CHOOSING A SURGEON
Hopefully, you have chosen a primary care provider you trust and one who will make what he or she thinks is the most appropriate surgical referral. And, hopefully, that surgeon will tell you if he is not the best choice for your particular condition.
However, it's your health and you obviously have the most to gain or to lose by your choice of a surgeon. In larger communities like ours it's more appropriate to seek the surgeon best able to handle your specific problem. That might be a totally different surgeon than the one who saved your neighbor's life last year after a car accident or who did a great job with your friend's thyroid tumor. Similarly, a primary doctor shouldn't refer everybody to the same surgeon without consideration of the specific condition being treated. Be aware that in larger communities with many practicing and even sub-specialized surgeons, some multi-specialty medical groups and HMOs refer to only one or a few of those surgeons who either work for them or have contracts. As result, they might block your access to the most experienced surgeons for your condition.
Ask around. Obviously, your doctor will have an opinion. Ask him or her questions about the surgeon before even making a surgical appointment. Some surgeons are willing to speak with you by telephone before you make an appointment. Do you know anybody who's had the same condition? Keep in mind that although it can be a hassle to travel to another town or city, for some conditions it is probably worth the drive. But don't drive simply to be at the "Miracle Center." Big names don't guarantee the best talent in all specialties. Many time those talented surgeons can be found right in your own hometown.
Write down your questions so you won't forget them when you're sitting in the surgeon's office, and call back if you come up with more questions after leaving. Don't be intimidated. We're just people like you, except we happen to do operations. Here are some fair and reasonable questions you should consider asking:
1. Are you board certified in your specialty? - Yes. Although this doesn't guarantee competence, it indicates the surgeon has completed a recognized residency program after medical school and has passed all written and oral exams required for certification. It is reasonable to expect a M.D. general surgeon to be a Diplomate of the American Board of Surgery within five years of finishing residency. Further certification represents sub-specialization. Realize that some general surgeons attain great skill without formal sub-specialty training or certification. Not all surgical sub-specialties even have additional certification, but these do:
- colon & rectal surgery
- vascular surgery
- pediatric surgery
- surgical critical care
- cardiothoracic surgery
- plastic surgery
2. How many of these operations have you done? How many in the past year? - There's no substitute for recent experience. Generally speaking, the more a surgeon focuses on an operation or class of similar operations the better he/she is going to be. This is no different than any other activity in life. Practice is essential. But like any other activity, some people "get it" quickly, others slowly or not at all. All surgeons have bad outcomes occasionally. A surgeon who does a specific operation infrequently can have only infrequent bad outcomes with it, and these bad outcomes can go unnoticed by the medical community. However, if a surgeon who does the same operation often doesn't do it well, the medical community will likely take notice and eventually limit patient referrals for that operation. Or so one would hope.
3. Are there any surgeons in the local area or surrounding communities with more experience than you? - If the answer is "yes" it doesn't mean your surgeon isn't qualified, but you are entitled to an honest answer. Surgeons often work together on difficult or new operations. And, it is sometimes reasonable for a less experienced surgeon to ask the assistance of a more experienced one without referring that patient away altogether. That way the surgeon learning the operation can gain the experience necessary to become an expert himself.
4. What other operations do you do? - Is there a focus or sub-specialty to the surgeon's practice, and is the operation you're discussing part of that sub-specialty?
5. What is the usual recovery? - Get an idea of the typical length of time in the hospital, time out of work or usual activities, magnitude and duration of pain, ability to drive afterwards. Keep in mind that everyone is different. How quickly you recover and even how much pain you feel after surgery might be more or less than other people you know who have had the same operation.
6. What's the worst complication you've ever seen? - This alone shouldn't keep you from having needed surgery, but it can put elective surgery in perspective. Is the surgeon experienced in handling the possible complications? Someone once defined an expert as someone who's already made all the mistakes. Beware of a surgeon who claims not to have had any complications. He's either inexperienced or dishonest.
7. Who locally would you have do your operation (or a family member's)?
If you know people who work in the hospital operating room, outpatient surgery area, recovery room or surgery ward, you might get a more objective answer from them. A glimpse from inside the system can be as helpful in our line of work as it is in yours.
8. Are you available after hours if I need you? Who will help me if you're out of town or unavailable? - All surgeons need assistance in covering their patients. Some take turns returning patients' phone calls with their partners or other local surgeons. Others only ask for coverage when they are out of town. Neither approach is inherently better than the other as long as the covering surgeons are interested and qualified.
A final consideration. Many operations are straight-forward and reasonably predictable. You might see the surgeon only once after surgery and, therefore, be willing to tolerate interpersonal differences. But if you have problems after surgery or require a more extensive initial operation, you might find yourself in a long relationship with your surgeon and office staff. In that situation it helps if you like and respect them as people.
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