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Principle four

 

 indikationswahl

"The most important principles, which are valid for me personally, and my colleagues, in surgical activities and in carrying out a surgical procedure are: human understanding for the patient, proven and current scientific knowledge, outstanding technical capabilities and proper selection of indication (selection of operative procedure)."

Hans U. Baer, MD
Associate Professor of Surgery
Baermed. - Centre for Abdominal Surgery, Zurich

The greatest art in operative areas of medicine is the ability to find the correct type of operation for each patient. In the past, this was relatively easy, with only a limited number of procedures available. However, today, even for relatively simple procedures, such as a hernia operation, there is no longer just one procedure, but a whole set of different methods. Each has its advantages and disadvantages; none is a hundred percent reliable, even with perfect execution. Operations may be open, closed, or minimally invasive, with or without foreign material implants. The surgeon must know all of them. In some surgical procedures, the surgeon might feel totally sure and able to recommend the intervention to the patient. On other instances, operations are carried out less happily and with less success.

Once the exact illness is determined, often after long and stressful examinations, the question arises for the abdominal surgeon as to whether the patient is operable. That is, based on the physical findings: is it reasonable to operate on a patient? The second point to be evaluated concerns resectability. This is the technical possibility to operate on a physical finding. Clarification of the operability is made based on heart, lung, kidney, and liver function and much more. These examinations are performed by the internists in the medical profession. The evaluation before the operation of whether the finding can be technically removed is often based on imaging procedures. From two-dimensional pictures the surgeon must determine the exact location of the organs and the diseases of the organs in the body, and decide if he can perform the operation with success.

When is it reasonable to perform which procedure on which patients? Principally, we look for the smallest, most careful surgical intervention, with the lowest risk with respect to physical fitness of the patient. Factors such as prior diseases, limitations in function of the organs and sometimes the biological age, often the attitude of the patient, must also be considered and carefully weighed and assessed. Determining the indication for an operation is also based on one's own knowledge, experience and preparedness to take risks, as well as the sense of responsibility, and the ability of the surgeon to often make vital decisions, completely alone, and carry them out. Time pressure, as well as often inaccurate or only insufficient findings, unclear findings and contradictory results of clarifications, pressurise the surgeons. All too often, one must make a decision in these situations, without being totally sure about it. Therefore, the selection of the correct operative procedure is, above all, a surgical art that can only be learned with total commitment and many years of work.

These principles are the focus of my life and professional experiences. They guide my activities and my understanding of humans, who entrust themselves to me as patients.


Hans U. Baer, Plamen Staikov

 

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