Secrets Your Surgeon Won’t Tell You

By molly atherton 7 months ago
Ah, the world of surgery—the masked heroes of the medical realm, armed with scalpels and suture kits. But behind those O.R. doors, there's a secret society of surgeons, silently wielding knowledge that they won't spill on the operating table. Ever wondered what your surgeon is really thinking as you count backward from ten? Or what clandestine rituals occur when you're blissfully under anesthesia? Join me as we peel back the surgical curtain and expose the secrets.

1. Mistakes Are Probably More Common Than You Would Think

Mistakes happen...surgeons are humans after all. And, despite the fact that they are incredibly talented and well-trained mistakes are inevitable. And, most of the time these are little things and not serious mistakes so that the person is rarely affected by it anyway.Image Source/ Hospital NewsIn essence, the acknowledgment of human fallibility in the medical field is not a cause for undue concern, but rather an integral part of the ongoing efforts to improve patient care. Surgeons, driven by a commitment to their profession and their patients, strive to minimize the occurrence of mistakes.Original content sourced from

2. They Won't Tell You About The Mistake

If a mistake did happen, something not so serious where the patient was fine and they would never realise - that the surgeon generally will not inform them of it. If it is a mistake that they managed to overcome then many surgeons don't feel that it is necessary.Image Source/ DoctorlIBUltimately, the decision to disclose a mistake to a patient often hinges on a delicate balance between the potential impact on the patient's well-being and the ethical imperative of transparency. Healthcare providers are increasingly encouraged to foster open communication with patients.

3. They Sometimes Get Abuse From Patients

Sometimes patients will give verbal abuse to their surgeon - or even sometimes physical. Whether this is because the patient is in a rage, is delirious or having an alcoholic rage. It is not a common occurrence as the surgeon doesn't usually interact with the patient.Image Source/ VOXSurgeons, like all healthcare professionals, are committed to providing the best possible care for their patients. Instances of abuse can be emotionally challenging for surgeons, who may be grappling with the dual responsibility of ensuring patient well-being while maintaining their own professional composure.

4. About 25 Percent Of Operations May Be Unnecessary

This depends on the hospital, the country and the rules regarding surgery. But, it is thought that there are a lot of unnecessary surgeries. This is because hospitals want to generate more money. And, surgery is something that they get a lot of money for.Image Source/ WikiSo sometimes administrators encourage more surgeries than perhaps are necessary. It's important to note that not all instances of perceived unnecessary surgeries are driven solely by financial motives. Other factors, such as variations in medical opinions and patient expectations.

5. When Things Go Badly They Have Stress Levelling Methods

Of course, surgery is not always successful. And, sometimes there is nothing the surgeon can do to save somebody's life despite trying their best. Each surgeon has their own calming mechanisms. According to one surgeon, as soon as he feels things going badly he starts talking very politely as a way to calm his mind.Image Source/ HealthlineIn essence, the world of surgery is not only about technical expertise but also about the ability to navigate the emotional complexities that arise when things don't go as planned. Surgeons, with their unique coping mechanisms, exemplify the resilience required to navigate the interplay of skill.

6. The Only Way To Know What Really Went On Is To Read The Notes

Of course, when you are being operated on there is no way to know what is really going on in that surgery room. And, many people are thankful for their operation and do not want to know behind the scenes. If you do, just ask to see the surgery notes then you'll really know.Image Source/ MBBS helpThe availability of surgery notes empowers patients who wish to gain a more comprehensive understanding of their medical journey. It fosters a sense collaboration between healthcare providers and patients, reinforcing that patients are better actively participating in their own healthcare decisions.

7. They Sometimes Find Strange Things

Inside bodies sometimes there are pretty gross and unexpected things found. One doctor said, “As I was running my hand along the bowel, I came upon something and said, ‘What the heck is this?’ It felt like a condom. Then all of a sudden, it wiggled! I dropped it, shocked. The guy had worms.”Image Source/ List VerseIt's worth noting that these occurrences are relatively rare, and the majority of surgeries proceed without such unexpected revelations. Nevertheless, they serve as vivid reminders of the intricate and sometimes mysterious aspects of the human body. Medical professionals navigate these situations.

