When most people think of "having surgery", they picture lying on an operating table. But that's actually a very small part of what surgery really involves. Surgery is a journey that begins weeks before the operation and continues weeks or months afterwards.
Understanding this helps you prepare properly, recover more smoothly, and know what to expect at each stage.
Before surgery: Preparation phase
This is where we lay the groundwork for a safe, successful operation. It includes:
1. The decision and consent discussion
We will have talked through:
- Why this operation is recommended for you specifically
- What it involves in practical terms
- The expected benefits and success rates
- The potential risks and complications
- What would happen if you chose not to have surgery
- Alternative treatment options
You should never feel rushed into signing a consent form. If you're uncertain, it's absolutely fine to ask for more time to think.
2. Pre-operative tests and assessments
Depending on the operation and your general health, you might need:
- Blood tests (to check kidney function, clotting, infection markers)
- Urine tests (especially for urological surgery)
- Heart trace (ECG) if you're over a certain age or have heart concerns
- Sometimes a chest X-ray or other scans
These aren't bureaucratic box-ticking — they help us identify any issues that might affect the surgery or anaesthetic, and fix them beforehand.
3. Medication adjustments
Certain medications need to be stopped or adjusted before surgery:
- (like warfarin, clopidogrel, rivaroxaban) — we'll give you precise instructions about when to stop
- — insulin doses usually need adjusting on the day of surgery
- — things like ginkgo, garlic supplements, or high-dose vitamin E can increase bleeding risk
Important:
Never stop or change medications without discussing it with me or your GP first. Some drugs are absolutely critical and must be continued; others might need careful timing around the operation.
4. Practical arrangements
Before your operation, you'll need to arrange:
- Time off work (the amount depends on the procedure and your job)
- Someone to collect you after day surgery or visit you if you're staying in hospital
- Help at home for the first few days if you're having a more significant operation
- Childcare or pet care if needed
- Transport to and from hospital
5. Fasting instructions
You will be given specific instructions about when to stop eating and drinking before surgery. This is absolutely critical for safety under anaesthetic. Typical rules are:
- No food for 6 hours before your scheduled time
- Clear fluids (water, black tea/coffee without milk) allowed up to 2 hours before
- No chewing gum, sweets, or mints during the fasting period
The day of surgery: What actually happens
Understanding the sequence of events can reduce anxiety significantly.
Arrival and admission
You'll check in at the hospital or clinic, usually 1-2 hours before your scheduled operation time. You'll:
- Complete final paperwork and identity checks
- Change into a hospital gown
- Have your blood pressure, heart rate and temperature checked
- Be asked about allergies and when you last ate or drank
Meeting the anaesthetist
The anaesthetist will review your medical history, explain the anaesthetic plan, and answer your questions. They'll discuss:
- What type of anaesthetic you'll have (general, spinal, local, or sedation)
- How you'll feel as you go to sleep and wake up
- Pain relief plans for after the operation
- Any specific concerns related to your health
In the anaesthetic room
Before entering the operating theatre, you'll go to an anaesthetic room where:
- A small needle (cannula) is inserted into a vein in your hand or arm
- Monitoring equipment is attached (blood pressure cuff, ECG stickers, oxygen probe on your finger)
- The anaesthetic is administered through the cannula
- You'll fall asleep within seconds — most people don't remember anything beyond this point
During the operation
You will be completely asleep (or completely numb if you've had a spinal anaesthetic and chosen to stay awake). The surgical team monitors you continuously. I perform the operation according to the plan we discussed, adapting as needed based on what I find.
Modern surgery is done with the utmost care for preserving normal structures, minimising bleeding, and ensuring the best cosmetic result possible.
