July 6, 2016
After the bariatric clinic weighed me in at my first appointment, I was handed a patient contract by the nurse. As she was taking my vitals, I was to commit to activities I would perform FOR LIFE before I had even seen the Physician’s Assistant. Looking back, I should have asked more questions, or at the very least, waited to see the doctor before making any lifetime agreements. Like Robert Johnson, I had no qualms selling my soul to the devil. But, instead of earning the ability to create the blues, I earned the ability to jump through hoops to become thin.
I’d like to blame the information session’s brainwashing for my instant disregard for what “the rest of my life” is, but this one was all on me. I had 35 years of conditioning to get to this point, and I handed my soul right on over to the clinic, who would become my own personal devil in the upcoming months.
Below is the patient contract.
Patient Contract – Patient Copy
The purpose of this agreement is to ensure your understanding and commitment required to produce a successful outcome with regard to your bariatric surgical procedure.
Instructions: Please read each paragraph, and once you agree to the contents of that paragraph, please write your initials on the line next to each paragraph. If you have any questions as to the meaning of any paragraph, please ask your physician to explain it to you.
I understand that this Agreement is essential to the trust and confidence necessary in a physician-patient relationship.
I understand that if I do not follow through with all of the terms of this Agreement that my physician may refuse to perform the bariatric surgical procedure or may discharge me as a patient from the practice at any time.
I understand that my care and treatment may include use of prescription drugs such as narcotics for pain control. I agree that if I misuse the drugs prescribed for me, my physician may terminate my care and treatment. Misuse includes altering prescriptions, taking other than the prescribed dosage, or using fraudulent or illegal means to obtain drugs.
I will fully communicate to my physician any concerns and will also communicate to my physician or other applicable healthcare provider any suspected complications after my surgery.
I agree to comply with the pre- and post-surgery protocols, which includes following the diet(s) provided and behavior modification.
I agree to abstain from the use of nicotine products for three months prior to surgery.
I am aware of the increased risk of ulcers and bleeding post operatively with nicotine use and commit to avoid smoking and nicotine use lifelong.
I am aware of the increased risk of ulcers and bleeding post operatively with NSAID use and commit to avoid NSAID use lifelong.
I agree to keep my follow-up appointments as recommended by my surgeon and or PA-C.
I agree to take vitamins, and calcium and other supplements for life as directed by my surgeon and/or primary care physician. (monthly average cost $55 – $60)
I agree to have blood work done for life on at least an annual basis.
I agree to see my surgeon and family physician as directed. It is my responsibility to provide my surgeon and family physician with records from these visits.
Any medical condition that exists or may develop, not in direct relationship to my obesity surgery, must be treated by my primary care physician (and/or appropriate specialty physician), and I agree to coordinate my care with my surgeon. I understand my surgeon may not be able to treat me or fill prescriptions for other medical conditions.
I agree to have a support person available to help me for the first two weeks post op.
I understand that successful long-term weight loss depends on following the principles and guidelines of my surgeon’s bariatric surgery program.
I have read this form and discussed any questions that I may have with my provider.