8. Lots Of Surgeons Have A Financial Conflict Of Interest

There are a lot of surgeons who face a conflict of interest between ethics and money. This is not to say they would jeopardise your health in any way. It just means that they may be more inclined to go down the surgery route rather than an alternative as it provides then with more money.Image Source/ WikipediaThe intersection of healthcare and financial considerations introduces a complex dynamic. It's important to recognize that financial conflicts of interest are inherent to the current healthcare system, and addressing them requires a collective effort from healthcare professionals, institutions, policymakers, and patients.

9. Most Surgeons Have A Complications Rate

If someone has been a surgeon for a while, the likelihood is that they will have a complications rate. This does not mean that they are not competent, it means that each case is different and sometimes complications are inevitable depending on the state of the person.Image Source/ sguIn fact, sometimes people think it is more worrying if they do not have one because they may be very new or may be hiding something. Patients, in turn, should be informed about the potential for complications and engage in open communication with their healthcare providers.

10. Surgeons Sometimes Make The Wrong Incision

The future incision is marked with a pen on the patient. And, if this pen is marked on wrongly this can lead to the wrong incision being made or an incision being made in the wrong place. This has happened before multiple times and sometimes it may be the wrong side of the body.Image Source/ BetternewsIn the aftermath of a wrong incision, healthcare providers engage in thorough root cause analysis to understand the factors contributing to the error and implement corrective actions. Moreover, technological advancements have been integrated to provide additional layers of safety.

11. Fatigue Can Interfere With Performance

Surgeons hours totally depend - sometimes they are needed a lot and they can work very unsociable and long hours. They may be in surgery for hours on end, and then wake up and have to do it all over again. Of course, fatigue affects performance even those who are a professional.Image Source/ The New Classical FM

But, it is something they learn to deal with. Moreover, advancements in technology and surgical techniques, such as robotic-assisted surgery, can offer support by minimizing physical strain and providing enhanced precision. These technological tools contribute to a comprehensive strategy.

12. Surgeons Are All About Control

Surgeons sometimes call themselves control freaks. Paul Ruggeri who is the author of Confessions of a Surgeon: The Good, the Bad, and the Complicated, said “When things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.”

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While the term "control freak" may carry a negative connotation in some contexts, in the surgical realm, it often denotes a commitment to excellence and a determination to ensure the best possible outcomes for patients. The pursuit of control is not just about managing the technical aspects of surgery.

13. It’s Better To Have Surgery Early In The Week

Lots of doctors and surgeons go away for the weekend, so it means that if you have your surgery at the end of the week, the same surgeon who operated on you may not be available if you face complications. Of course, picking your surgery date is not usually an option however. Image Source/ Hospital NewsWhile the availability of the surgical team is a factor to consider, patients should be reassured that healthcare institutions are equipped to handle unexpected events and complications, regardless of the day of the week. Additionally, open communication with the healthcare team can help patients understand.

14. Some Surgeons Make A LOT Of Money From Device Manufacturers

Sometimes doctors make up to millions from devices from manufacturers. Sometimes the same doctors have actually performed a record number of implants for that company. Of course, this can then be an incentive to use those devices from that manufacturer which may not always be the best option.

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Healthcare institutions and professional organizations have developed guidelines and policies to address these concerns. Many advocate for disclosure of financial relationships between healthcare providers and industry, allowing patients to be aware of potential conflicts of interest.

15. Death Really Affects Them

Some people are under the perception that surgeons get so used to dealing with death that it no longer affects them or they are able to shrug it off. This is not the case. Surgeons who experience death with their surgery are very much affected and feel loss for their family who are waiting for them.Image Source/ facs.orgPeer support and open communication within the medical community foster an environment where surgeons can share their experiences, seek guidance, and find solace in the shared understanding of the complexities of their profession. The idea that surgeons become emotionally immune to the effects of death is a misconception.

16. Some Surgeons Won’t Mention Operations They Don’t Know How To Perform

This means that if you need surgery, the surgeon might suggest a surgery which, they can personally complete. Yet, there potentially may be another way to do it which would be better, however, if they do not know how to perform it personally then they will not suggest it as an option.

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Healthcare systems also play a role in fostering a culture that values continuous learning and collaboration. Interdisciplinary teams, where specialists from different fields collaborate on complex cases, can contribute to a more comprehensive approach to patient care.