Recovery room (immediate post-operative care)
After the operation finishes, you're taken to a recovery area where specialist nurses monitor you closely as the anaesthetic wears off. You'll:
- Gradually wake up (this can take 15-60 minutes depending on the anaesthetic)
- Be given pain relief if needed
- Have your blood pressure, heart rate, and oxygen levels monitored
- Stay until you're stable and comfortable enough to move to the ward or day surgery unit
After surgery: Recovery and healing
This is often the longest and most important phase. Recovery isn't linear — you might feel better one day and worse the next. That's normal.
The first 24-48 hours
Immediately after surgery, you can expect:
- — usually manageable with the painkillers we prescribe; should be improving day by day
- — the anaesthetic can leave you feeling tired and "fuzzy" for a day or two
- — some people feel sick after anaesthetic; anti-sickness medication helps
- — depending on the surgery, you might need to limit certain activities
When to seek urgent help after surgery:
- Severe pain that doesn't improve with prescribed painkillers
- Heavy bleeding from the surgical site
- Signs of infection (increasing redness, heat, swelling, pus, fever over 38°C)
- Inability to pass urine (especially after prostate or bladder surgery)
- Chest pain or difficulty breathing
- Swelling, redness or pain in your calf (possible blood clot)
If any of these occur, contact me immediately or go to A&E if it's out of hours.
The first 1-2 weeks
This is the early healing phase. You should:
- Rest, but not completely immobilise yourself (gentle movement aids healing)
- Keep the wound clean and dry as instructed
- Take medications as prescribed, including the full course of antibiotics if given
- Gradually increase activity as comfort allows
- Avoid heavy lifting, vigorous exercise, or sexual activity during this period
Weeks 2-6: Gradual return to normal
By this stage:
- Most pain should have settled significantly
- Wounds should be healing well (stitches may dissolve or be removed)
- You can usually return to light work and normal daily activities
- Sexual activity can typically resume after 3-4 weeks for most procedures (I'll give specific guidance)
- Full physical exercise and heavy lifting usually allowed after 4-6 weeks
Beyond 6 weeks: Long-term outcomes
The final stages of healing continue for months. Scar tissue matures, swelling fully resolves, and you see the final result of the surgery. Follow-up appointments help us monitor your progress and deal with any late complications.
Complications: What can go wrong and how we manage it
No surgery is without risk. Being honest about complications doesn't mean I expect them — it means I respect your right to make an informed decision.
Common, minor complications
These happen in a small percentage of patients and usually resolve without long-term problems:
- Bruising and swelling at the surgical site
- Minor wound infections (treated with antibiotics)
- Temporary numbness or altered sensation near the wound
- Mild bleeding or blood in urine (depending on procedure)
Rare but serious complications
These are uncommon but we discuss them because they can occur:
- Significant bleeding requiring transfusion or further surgery
- Deep infection or abscess formation
- Blood clots in the legs (DVT) or lungs (pulmonary embolism)
- Damage to nearby structures (I take every precaution to avoid this)
- Anaesthetic complications (extremely rare with modern techniques)
For each specific procedure, I will explain the particular risks relevant to that operation, including rates of complications and how we minimise them.
When things go wrong: honesty, responsibility, and duty of candour
I want to talk about something that matters deeply to me, and which I believe you have a right to understand: what happens when complications occur, and why I will always tell you about them — even when they're minor.
The regulatory framework: duty of candour
In UK medical practice, there's a legal and professional requirement called "duty of candour." It means that when something goes wrong during medical care — particularly if it causes moderate or severe harm — healthcare professionals must inform the patient (or their family) promptly, honestly, and fully. This includes apologising, explaining what happened, what will be done to put it right, and what will be done to prevent it happening again.
Medical students and junior doctors are taught about duty of candour in exams. They're asked questions like: "In which circumstances must you tell a patient that things have gone wrong?" The expected answer focuses on the regulatory threshold — the point at which disclosure becomes legally mandatory.
And that's fine, as far as it goes. Duty of candour is an important safeguard. It establishes a minimum standard of ethical behaviour and protects patients from being kept in the dark about serious complications.
