Elective surgery for hemorrhoidal complaints: The decision to operate

The effective management of hemorroidal disease requires that the surgeon be cognizant of significant changes in healthcare that have occurred in the past several years. These are seen in three areas: the doctor-patient relationship, how patients access information about their health questions, and how quality in healthcare is being measured. The doctor-patient relationship has evolved from being doctor centered to patient centered. The hallmark of this new model is patient engagement in their care. Published data suggests that surgeons have not been particularly adept at this transition. A majority of patients now seek out medical information on the internet and will present with information in hand of highly variable quality. Yet, only 8% of patients believe that the online information found was unreliable. Paradoxically, only one-third of internet sites have been identified as good or excellent. The third area of change relates to how quality in healthcare will be measured. There is increasing emphasis on the “patient experience” as a quality metric. To resolve the implied tension between evidence-based medicine and patient-centered care, there needs to be a change in professional attitudes and increased emphasis on interpersonal and communication skills. Once a mutual decision to proceed with surgery has been reached, counseling regarding pre-operative preparation as well as the anticipated recovery process is appropriate and will lead to greater satisfaction with the outcome. In circumstances of acute thrombosis or strangulation with necrosis, immediate surgical intervention with resolution of pain will almost certainly be perceived by the patient as valuable.