17. They Can Switch States And Get A New License

So in the U.S, a surgeon may receive a penalty for example a D.U.I but if they switch states then they could get a license there and potentially be performing a surgery a day after. Sometimes the background check is not always completed due to it taking time and 10 dollars per check.Image Source/ njrcentreConcerns about such loopholes in the system have prompted discussions within the medical community and regulatory bodies. Efforts are being made to enhance collaboration between state medical boards and improve the efficiency of background checks.

18. Don’t Always Take Your Primary Care Doctor’s First Recommendation

Even when your primary care doctor gives a recommendation doesn't always mean it may be the best choice for you. Referrals may possibly be motivated for different reasons such as doctors working within the same multi-specialty group. A second opinion is always good.

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Patients are encouraged to actively engage in their healthcare decision-making process and advocate for their well-being. If your primary care doctor recommends a particular course of action, don't hesitate to ask questions, seek clarification, and express any concerns you may have.

19. Sometimes They Don't Inform You About Side Effects

Sometimes you will be recommended a surgery and the surgeon will carry it out but they often do not inform the patient of potential side effects. It's a very good idea if you are considering surgery to ask about any side effects that may happen as a result.Image Source/ wikiOr if the surgery may not be totally necessary and there are other options. Additionally, patients have the right to seek a second opinion before deciding to undergo surgery. Consulting with another healthcare professional can offer an alternative perspective and provide additional information.

20. Go To Your Pre-Op Appointment With A Family Member

Many people suggest that you should attend your pre-op appointment with a family member if possible. The reason behind their thinking is that you may receive better care and treat you as someone with loved ones rather than someone to merely operate on.Image Source/ zimmerbionetMedical discussions during the pre-op appointment may involve complex information. Having a family member present can help ensure that all important details are understood and remembered. They can take notes, ask clarifying questions, and assist in recalling information later.

21. The Most Stressful Thing For A Surgeon Is A Non-Compliant Patient

Not only does a surgeon get stressed for potential complications during surgery but another thing that weighs on their mind is when they have a patient who does not comply. This is when a surgeon has recommended a certain treatment in their best interest.Image Source/ imdbOr perhaps suggested a method of after-care after the operation - and the patient ignores them. To address these challenges, effective communication and patient education become paramount. Surgeons may invest additional time in explaining the rationale behind recommended treatments.

22. Obesity Makes Things More Difficult For The Surgeon

It is not something that a surgeon will openly discuss, the fact that it is harder to operate on patients who are largely overweight or obese. This is for a variety of reasons including the fact that the incisions have to go deeper through more layers of fat etc.Image Source/ topdoctors.comObesity is associated with an increased risk of certain complications, such as wound healing issues, infections, and respiratory challenges during and after surgery. Surgeons must carefully manage these risks to ensure the best possible outcomes for the patient.

23. They Love receiving Thank You Letters

This is often something that people don't bother to do because they are under the impression that the surgeon will have so many patients that they perhaps don't have time for letters. Wrong. Surgeons love receiving grateful letters which make them feel appreciated.Image Source/ PinterestMedicine, including surgery, is a challenging field with its share of complexities and demanding situations. Positive feedback in the form of thank-you letters can serve as a motivational factor, encouraging surgeons to continue providing high-quality care and striving for excellence.

24. They Truly Care

This point is along similar lines. Some people think that operations, saving lives, and performing complex procedures is just something they take as part of the job. But they do truly care about each individual case and patient and their well-being and health.Image Source/ en.emergency.netMany surgeons engage in ongoing relationships with their patients, providing continuity of care beyond the operating room. Follow-up appointments, monitoring progress, and addressing post-operative concerns are integral components of their commitment to patient care.

25. Some Surgeons Have Been Found Taking Pictures

Now, this is not common. Most surgeons have integrity and respect for their patient but there are cases where some surgeons have been found taking pictures of their patient while they are unconscious on the operating table, merely for their own amusement.Image Source/ surgeons.orgThe discovery of such behavior can have profound effects on the trust patients place in the medical profession as a whole. It may lead to feelings of betrayal and reluctance to seek medical care in the future. Surgeons found engaging in unethical behavior may face severe professional consequences.

26. Question If You Need A Stent

Having a stent is an amazing thing which, can save lives. But that being said, it is sometimes not the only option. There are some instances where medication would also work. Because having a stent is having a foreign substance permanently implanted in your body which comes with some risks too.

