It’s important for both us and the patients to prepare for surgery. So, part of us preparing for surgery is when you see someone in a clinic, if it’s an elective operation, you have to think about the approach of what you’re going to do. So, part of preparing for surgery is definitely deciding if it needs doing – because any surgery presents risks to people. You have to talk through the risks and benefits with the patient, as part of what’s called the informed consent process. They have to know all of the risks, all of the benefits, and want to have it done.
We can make our recommendations, but ultimately the patient has to decide if they’re happy to go ahead with the surgery if they are able to do so. If it’s an emergency operation, or an operation that’s for cancer, or something very severe, and the person isn’t able to give their consent and able to say what they want, because they have problems such as learning difficulties, or if they have dementia, or cognitive impairment – then we have like an MDT process. Which is getting everyone involved and deciding what’s in the best interest for the patient.
Personally, before you go into an operation, you have to get them to sign the consent form, and in doing so, you have to say what you’re going to do. You have to know what you’re going to do – are you going to do an open operation? Are you going to do a keyhole operation? What are you going to do and what are the things that you might have to do?
If you’re doing something simple, you will generally put what you’re going to do. If you’re going to do it as a keyhole operation, you always have to prepare for it to become an open operation, because you can’t always do a keyhole. Then you have to figure out what you might have to do if things go wrong. So, depending which part of the body you’re going into, you have to think about the steps of the operation. So before I go in, and start an operation, I’ll walk through the steps right from where I position myself around the patient, which side am I going to be on, because you think about which dominant hand you use. If you’re doing a keyhole operation, you think where you’re going to stand, and where there has to be a screen. You have to be able to see the screen best to be able to coordinate with your hands.
Then you go through each of the steps of the operation, what you need to ask for at each step, because some things need to get ready. So, if you need to put clips on something, some point you need to think when am I going to need to do that, when do I need to ask the nurse who’s giving you the equipment to do that, and how am I going to approach this depending on what information I’ve got about the patient, whether you’ve got scans, what the patient’s pathology is, what you’re doing, and then you walk through the steps.
Before I scrub up, before I get ready for the patient, I’ll go through every step of the operation and then as you’re going in often you verbalise what you’re doing as you’re going along, even if you’re the most senior person in the room, just to sort of make sure you’re doing everything at every step. Patients prepare for surgery as well, so especially big surgeries. They go to things like surgery school, so that they’re at the fittest they can be beforehand. It’s a process, we’ll get it right first time, which means if a person is as optimised, and as informed as they can be at the time of surgery and everyone’s the most prepared – it’s less likely to go wrong.
