Wouter Leclercq

Chapter 1 12 The severity of the symptoms or possible progression of the disease will put pressure on the patient, who is expected to make choices about things he/she has never had to think about before. Because of these many options, a patient can quickly lose sight of things. The physician tries to lead the patient in the right direction, enabling him to make the right choice, by providing coordinated information and advice. Patients often don’t know who and what they can rely on; they look for security that is often not available. In these circumstances, it can be difficult to feel ‘connected’ to a physician you have known only briefly, and to trust his advice. This can lead to feelings of doubt about the selected option. These uncertainties, the multitude of options and the advice do not stop once the surgical procedure is over. 10-15 Until a few years ago it was customary for patients to remain in the hospital while recovering. These extended hospital stays provided physicians and nurses with ample time to instruct and advise patients. However, modern medicine has fully embraced the practice of Enhanced Recovery After Surgery (ERAS). Faster mobilisation and maintenance of fitness are paramount for postoperative treatment nowadays. Rarely do patients stay in the hospital longer than one week, and day care is common practise. 16-17 The downside of this clinically optimised care is a loss of time to adequately communicate all knowledge about the postoperative process to our patients. The patient arrives at home and is considered ‘self-reliant’, but is once again searching for answers: what can I do, what am I allowed to do, what can I expect? Any untoward events such as infection or pain can lead to dissatisfaction and ultimately to a loss of confidence in the physician. A medical claim or complaint may be the sum of these events. 18-25 Improved preoperative counselling may be part of the solution as patients know beforehand better what to expect. They may be well-informed before, during and after surgery and recovery. Moreover, an appropriate preoperative counselling ensures that patients possibly recognise negative events more quickly, will seek and receive help, or can consider disappointing results in a broader perspective than just themselves. These patients, regardless of a beneficial outcome, are generally more satisfied. In the end, an important parameter is the way a patient and their loved ones look back on the treatment process? Only by optimally preparing and guiding patients using modern resources are we able to provide a patient with a solid basis to rely on during the SIC process. Endless space, initially representing the vast variety of options, then becomes a blanket of support, attention and advice that the patient can fall back on in times of uncertainty. 26-30