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While stents can be highly effective in restoring blood flow to the heart, they are not without risks. Complications such as blood clots, stent thrombosis, and restenosis (re-narrowing of the artery) can occur. Patients should be informed about these potential risks and inquire about strategies.

27. They Are Not Always Board Certified In Their Speciality

Maybe just ask this question once you have been assigned a surgeon to double check that they are board certified in the speciality. Because sometimes they are not. Again, this depends on the country and place as to the rules and how they are applied.Image Source/ drlepagePatients can openly discuss their surgeon's board certification status during pre-operative consultations or when meeting with their healthcare team. It is a reasonable and important question to ask to ensure that the surgeon's qualifications align with the medical needs of the patient.

28. People Lie To Them

For some reason, people lie to their surgeons even though it is going to become crystal clear as soon as they operate. So, it's much better that they know the truth before operating. For example, some people are embarrassed to say they have had plastic surgery before.Image Source/ today.comFor example lip suction. But, it means the surgeon has to go about things differently so they prefer to know the truth. Patients should feel encouraged to express their concerns and ask questions about their surgical procedures. Surgeons can provide valuable insights and clarify misconceptions.

29. They're Scared Of Being Sued

Surgeons are scared of being sued. Being in such a high-pressure job with so much responsibility means that a lot can go wrong. And, it means that complaints are serious. So, surgeons are fully aware that someone may try and sue them for a lot of money making them hyper-aware and scared of the risks.Image Source/ aamc.comSurgeons are acutely aware of the public perception of the medical profession. Negative outcomes or media coverage of medical incidents can contribute to an environment where patients are more inclined to pursue legal action, and surgeons may be apprehensive about the impact on their reputation.

30. Instruments Have Been Left Inside The Body

Okay, this is not a frequent thing. But there have been claims where surgeons are performing an operation and they misplace an instrument during the stressful situation which is operating. And...they have actually ended up inside the body some have claimed.Image Source/ CTVDespite the rare occurrence of retained surgical items, healthcare professionals acknowledge the gravity of such incidents and strive to minimize the risk through enhanced communication, procedural safeguards, and ongoing education within the surgical community.

31. Hospital Employees Know Best Who Is A Good Doctor And Who Isn’t

When you are having surgery, you might automatically want the one who has the most impressive degrees or the biggest titles. But it’s hospital employees who know the ins and outs of who’s truly a good doctor or not, no matter what a degree says, so it just goes to show...Image Source / Modern HealthcareThe ability to empathize with patients and demonstrate genuine compassion is a hallmark of a good doctor. Hospital employees can assess how doctors connect with patients on an emotional level, addressing not only their medical needs but also their emotional and psychological well-being.

32. Surgeons May Say You Need Surgery Right Away – Even If You Don’t

Surgeons will usually push for surgery to be performed straight away, even if an operation isn’t urgent. That’s because they worry about the risk of letting you leave and then something going wrong, and questions then raised about why surgery wasn’t immediately performed.Image Source / Encyclopedia BritannicaSurgeons often engage in shared decision-making with patients, considering their preferences and values. Some patients may prefer immediate intervention for peace of mind or personal reasons, and surgeons may align their recommendations with patient preferences.

33. As Well As Asking What The Problem Is, You Should Problem Question How Fixing It Will Actually Help

When you have questions for your surgeon, the most obvious one will be asking what’s wrong. But you should also question how surgery and fixing the problem will actually help. This is because, oftentimes, there might be a problem but fixing it might not actually be needed.Image Source / WikipediaEvery surgical procedure carries inherent risks and potential benefits. Questioning the necessity of surgery enables patients to weigh the potential benefits against the associated risks. This information is crucial for making an informed decision that aligns with the patient's priorities and values.

34. Teaching Hospitals Are The Best For Serious Conditions

When you think of a teaching hospital, you might think you don’t want to risk being attended to by people still learning, but teaching hospitals are actually the best for treatment. That’s because you’ll get the latest treatment methods, as well as resident doctors being on hand 24/7 and surgeons always on call.Image Source / WikipediaTeaching hospitals are often affiliated with medical schools and research institutions. This environment fosters a culture of continuous learning and research. Patients may have the opportunity to participate in clinical trials or benefit from treatment strategies developed through ongoing research initiatives.

