Surgery May Hurt Elderly More then Help

One of the ancient principles of medicine is Primum non nocere, the Latin phrase that means "First, do no harm". It means that sometimes doing nothing is a better decision than doing something that might cause more harm than good. It is an ethical precept for physicians, but it becomes harder and harder to adhere to as more and more exotic tests and treatments are at our disposal. 

But just because we can do tests or surgery doesn't mean we should. Looking at the whole patient; their lifestyle, beliefs, support system and activity level, should be part of the analysis and decision.

There are so many ways and times in treating patients that doing nothing can be the best decision.  A prime example is Mr. Leon Sanit who is 97 years old. Mr. Sanit lives in Los Angeles and plays tennis every single day at 11 A.M. He was diagnosed with bladder cancer and doctors recommended surgery that had a 50% chance of extending his life. Here is a guy with an active life, playing tennis at age 97, who has wisely decided to forgo surgery and just enjoy himself.

The risks of surgery in a 97-year-old are considerable. The convalescence and recovery itself are risky and would certainly impact the good time he has left in his life. The odds of him ever being back on the tennis court are considerably lower than the chance he would live longer.  

I know of another elderly man (a friend's father) who had surgery for prostate cancer, even though he was over 80 years old and had a lower Gleason score, which means it is a slower growing form of cancer. I was upset to learn his physicians had recommended surgery. He had a bad post-op course and never really returned to his pre-op activity level. He died within a year of the surgery. Doing something, was worse than doing nothing.

One way patients can help a doctor stop and consider the recommendation for surgery or treatment is to ask, "if this were your mother/father/wife...would this be the treatment you would recommend?"  At the very least it slows the process down and makes it a more thoughtful one.


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