No need for a bag: Informed consent for treatment of rectal cancer

Denise Grady's story:
Six years ago, a relative of mine found out that she had rectal cancer, and would need surgery, radiation and chemotherapy. She lives in a small town, and consulted a local surgeon at a community hospital.

He was pleasant and kind, and clearly explained her condition and the operation he would perform. He was also painfully honest, and said that because the tumor was large, he doubted that he would be able to save the sphincter muscles that make bowel control possible. She would very likely need a colostomy, a procedure to divert wastes out through an opening cut in the abdomen, and would have to wear a colostomy bag for the rest of her life.

She thought it over, and decided that, instead, she wanted a doctor who operated on patients like her all the time. She found a surgeon who specialized in rectal cancer, and today she's in good health, with no need for a bag.

Practice makes perfect for surgeons too. Hospitals and surgeons that perform a higher number of a certain kind of procedure are better at it. It’s not just the surgeon's skill; outcomes are better if nurses, intensivists, respiratory therapists, and physical therapists are more experienced at treatment of a given condition.

This goes beyond "informed consent," which sometimes refers only to a perfunctory explanation and an unquestioning patient. Patients should insist on a "well-informed consent" based on their active weighing of pros and cons.

Advice: If surgery is really necessary, have it done at a high volume hospital by a surgeon who has performed many of the procedures you need.

Read a story about well-informed consent.

Thanks to Denise Grady for the source article in today's NY Times.