35. Giving Yourself Time To Heal Isn’t Something To Just Dismiss

We’re all guilty of it: ‘Oh I’ve been resting long enough, I’m fine, I’ll go back to work early, it doesn't matter what my doctor said because I'm feeling okay’. But one of the biggest mistakes during surgery recovery is not giving yourself the correct amount of time to heal. This can lead to complications.Image Source / Take Your SuccessMany surgeries require rehabilitation or physical therapy to restore strength, flexibility, and function. Following the recommended recovery timeline allows individuals to engage in rehabilitation activities at the appropriate stages, facilitating a more effective recovery.

36. Pre-Op And Post-Op Details Are Just As Important

Surgeons get faced with question after question about the actual surgery itself and what’s going to happen, but the same amount of detail isn’t usually asked about the pre-op and post-op. But these are just as important, and should be asked about, always.Image Source / BetterteamPre-operative discussions often involve obtaining informed consent. Patients should have a clear understanding of the surgical procedure, potential risks, and alternative options. Asking questions about the consent process ensures that patients make informed decisions about their treatment.

37. They Can Recommend Great Products To Reduce Scarring

Surgeons might recommend products like ScarEase, Scarguard and Mederma for reducing the appearance of scarring after surgery. You can apply daily as soon as the wound is healed, and you can also use sunscreen with zinc oxide to protect the wound for at least six months after surgery.Image Source / WikipediaSurgeons consider the individual characteristics of each patient and the nature of the surgery when making recommendations for scar management. Patient compliance and adherence to post-operative care instructions play a significant role in achieving optimal results.

38. Doctors Are Aware Of Other Doctors They Deem ‘Too Dangerous’ To Be Working

According to one doctor source, they always ask during a national conference of doctors if anyone knows of another doctor who they believe shouldn’t be practising medicine because they’re too dangerous – and every hand goes up. That's right - every single one.Image Source / The GuardianIn many jurisdictions, healthcare professionals have legal and ethical obligations to report impaired or incompetent colleagues. These obligations are in place to safeguard patients and maintain the integrity of the medical profession. Doctors face the challenging task of balancing professionalism and advocacy for patient safety.

39. Surgeons Might Go To Operate On The Body The Wrong Way Round

One surgeon reports that they went to operate on the back of a patient’s knee instead of the front before they realised their mistake! It just shows the easy mistakes that can be made, even when wide awake. Though even an everyday person would know what the back of a knee looks like...Image Source / Royal Papworth Hospital NHS Foundation Trustatients are often positioned in a way that provides optimal access for the planned surgery. However, the specific positioning, coupled with the orientation of the surgical site, can create challenges. Surgeons need to maintain a clear understanding of the planned procedure.

40. Some Surgeons May Pray For Their Patients During Their Own Personal Time

A lot of patients might think that their doctors don’t care. But some surgeons not only care, but they pray for their patients, too. One surgeon even noted that his whole family pray for his patients during dinner if it’s a night before surgery, believing this will give them the best possible chance.Image Source / Church Of Jesus ChristThe practice of praying for patients can vary among surgeons based on their cultural and religious backgrounds. For some, prayer is an integral part of their belief system and a means of seeking support for their patients. Engaging in prayer may serve as a coping mechanism for surgeons, too.

41. Surgeons Can Often Get Depressed

A lot of the time doctors can be dismissed as neutral, professional or maybe even lacking emotion when they have a job to do. But when patients die in the operating theaters, surgeons can be plagued with thoughts about their death, their family and succumb to depression, too.Image Source / Greater Good Science CenterThe pursuit of perfection and adherence to high professional standards can be both a strength and a challenge for surgeons. While these traits contribute to excellence in their work, they may also set the stage for self-critical thoughts and a sense of failure when outcomes do not meet their expectations.

42. You Might Get The More Expensive Medical Device Just Because Your Surgeon Has A Financial Relationship With The Supplier

You’d like to think that with medical bills, you’ll always get recommended the most suitable option, and hopefully the cheapest. But nope. If your surgeon has financial incentive with the vendor of a particular device, even if it’s not the most suitable or it’s the most expensive, then they’ll probably recommend that one.Image Source / The Royal MarsdenTransparency in healthcare is crucial. Patients have the right to be informed about any financial relationships their surgeon may have with medical device suppliers. Full disclosure allows patients to make informed decisions and raises awareness about potential conflicts of interest.

