Health · Language

“Routine Operations”

In a recent TV news item about the junior doctors’ strike the presenter spoke about operations being cancelled. The presenter said, “Routine operations, such as hip replacements and knee replacements” were being cancelled. My immediate thought was, “Since when has a hip replacement been routine?” but maybe I’m just not familiar enough with medical terminology. Maybe “routine” in this case simply means “non-emergency”. If so I can’t be the only person who thinks that “routine” suggests something different. To me it suggests that the procedure is simple or straightforward. Is “routine surgery” the same as “elective surgery”, in that you choose when to have it done? Next time I talk to a doctor I’ll have to clear this one up, but I have no immediate plans to see a doctor either socially or professionally.

For over ten years I have been inclined to say, “There’s no such thing as a routine operation” after hearing of the death of a friend’s father. He died because of a post-operative infection: the “routine operation” itself was a success but that wasn’t much consolation. If he hadn’t had the surgery he wouldn’t have died of the infection. I avoid saying, “There’s no such thing as a routine operation” when someone I know is going into hospital but the thought is always there, and no doubt it would be on my mind if I were recommended some “routine procedure”. So far I haven’t needed any. I have managed to get past 50 without ever spending a night in a hospital bed. The only general anaesthetic I’ve had was at the age of 7 or 8, to have some of my baby teeth removed, and that only lasted about 15 minutes. It was common practice back then, to make room for adult teeth, but doesn’t seem to be so widespread these days. Instead, removal of rotten teeth is currently the biggest cause of childhood hospitalization, running at around 25,000 cases per year.

In general I aim for accurate use of language. I know that “enormity” simply means “size” and that people use it to suggest something big (as in “the enormity of Leicester City’s achievement in winning the Premier League”) because that’s what it sounds like. Similarly, people use the word “decimate” to suggest something that has been completely destroyed. Its literal meaning is that 1 in 10 of a group has been affected. The accurate meaning of “Native American populations were decimated by diseases introduced by European colonists” is that 1 in 10 of them died. In fact it was more like 19 out of 20 – an estimated 19 million died, from a population of 20 million – but “decimated” sounds much worse than just 1 in 10. And (sorry for going on about this) “bog standard” sounds like something that’s not very good although its derivation appears to be from the acronym BOG (British or German), which meant something of the highest quality. If you wanted some replacement parts or new machinery for your factory you’d want “British or German (BOG) standard” because that was the best.

I understand that we use words because of how they sound, not because of what they mean, and have never corrected anyone on an inaccurate use of enormity or decimate (but have had many discussions about the derivation of “bog standard”). Perhaps someone needs to teach me that “routine operation” isn’t what it sounds like: it could still be complex and dangerous.

Back when we were taking ante-natal classes, nearly 12 years ago now, we were given very useful acronym-based advice about how to approach non-emergency medical intervention (such as epidurals for a first-time mother). The acronym was BRAN. Ask yourself, and the medical team, what are the Benefits, what are the Risks, what are the Alternatives, and what happens if I do Nothing? If I am ever recommended a “routine operation” I hope that this acronym comes to mind in making my decision: if the benefits are not life-changing, if there is a tiny risk of something very bad happening, and if there is no alternative (non-surgical) course of action I’ll probably do nothing.

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