But it's not why I tell you when things go wrong
For me, duty of candour isn't the reason I disclose complications — it's simply the regulatory mechanism that ensures a baseline level of honesty across the medical profession. It's the floor, not the ceiling.
The truth is this: even when something goes wrong that's minor — something that causes no lasting harm, something that's quickly fixed, something below the "threshold" where disclosure is legally required — I will still tell you about it. Immediately. Not because I have to, but because I don't know how to do it any other way.
If I nick a small blood vessel and have to spend an extra few minutes securing it during surgery, I'll mention it when we speak afterwards. If a stitch doesn't sit quite right and I have to redo it, you'll know. If something unexpected is found during the operation, even if it doesn't change the outcome, I'll explain what I saw.
Why? Because you're not a passive object being operated on. You're a person who's trusted me with your body, and that trust demands complete honesty.
What this means in practice
If a complication occurs during or after your surgery, here's what will happen:
- You will be told promptly.
- I won't wait for a convenient moment or hope you don't notice. If you're still in hospital, I'll speak to you face-to-face as soon as you're awake and lucid enough to understand. If the complication is discovered later, I'll contact you directly.
- I will explain what happened in clear language.
- Not medical jargon designed to obscure, but plain explanation of what went wrong, why it might have happened, and what it means for you.
- I will take responsibility.
- If the complication was a direct result of something I did (or failed to do), I will say so. If it was an unavoidable risk that materialised despite proper technique, I'll explain that too. You deserve to know the difference.
- I will outline what we're going to do about it.
- Most complications can be managed. I'll explain the plan for fixing the problem, the likely timeline for recovery, and what additional treatment (if any) might be needed.
- I will apologise when appropriate.
- If you've suffered harm, distress, or inconvenience because something went wrong during your care, you deserve an apology. Saying sorry isn't an admission of negligence — it's basic human decency.
- You can ask questions, and I will answer them.
- You might be shocked, upset, or angry. Those are all reasonable responses. Ask whatever you need to ask, and I'll answer honestly, even if the answers are uncomfortable for me.
The difference between complications and errors
It's important to understand that most complications are not errors. They're recognised risks of surgery that can occur even with perfect technique.
- is when a known risk of the procedure occurs. For example, post-operative bleeding, infection, or delayed wound healing. These are possibilities we discuss beforehand.
- is when something goes wrong because of a mistake — wrong site surgery, using the wrong medication, operating on the wrong patient, leaving an instrument inside, or technical errors in performing the procedure.
Errors are rare, but they can happen — surgeons are human. When they do occur, the duty of candour is even more critical, because the patient deserves to know that this wasn't an unavoidable risk but a preventable mistake.
But here's what matters: whether the problem is a complication or an error, you will be told. I don't differentiate between "things I legally have to disclose" and "things I can get away with not mentioning." If it happened during your care, it's your right to know.
What if you're not happy with how a complication was managed?
You have every right to question decisions, ask for a second opinion, or raise concerns if you feel a complication wasn't handled properly. This doesn't damage our relationship — it's part of being an active participant in your own care.
If you want to make a formal complaint, you can do so through the hospital's complaints procedure (for NHS care) or through the clinic management (for private care). You can also contact the Care Quality Commission (CQC) or, if you believe there's been serious professional misconduct, the General Medical Council (GMC).
I hope it never comes to that, but knowing your rights and the avenues available to you is important. Good doctors aren't threatened by accountability — we welcome it.
My commitment to you:
Complications are part of surgery. They cannot be eliminated entirely, no matter how skilled the surgeon or how careful the technique. What can be controlled is how we respond when they occur.
I promise you complete honesty, timely communication, and every effort to put things right if something goes wrong. That's not because of regulatory duty — it's because it's the only way I know how to practice medicine.
The key thing to remember: surgery is a partnership. Your job is to follow instructions, report problems early, and be patient with your body as it heals. My job is to perform the operation expertly, anticipate problems, support you through recovery, and tell you the truth — always, and completely.