How to Build the Trust of Your Referring Physicians
Patients with typical gastroesophageal reflux disease (GERD) symptoms who respond well to medical therapy typically are not referred for antireflux surgery. The surgeon is far more likely to see referrals for patients with atypical GERD symptoms that have not responded to treatment with proton pump inhibitors (PPIs). Although the PPIs are far from perfect in eliminating GERD symptoms, failure to respond to PPIs is a red flag that should alert the astute clinician that GERD might not be the cause of symptoms. Excellent surgical outcomes will go a long way in building the trust of the referring physician, and the best way to achieve those excellent outcomes is to ensure that the “refractory GERD symptoms” prompting the surgical referral are indeed due to GERD. This can be accomplished by a careful preoperative work-up, which is outlined in this chapter. In preoperative discussions with the patient, the surgeon will build trust in the referring physician by being open in presenting the risks and benefits of alternative treatment options, by realistically appraising the operation’s anticipated benefits and by clearly presenting the potential complications of fundoplication. In these discussions, the surgeon should not exaggerate the risk of GERD complications like esophageal adenocarcinoma, nor make unsubstantiated claims that fundoplication is superior to medical therapy in preventing these complications. Such tactics are often construed, appropriately or not, as attempts to frighten a patient into an operation, tactics that are not likely to instill trust in the referring physician.
KeywordsGastroesophageal reflux Reflux esophagitis Proton pump inhibitors Antireflux surgery Fundoplication Barrett’s esophagus Esophageal adenocarcinoma Multichannel intraluminal impedance monitoring Esophageal pH monitoring Esophageal manometry
- 4.Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W. Long-term outcome of medical and surgical treatments for gastroesophageal reflux disease. Follow-up of a randomized controlled trial. JAMA. 2001;285:2331–8.CrossRefPubMedGoogle Scholar
- 5.Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engström C, Julkunen R, Montgomery M, Malm A, Lind T, Walan A, Nordic GERD Study Group. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol. 2009;7:1292–8.CrossRefPubMedGoogle Scholar
- 16.Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, DeVault K, Fass R, Gyawali CP, Kahrilas PJ, Lacy BE, Pandolfino JE, Patti MG, Swanstrom LL, Kurian AA, Vela MF, Vaezi M, DeMeester TR. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel. J Am Coll Surg. 2013;217:586–97.CrossRefPubMedGoogle Scholar