Medic-ALL(09;16;2015) SURGERY AND ETHICS
By Kayode Kuku MB;BS
Experiencing medical practice as a student and physician in a “developing”
country, I came in contact with a lot of patients who hated to hear of the option of having surgery to manage whatever condition they were being
managed for. From the simple surgical procedures (appendicectomies, lumopectomies)
to the cesarean-sections for child delivery and even more major surgeries to
improve the patients’ quality of life, having surgery was bad news to most.
It was common to associate the phobia for surgery with the
level of education of some of the patient, but I later found that even the most learned shared in
the phobia apparently. I came to realize that the dislike for surgery was a
general phenomenon and this submission was substantiated following my exposure
to patients in the developed society, it didnt matter if it was a minor excission procedure or a total knee replacement. The fact is most people would prefer not
to have surgery, while some have an outright phobia for surgery.
A while
ago I came across the term“Tomophobia” which refers to the fear of
surgery or surgical operations. It is considered a social phobia. Tomophobia is said to be caused by a number of reasons,
which include: 1) A bad situation or traumatic event occurred in the person’s
life as a child involving a surgery; 2) The risks associated with having
surgery (i.e., in extreme cases, death); 3) Some are afraid of how their life
will be after a surgery (i.e., diet, movement, sex, health, longevity); 4)
People are scared of contracting other illnesses or getting sicker after a
surgery; 5) Some are afraid of having major procedures like heart or brain
surgeries; 6) Some are just afraid of
possible negative outcomes from surgeries (i.e., scars, bruising, or loss of
mobility); and 7) While others just don’t
like anything that causes them pain, including surgery. These are only a few possible causes.
There are probably hundreds more causes.
The symptoms of Tomophobia typically include extreme
anxiety, dread and anything associated with panic such as shortness of breath,
rapid breathing, irregular heartbeat, sweating, excessive sweating, nausea, dry
mouth, nausea, inability to articulate words or sentences, dry mouth and
shaking. Tomophobia is treated counseling, hypnotherapy, psychotherapy, Neuro-Linguistic
programming and medicines could also be prescribed.
However, I honestly do not think that majority of the
patients I have come across in practice who have either fled the doctor’s office or cried when given
the option of surgery suffer from Tomophobia. For most it’s probably more of a natural
feeling of not wanting to be cut with a knife or scalpel, hence the thought of
having an invasive procedure coupled with the imagination of a cut through the
skin sends shrills down the spine of the patient and gives rise to resulting anxiety.
Even after consenting to have surgery, patients experience anxiety. An
important step in dealing with surgical anxiety is to become as well informed
as possible regarding the illness, prescribed therapies, and surgical
treatment. Having a complete understanding of the procedure,the indication, the methods to be applied, and how it is performed can relieve a great deal of worry. An
understanding of anesthesia and the low risks of having anesthesia may also
help with concerns about surgery. Both the patient and the surgeon have a role
to play in this regard.
If anxiety is caused by a lack of knowledge about the procedure,
it is essential that the patient asks questions and finds the satisfactory answers until the
decision to have the surgery and the choice of surgeon is fully understood. For
many, anxiety is a normal response to being expected to make a life altering
decision with minimal information. Once the patient has the necessary facts the
anxiety may be relieved. In some cases, anxiety occurs when the patient has no
idea of what the surgery entails and is left to imagine what the procedure and
the result will be like. The physician performing the surgery can provide a
realistic idea of what the outcome of the surgery will be and a typical course
of recovery.
Other patients are not comfortable with the idea of surgery,
because of the length of their stay in the hospital and recovery time. This is understandable in the case of patients
who have to take time off from their regular work schedule and bear the financial
implications of so doing. It is the duty of the managing team and surgeon to adequately counsel the patient on the importance of having the surgery, discuss the possible length of hospital stay and recovery and if applicable, the urgency or not.
The truth is that, doctors have an obligation to help their
patients and to refrain from providing ineffective treatments (beneficence and
non-maleficence). The goal of medicine is to promote the welfare of patients,
and physicians and surgeons possess skills and knowledge that enable them to
assist their patients. Due to the nature of the relationship between physicians
and patients, doctors are expected to weigh and balance possible benefits
against possible risks of an action in the management pf a clinical scenario.
What this means is that the best of surgeons know exactly when NOT TO offer or
do surgery for a patient. So, patients be rest assured, no real doctor likes to
cut you open for the fun of it, ask all your questions to deal with whatever
fears you have, the surgeon is always more than happy to answer.
Medic-ALL. Inc 2015!
Refs: Anxiety Disorder. Patient Version. U.S. National Institutes
of Health,
