to do.
I do have some concerns about some asymetry that I have (my right side of my face is more prominent than the left) so definately want to talk this through with him before going ahead.

As a background info, he is the same surgeon who did my genioplasty (only for cosmetic reasons) about 7 years ago, and also took my 4 wisdoms out 16 months ago.. before I started my ortho treatment.

Maybe it's because he knows i'm fairly familiar with the basics of whats going on, that he didn't offer up the info that easily!

I'll try to update this post with the outcome of my next meeting!

Dave