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Wednesday, January 30, 2008 9:00 AM

Newscast: Lead Story - What to Ask Before You Undergo Elective Surgery

(opening music)

Rand: This is Healthcare 411 for the week of January 30, 2008.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Debra: I’m Debra James.

Rand: And I’m Rand Gardner.

Debra: Coming up:

Rand: Shingles infections in America reach nearly a million.

Debra: A new AHRQ review compares rheumatoid arthritis medications.

Rand: And we’ll tell you what you need to ask your doctor before your next elective surgery.

Debra: More after this message from AHRQ.


[Begin PSA: Questions are the Answer]

Narrator: Medical mistakes claim tens of thousands of lives every year. The health care community is working on it, but you can help. When you communicate with your doctor, when you ask more questions, you reduce your risk of suffering a medical mistake. Doctors cant answer if you don’t ask. Help reduce your risk. Questions are the answer. Learn the 10 questions you must ask. Visit www.ahrq.gov. This message brought to you by the U.S. Department of Health and Human Services, The Agency for Healthcare Research and Quality, and the Ad Council.

[End PSA]


Rand: Now the numbers.


Rand: Nearly a million Americans are being treated for shingles infections each year at a cost of about $566 million, according to the latest AHRQ research. People with shingles experience burning or shooting pain, tingling or itching and possible blistering. Medical treatments include antiviral drugs and pain medications. AHRQ research found Americans age 65 and older are seven times more likely to get shingles. The shingles infection is caused by a virus the same virus as chicken pox but shingles itself is not contagious. However, if people with shingles have blisters, they can spread the virus.

Debra: About two million people in the U.S. have rheumatoid arthritis, a long-term illness that causes painful joint and tissue swelling. While the cause of this disease is unknown, researchers have long-studied treatments that typically begin with medications. But which drugs work best? A new AHRQ review of published evidence found there’s actually little difference between individual rheumatoid arthritis medications. In many cases, combining them is often the best strategy. AHRQ researcher Dr. Carmen Kelly is here to explain the review. Dr. Kelly, welcome.

Dr. Kelly: Thank you.

Debra: First, can you explain what types of medications were included in the review and what were the key findings?

Dr. Kelly: We reviewed published evidence to compare the benefits and harms of three types of medications. The three were synthetic disease-modifying antirheumatic drugs, known as DMARDs, biologic DMARDs, and corticosteroids. What we found was that combining methotrexate, a synthetic DMARD, with one of the biologic DMARDs works better than using methotrexate or a biologic DMARD alone. Essentially, when it comes to battling rheumatoid arthritis, combining medications often works best.

Debra: Did your review find that the patient’s condition played a role in which medication combinations worked best for them?

Dr. Kelly: Yes we did. In fact, for patients who had early rheumatoid arthritis, we found that methotrexate works as effectively as the biologic DMARDs adalimumab and etanercept.

Debra: What about other varations between the medications?

Dr. Kelly: Well, Adalimumab and etanercept showed better short-term results as measured by X-rays of the joints. We also found that combining biologic DMARDs and methotrexate increased the risk of serious infection, including a reoccurrence of tuberculosis.

Debra: Did the review find any specific combinations that were generally worked best?

Dr. Kelly: Currently, we don’t have enough scientific evidence to conclude whether one combination of medications is better than another. Also, many questions still remain about the risks of these drugs, from relatively minor side effects to severe and possible life threatening problems. Certainly, this review has revealed new information about treating rheumatoid arthritis but it has also shed light on where more research is needed.

Debra: Dr. Kelly, thanks for joining us.

Dr. Kelly: My pleasure.

Debra: Up next, what to ask your doctor before your next elective surgery.


Rand: Every year, more than 15 million Americans have surgery. The good news is that most operations are not emergencies. They are considered elective surgery which means you have time to prepare. In this segment of Navigating the Health Care System, AHRQ Director Dr. Carolyn Clancy is here to talk about what to ask your doctor before you undergo surgery. Dr. Clancy, welcome.

Dr. Clancy: Thank you.

Rand: Dr. Clancy, why is it important to prepare for surgery?

Dr. Clancy: Surgery is a big deal no matter what kind of operation you’re having. It’s very important that you ask as many questions as possible so that you can be an informed and active participant in your own health care.

Rand: Well, what type of questions should we ask before we undergo surgery?

Dr. Clancy: Before having surgery, it’s almost impossible to have too much information. The types of questions someone should ask about a procedure before having it include: the exact name of the procedure; why it’s being recommended; what are the risk and benefits of having this done; the alternatives - what happens if I just wait and see or take medicines; what kind of doctor will be doing the procedure; how many times the surgeon or other physician has done that procedure, and what kinds of outcomes that person has had; where the procedure will be done and what kind of anesthesia will be used; what recovery will be like; and how much it will cost, and if your insurance will cover it.

Rand: Usually if we’re going to have surgery, there’s more than one doctor involved in our care. Are there different types of questions that I should ask for, say, our primary care physician versus our surgeon?

Dr. Clancy: When you’re seeing a primary care physician who recommends that you have surgery, you’re going to be wanting to discuss why you need surgery and are there any other alternatives that wouldn’t be surgery. Once the decision to have surgery has been jointly made with your primary care doctor and you are referred to a specific surgeon, you’d want to be asking the primary care physician - what’s your experience with this individual been; how do his or her patient’s do; do you have a long track record or is this someone new that you don’t know very well either? The surgeon, on the other hand, you’re going to want to know quite specifically from that individual what’s the recovery time like; what are the complications; what kind of anesthesia am I going to have; is it likely that you might change your mind when the surgery starts, you know, are there unanticipated circumstances that might arise where you’d do a slightly different procedure than that you’re telling me today, and does it matter, and so forth.

Rand: Do you recommend that people get a second opinion before they decide to actually have surgery?

Dr. Clancy: Getting a second opinion can be very helpful in terms of reassuring you that you’re making the right decision. So if you have any doubts, a second opinion is a great idea. Most doctors would welcome a second opinion, particularly if there is any debate or controversy about what is the logical next step.

Rand: Are there other sources of information available to us?

Dr. Clancy: The really good news about having surgery is, for many procedures, groups have developed specific brochures that talk about that procedure, so it’s very important to ask the doctor and/or the nursing staff where I can get more information.

Rand: Well AHRQ has developed a brochure, called "Having Surgery? What You Need to Know," it’s available online at ahrq.gov/consumer. The publication is part of a series of health care resources from AHRQ to help people be more active in making informed decisions, and more satisfied with their treatment. Dr. Clancy, thanks for joining us.

Dr. Clancy: It’s been a pleasure. Thank you.


Debra: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov.

Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Debra James, I’m Rand Gardner. Please join us for the next edition of Healthcare 411.

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