Learning When Not to Operate: From Patient Selection to Withdraw of Care

When not to operate is a difficult and highly nuanced decision which is best formulated by patient-physician shared decision-making. Creating a personal connection to facilitate an empathetic understanding of patient values can help deliver non-maleficent, goal-concordant care. Disclosure of prognosis and critical information as it relates to the patient’s goals can help prevent unnecessary and potentially harmful interventions. Review of current guidelines as well as strategies for efficient yet effective communication is vital to tailoring your discussions with patients and their families during these critical moments. Similarly, patient selection is an important consideration to discuss with patients regarding the need for delay of an operation to provide improved quality outcomes of care. These considerations are outlined as it relates to preventative measures for minimizing risks associated with elective surgery as well as proper counseling for patients to understand the risk at hand. Appropriate identification of surgical candidates, timing of surgical intervention, and communication throughout the dynamic interface of care are crucial.