Did We Forget the Patient?

Sitting beside Dr. Picard Marceau at a standards committee meeting many years ago I realized that I was smiling as he was talking. He was rising to the obvious passion of what he feels is a literary injustice to the surgery BPD also known to many as the Duodenal-Switch. He is requesting, if not demanding, that in the new patient handbook,

(that would be available through the American Society of Bariatric Surgery), the description of the surgery be more specific. I smile because, as perturbed as he was, what he displayed was a passion of what he believed to be the most important part of the new booklet. He just wanted to be sure the description would be written accurately. Anyone who knows Dr. Marceau is very aware of his belief that fundamentally any bariatric surgery and particularly the BPD should be effective and safe and most importantly correlate with the quality of life.

I thought back to a letter Dr. Marceau had once written in rebuttal to some of the problems other doctors felt the Duodenal Switch could potentially create. His response was clear; “In my opinion the first objective of bariatric surgery is to help diseased and debilitated patients reach a better quality of life.” He proceeded to say that so much attention is given to whether the operation done improves “life expectancy” when it was obvious that it is the improvement in the “quality of life” that is the first goal of these patients. And finally that quality of life is so important in this adventure that even a risk of certain long-term problems will have to be weighed against the advantage of a longer and better life. I respected that statement as well as respecting the man who wrote it. His concern was clear.

We do not have to go very far to see that frequently what is forgotten in this growing medical specialty is concern for the patient. Not at the time of surgery or while they are in the hospital, but later. Later after the patient has gone home and the weight loss process begins. Later when the adjustment to their “new world” is beginning. Later when they are alone and the surgeon is not around. How do they adjust to eating differently after a lifetime of poor dietary habits? The brain was not directly involved at the time of surgery but we somehow feel that behavioral changes will automatically go along with the physiological change. How unfair are we to assume this? If we look at all of the patients as a whole, we see those who have more times than we could count, considering themselves as failures. Failures at dieting, self-control, emotional restraint, relationships, and the list could go on. Now we assume that after having bariatric surgery, the patient will feel differently about themselves, they will win the battle of the bulge, wear smaller clothes, fit into society, find love and be happy ever after. They will be winners. We expect it. We may not follow up on our predictions, but shouldn’t it be, weight loss equates to winning the battle? Did we forget to ask the patient if they feel like winners?

If our goal is to improve the quality of life of the obese individual we must never feel that surgery alone is all that is needed. We must be fair. Our passion to help them adjust to their “new” lives should supercede our passion of having large egos. Surgery, no matter which one, is the key that opens the door to all who desire to have the experience. Follow-up exams, data collection, support groups and continuing patient education are our responsibilities that we should provide for those who choose to walk through that door.

I have learned many lessons from Dr. Marceau such as the necessity of believing in yourself and your abilities and the importance of fairness but most of all, that if you believe in something you should pursue it with a passion. Our desire and first objective of bariatric surgery should be to help diseased and debilitated patients reach a better quality of life. Our passion should be to help them achieve it.

Jacquelyn K. Smiertka, RN, has been a bariatric surgery clinical coordinator for thirty five years. Mrs. Smiertka is a member of the ASMBS and IFSO. She has presented papers at numerous meetings in the United States and Europe.