43. Too Many Questions = Pain In The Ar*e

You have a right to ask questions, but apparently there’s a limit before a surgeon can be 100% done with speaking with you. This counts for relatives of the patient, too. If their constantly bombarding the doctor with questions every time they enter a room, they might start avoiding going into the room.Image Source / MSF BlogsEstablishing effective communication strategies can help address questions without causing inconvenience. Surgeons may encourage patients and their families to compile a list of questions, prioritize concerns, or designate specific times for more in-depth discussions.

44. Every Surgery Can Carry The Risk Of A Blood Clot

Pretty much every surgery, no matter what it is, carries the risk of a blood clot forming as a result. The key sign to look for is pain, swelling or a red appearance in your calf after you’ve had surgery – you should then called your doctor straight away.Image Source / NHSPatients are educated about the signs and symptoms of DVT, and it's crucial to be vigilant in recognizing potential indications. Pain, swelling, redness, and warmth in the calf or thigh are common symptoms that may suggest the presence of a blood clot.

45. You Don’t Have To Make An Immediate Decision About Prostate Cancer Surgery

It’s understandable if you panic and think the sooner the better when it comes to surgery, but for prostate cancer, there’s actually no immediate rush. It can be slow-growing, so you have time to think about it before you make the surgery decision.Image Source / The Pharmaceutical JournalProstate cancer treatment decisions are often made through a process of shared decision-making between the patient and the healthcare team. This involves discussing the risks, benefits, and potential side effects of each treatment option to align with the patient's preferences and values.

46. A Monotone Voice From A Surgeon May Mean Trouble In The Operating Room

If a surgeon suddenly has a lifeless voice with monotone P’s and Q’s, it can be an indication to the other staff in the room that something has gone wrong. The monotone mentality can be a tool to try and keep calm. But of course if everyone then realises being monotone means something’s wrong, maybe they’ll panic anyway!Image Source / Incision CareThe monotone mentality may be a deliberate strategy to maintain focus and control during critical moments of a surgery. Surgeons are trained to stay composed and make decisions in the best interest of the patient, and adopting a monotone voice can be part of that disciplined approach.

47. Surgeons Might Actually Fall Asleep – In The Middle Of A Procedure

It’s no secret that doctors and surgeons are very tired working long hours. But one surgical intern admitted they actually nodded off for a moment in the middle of stitching up a leg wound. Yikes. It's understandable if you're also stood very still for a long time.Image Source / DeviantArtAddressing workload, scheduling, and support systems can contribute to a healthier work environment for medical professionals. While the admission of falling asleep during a procedure may be concerning, it underscores the importance of prioritizing healthcare professional well-being.

48. They Like To Hear What You Have To Say Under The Influence Of Anesthesia

As if surgery wasn’t mortifying enough, you then have to worry about babbling your innermost secrets to a room full of medical staff who are all to eager to hear what you have to say. Of course, most of it will be nonsense, but that doesn’t make it any less entertaining.Image Source / WikipediaIn summary, while humorous moments may arise during surgery, medical professionals prioritize patient well-being, comfort, and confidentiality, maintaining a balance between professionalism and understanding the lighter side of the surgical journey.

49. Residents Learning How To Operate Might Not Always Have An Attending Physician Next To Them

It’s somewhat of a comfort to think that those doctors who are still learning do have an attending physician there to make sure they’re doing everything right. But ‘present’ doesn’t always mean right next to them. They might just be in the vicinity, checking in every hour.Image Source / East and North Hertfordshire NHS TrustResidents often engage in simulation training, which allows them to practice and refine their skills in a controlled environment. The process of residents learning how to operate involves a carefully crafted balance between independence and supervision.

50. You Or Your Family Could Donate Blood For Your Own Surgery – And It’s Encouraged

For elective surgery, you might want to see if a family member wouldn’t mind donating blood. You can talk to your doctor about this option – or about donating blood yourself – because blood stored in banks for patients can often be rejected or reacted to negatively by your body.Image Source / LGW – Legion of Good WillThe practice of donating blood for one's own surgery is a proactive approach to enhance the safety and success of elective procedures. Open communication with healthcare providers allows for personalized preoperative planning that addresses the specific needs and concerns of each patient.