3. Without an anesthesiologist available, you may not receive adequate pain management: "When my doctor removed a uterine polyp without anesthesia, it felt like someone was stabbing my uterus with an ice pick," says 36-year-old Amanda Smida, of Fort Collins, Colorado. "I would gladly have gone to the hospital instead had I known the agony that would be involved."
4. Backup help may be insufficient: In the rare event of a serious medical complication requiring more emergency treatment than the office can provide, the biggest danger lies in the minutes before an ambulance arrives, says Arthur A. Levin, director of the Center for Medical Consumers, a New York–based patient advocacy group. But the staff at an unaccredited physician's office may not be trained or experienced in resuscitation care. In 2006 Kimberley Taylor, 53, went into respiratory arrest while having cosmetic surgery in her Tucson doctor's office. When paramedics arrived, they discovered that a breathing tube meant to revive her had erroneously been placed in her esophagus (leading to her stomach) rather than her windpipe. Although they moved the tube and whisked Taylor to the hospital, her brain had been deprived of oxygen for too long, and she died nine days later.
Making the Decision
Even if an office is regulated and all safety standards are in place, OBS is not for everyone—or for every procedure. If you have an underlying respiratory problem—severe asthma or chronic obstructive pulmonary disease, for instance—or sleep apnea or heart disease, you belong in a hospital, Swanson says. OBS is also not appropriate for complex or risky operations like neurosurgery.
If you do choose OBS, have a frank conversation with your doctor about the pain involved and her plan to minimize it. A 2007 Canadian review of more than 331,000 colonoscopies in Ontario, where the procedure is not regulated in office settings, found that doctors were three times less likely to complete the procedure when done at their practice. The authors hypothesize that office-based physicians may undersedate patients, resulting in too much discomfort for some to continue.
Still, patients whose doctors follow strict precautions can have a satisfying OBS experience. Until all states decide patient protection comes first, though, it's up to you to do everything you can to ensure that it's a safe one. "You should always ask your physician questions before undergoing surgery," Kulczycki says. "But when the surgery is happening in an office, it's even more crucial to make sure that you're fully informed."
Next: 6 questions you need to ask before undergoing surgery in your doctor's office
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