Second Opinion: The Columbia Presbyterian Guide to Surgery.  By Eric A. Rose. St. Martin's Press, New York, 2000. Pages: 350. Price: $27.95.

Vignette: You are completing a preanesthetic evaluation on a patient who is scheduled for a laparoscopic tubal ligation. When you ask if she has further questions, she begins with a litany of queries generally addressed by the patient's surgeon, including what the surgery entails and what her options are. You realize this patient truly does not understand what the surgery means. How could this patient have obtained more information?

Dr. Eric A. Rose, Surgeon-in-Chief, Columbia Presbyterian Center, has written a patient-focused, clearly worded, no-nonsense guide designed to empower the patient to be an active participant in his or her surgical treatment planning. Dr. Rose believes no patient should have surgery without first understanding the medical problem at hand and how the operation is going to help that problem. He maintains that if the patient is unsure of either issue, he or she should seek a second opinion. The book describes (1) the mechanism of obtaining a second opinion and (2) actually what could be obtained in a second opinion for 45 separate surgeries.

Second Opinion  is divided into three parts. Part 1, “Do I Need Surgery?” gives practical guidelines designed to help enable the patient in becoming an active and enlightened health care consumer. The first chapter, “Understanding Your Medical Problem, and its Surgical Solution,” assists in formulating questions that should be asked for the patient to understand the risks, benefits, and complications of any proposed procedure. Dr. Rose encourages the reader-patient to be proactively involved in the decision-making process, including assuming the responsibility to “choose medical professionals who are caring and knowledgeable.” He gives advice on ways to better understand the medical condition, how the surgical procedure will help correct the condition, and how to assess risks. The remaining chapters in part one deal with the mechanism of obtaining a second surgical opinion, evaluating the alternatives to surgery, and finally, choosing the right surgeon. The last chapter discusses what to look for in a surgeon and how to evaluate his or her experience, education, certification, and credentials.

In part 2, the chapter “Before, During, and After: Optimizing Your Hospital Stay” contains recommendations regarding prehospital arrangements together with information on advance directives, living wills, and “do-not-resuscitate” orders. “Using Special Services” explains auxiliary hospital services, including that for autologous blood donations. “Planning Your Hospitalization” contains a section on anesthesia evaluation in which the author advises the patient-reader to insist on a visit with the anesthesiologist in advance of the operation and reviews the role the anesthesiologist will have in the presurgical process. “What to Expect in Recovery” deals with the postanesthesia and intensive care units as well as the ward. The section of this chapter devoted to pain mentions the importance intraoperative anesthesia care has on pain management and introduces regional anesthesia and patient-controlled analgesia.

The chapter of most interest to the anesthesiologist and to many patients is “What You Need to Know About Anesthesia.” Drs. Ellise Delphin and Andrew Feit, anesthesiologists acknowledged by the author in the first page of the book, obviously contributed significantly to this chapter. The critical importance of the anesthesiologist in patient care is highlighted throughout, a refreshing articulation from a surgeon-author.

The bulk of the book is in part three, “What's Going to Happen to Me,” in which 45 different surgical procedures are described. Each separate section follows a similar format discussing: the part of the body subject to the operation, reasons for having the operation, what could happen if one doesn't have the surgery, factors that increase risk, possible complications, probable preoperative tests, basic steps of the operation (including anesthesia), and what to expect postoperatively. Illustrations complement nicely the clear and concise description of each procedure. The most common types of elective breast, skin, cardiothoracic, endocrine, gastrointestinal, urologic, orthopedic, reproductive, transplantation, and vascular surgery are described, however, notable exceptions of common surgeries such as tonsillectomy, myringotomy, Caesarian sections, dilation–curettage, and open reduction–internal fixation are not mentioned.

The author has succeeded in educating patients on what to expect in regard to anesthesia and surgery and empowers them to be educated, informed, and assertive collaborators in their health care decisions. This will be an easy book for you to recommend to family, friends, and patients who may have questions about their planned laparoscopic surgery.