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Understanding Blood and Blood Components

Bloodless Chart

Learn more about blood and 'minor blood fractions' with this helpful interactive chart.

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Bloodless Medicine

Is a Cooperative Surgeon Enough?

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For patients such as Jehovah's Witnesses who do not accept blood transfusions, a first concern when scheduling surgery are questions such as, 'Will the doctor cooperate with my wishes?' 'Will he respect my beliefs?' At the Center for Bloodless Medicine at Allegheny General Hospital we are frequently asked these questions by prospective patients. There are however other questions that a prospective patient might do better to consider.

To a Doctor, What Does It Mean to "Cooperate With Your Wishes" for Bloodless Surgery?

At its most basic, the wish of the Bloodless patient is to not be transfused. So cooperating with him could be defined as agreeing to not transfuse him. In nearly every situation, a doctor really has no choice but to abide by his patient's wishes. So a doctor who agrees to cooperate with a patient's wishes may just be affirming his recognition of patient self-determination and his own legal and ethical responsibilities.

To a Doctor, What Does It Mean to "Respect Your Wishes" for Bloodless Surgery?

Patients who refuse transfusions on religious grounds want a positive outcome from their medical procedure just like any other patient. Because of religious convictions however they will not accept transfusions even if this decision puts them at greater risk for complications or even death. So a doctor who respects a religious determination to refuse transfusions has to be prepared to allow his patient to suffer harm or even die rather than be transfused. This is how some physicians would define respecting the patient's wishes.

What Does the Bloodless Patient Really Want?

The patient who inquires about a physician being 'cooperative' is likely asking for more than for his doctor to agree to uphold the law or to potentially allow him to die rather than transfuse him. Therefore some better questions might include:

  • How often do you typically transfuse patients for this procedure?
  • Are there adjustments that you can make to how you perform this procedure so as to decrease the blood loss and therefore the chances of transfusion being indicated for me?
  • Do you clearly understand what products and procedures I will and will not accept in view of my refusal of transfusions?
  • Is there anything that I can do before surgery so as to improve the chances for a successful procedure without transfusions?

The answers to these questions may help you to evaluate how comfortable you feel with the surgeon and his plan for you. But there is still a more fundamental question.

Is a Cooperative Surgeon Enough?

Your care in a hospital will involve many persons other than your surgeon. These persons will comprise your medical team. This can easily include dozens of physicians as well as nurses, technicians and Operating Room personnel. The strength of your team will be dependant upon the level of each individual's commitment to your care. So in terms of seeking out the best of care for the Bloodless patient, you will want to know if there is a team that is both cooperative and capable. Who is on the team?

The Cooperative Team

  • Anesthesiology. This group needs to know and understand your wishes. They are involved in the administering of blood and blood products as well as the operation of equipment which may be used to salvage blood.
  • Every other physician in your surgeon's department. They may see you in the post-operative period as they monitor your recovery. These other physicians may cover for your surgeon and make decisions in your care.
  • Medical Services. Aside from the surgical service, a medical service such as Internal Medicine, Cardiology or Nephrology may look after aspects of your recovery. It is not at all unusual for multiple teams to be involved in your post-operative care. Any of them could be involved in decisions which would effect your desire to be treated without transfusions. This is important as transfusions in surgical patients often happen in the days following surgery.
  • Residency Staff. In a teaching hospital you will be cared for by physicians in training called residents. These work under the supervision of attending staff. Often these are the first physicians that you will see each day. These doctors write orders for transfusions, medicines and treatments.
  • Nursing Staff. Nurses monitor your vital signs, draw blood for phlebotomy and put into practice the orders of your physicians.

The above is obviously only a partial list of all the persons who may directly impact your care. While you may choose your surgeon, the rest of the team comes together according your needs and without your ability to choose each individual. Any one of these individuals can turn an otherwise positive experience into a negative one. How can you maximize the cooperativeness of each member of your team?

A Center for Bloodless Medicine and Surgery

Recognizing the need for a multi-disciplinary team approach to Bloodless Medicine and Surgery, some hospitals have organized Centers for Bloodless Medicine and Surgery. Instead of just individual physicians working with patients, a coordinated approach is established. While the experience levels of these centers can vary, these Centers offer the following benefits:

  • A Patient Coordinator. This hospital employee's job includes making sure that your wishes are clearly understood by all members of the medical staff. They will likely meet with you early in your hospital stay so as to spell out exactly what you desire. They are then a resource to the staff both in understanding your wishes and in coordinating with physicians and services in the hospital so as to meet your needs.

    Coordinators are available to the rest of the medical staff on a continuous basis and serve as a valuable resource to the medical team. The Bloodless Medicine Coordinator is your personal advocate for receiving Bloodless care. These coordinators have the connections and experience to help you find suitable physicians to meet your needs.

  • Physicians Experienced in Bloodless Medicine and Surgery. The primary group of patients who categorically refuse transfusions are Jehovah's Witnesses. This group numbers less than 1 % of the general population. As such, statistically speaking the average physician not associated with a Center for Bloodless Medicine may go many months or even years without treating one of these patients.

    Since many patients who are Jehovah's Witnesses choose to have their care at a Center for Bloodless Medicine and Surgery, these Centers in turn are much more experienced in meeting their needs. This gives all of the staff, not just a few individually 'cooperative' surgeons, greater experience which can be applied in your care.

  • A Culture of Bloodless Medicine. Over time a Center for Bloodless Medicine and Surgery will affect the culture of an institution. Patients who refuse transfusions tend to be viewed by some in medicine as 'problems'. Over time and with a coordinated approach these patients viewed by some as 'problems' are instead viewed more appropriately as challenges.

    As the hospital meets these challenges, it may begin to take pride in their ability to provide higher level of care for patients who cannot be transfused. This creates a welcoming atmosphere for the patient seeking care without transfusions. Appreciative patients reinforce this cycle. Patients in a mature Center for Bloodless Medicine and Surgery often note that the way their needs are met surpasses what hospitals without a Center are able to accomplish.

In Conclusion

Many years ago patients such as Jehovah's Witnesses had a difficult time just finding a doctor who was willing to care for them in view of their refusal of transfusions. Times have changed. Accordingly patient expectations can change too. Simply finding a doctor who agrees to respect you or cooperate with you is no longer enough. You do well to ensure that your entire medical team will meet your needs for Bloodless Medicine and Surgery.

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