How do you choose a surgeon?

[+ FreshFluff]

I’m looking into a procedure that involves removing multiple things that are adjacent to important organs. This procedure, which is technically elective, is known for being extremely difficult, especially when done laparoscopically. As a result, my doctor has recommended that I seek out a subspecialist. I don’t care about location; I’ll fly anywhere. I’ve asked doctors I know for referrals, I’ve gone to FB groups to get opinions, and even looked at online reviews, but I have to do some of the legwork myself. I’ve already done a consult and plan to do several more. I’m willing to do this anywhere in the US.

 

What should I look for when assessing a surgeon? Of course, more experience in the specific procedure is always better, but what are other factors one should look for?

 

For example, should age be a factor? One surgeon I’m going to consult with is a leader in the field; he does this procedure alone all day multiple times a week. But he is 70 and will retire soon, which concerns my parents. Is the loss of hand eye coordination and manual dexterity is enough to cause problems with an exceptionally tricky surgery? Is being close to retirement an issue regardless of age? On the other end of the spectrum, doctors and some patients have expressed concern that a prominent 40 y.o. surgeon in the field is still a bit green and not as focused.

 

I know that there are physicians, including surgeons and anesthesiologists, of all ages here. Some of you have PM’d with me over the years and helped me. I hope I’m not offending any of you; I debated whether to post this. I’m just trying to understand and would definitely like to hear your thoughts. TBH, I’m scared and frustrated by the whole thing.

BTW, I’m being vague about the procedure because I hope this thread can be useful to others and in order to avoid getting too graphic.

Edited February 15, 2019 by FreshFluff

[+ newatthis]

Doctor friends of mine say "a good doctor will know the other good doctors."

[rvwnsd]

When my mother required surgery and was not capable of participating in the decision-making process it was up to my father, brother, and me to select the surgeon. She was in a regional hospital in a far-flung Chicago suburb and was in precarious health, so traveling cross-country was not an option. Still, we had a very wide field of options give the sheer number of providers in metro Chicago.

 

Here's how we evaluated potential candidates:

• Experience: Didn't want someone who was too young or too old
  
• Attitude: We looked for someone with a combination of confidence, compassion, and humility. We did not want a cocky, condescending jerk. She had one of those already.
  
• Honesty: She was 76 years old and in poor health. Didn't want someone who would promise she would be salsa dancing the following day.
  
• Personality: Although we were not going to hang out with the person, we wanted someone who could explain himself and could relate to my mom and to us as people, not just as that day's day at the office.
  

We ended up selecting a surgeon who was in his late 40's/early 50's. Her performed the surgery at the hospital in which my mother was a patient. He hit all the right buttons, but what tipped the scales in his favor were his candor about the surgery itself and his concern about transporting my mom 75 miles to a nationally-recognized hospital in downtown Chicago and its effect on her as well as my dad's ability to travel there in his precarious state.

 

He was the right choice. The surgery was a success.

[Rudynate]

I think there is a sweet spot as to the doc's age - late 40s to early 50s. I've had two spine surgeries, same surgeon for both, he was in this age range. He was a triathlete, which mattered to me, and chief of the service, so I had no doubts about his maturity, experience or qualifications. I couldn't have had a better doctor, especially for the second surgery which was a 6.5-hour procedure.

[+ Charlie]

Since my primary care physician is very good, and knows all the local surgeons, I trust his recommendations. That being said, I have never needed complicated surgery, so I am not sure what I would do if I needed a specialist who was not available locally. I like rvwnsd's procedure.

[+ FreshFluff]

Thanks, everyone. @Rudynate , late 40s to late 50s is my ideal age range too. I found two local surgeons in that range and have met with one already. I am generally happy with what the procedure she described. My hesitations are

(1) I forgot to ask her how often she does this procedure, particularly laparoscopically. I need to give her some new MRI results, so I’ll ask when I meet with her again.

(2) I wonder how well she stitches up the incisions. Rumor has it that the heavily hyped 70 y.o. surgeon stitches up incisions like a plastic surgeon, which I assume means from the inside. I’ve seen huge variation in how incision scars of all kinds look, and it appears that the southern cal surgeons care more about the cosmetic result.

 

I’m really apprehensive about the whole thing. It could go well and improve my quality of life or it could go really badly. And I wonder if they’ll still go laparoscopic after seeing the new MRI results.Unfortunately, I don’t have much choice; the adjacent organs are already suffering.

 

@Charlie and @newatthis , I did get referrals from doctors. My family’s GP was kind enough to ask specialists for names.

 

@rvwnsd , sounds like you chose wisely for your mom and got a great result. I know what you mean about doctors who overpromise, particularly since they can change strategies once they’re in.

 

@BnaC , I’ll be asleep so cold hands are fine.

Edited February 16, 2019 by FreshFluff

[+ g56whiz]

I’m 74. I’m about to get stents from a cardiologist who’s my age. He’s more alert and energetic then my own cardiologist. Unlike my small town cardiologist he practices in a larger market which gives him the luxury to specialize only in stents. I’ve had a low platelet complication. He called in a hematologist who’s also our age. Unlike his younger colleagues, he heard my voice and checked it to discover that the meds I was on caused thrush which he treated immediately.

 

I agree with concerns about the age of providers. I’m just glad I got lucky.

 

BTW the cardiologist is from China and the hematologist from South Africa.

[Rudynate]

Thanks, everyone. @Rudynate , late 40s to late 50s is my ideal age range too. I found two local surgeons in that range and have met with one already. I am generally happy with what the procedure she described. My hesitations are

(1) I forgot to ask her how often she does this procedure, particularly laparoscopically. I need to give her some new MRI results, so I’ll ask when I meet with her again.

(2) I wonder how well she stitches up the incisions. Rumor has it that the heavily hyped 70 y.o. surgeon stitches up incisions like a plastic surgeon, which I assume means from the inside. I’ve seen huge variation in how incision scars of all kinds look, and it appears that the southern cal surgeons care more about the cosmetic result.

 

I’m really apprehensive about the whole thing. It could go well and improve my quality of life or it could go really badly. And I wonder if they’ll still go laparoscopic after seeing the new MRI results.Unfortunately, I don’t have much choice; the adjacent organs are already suffering.

 

@Charlie and @newatthis , I did get referrals from doctors. My family’s GP was kind enough to ask specialists for names.

 

@rvwnsd , sounds like you chose wisely for your mom and got a great result. I know what you mean about doctors who overpromise, particularly since they can change strategies once they’re in.

 

@BnaC , I’ll be asleep so cold hands are fine.

 

 

You're right, you should find that out. The scars from my spine surgeries are barely visible because the were closed from the inside out. As a matter of fact, on the outside all there were were a few big wire sutures in a zig-zag and then steri-stips to hold the edges of the wound together.

[BaronArtz]

Dear FF - although it is elective, I am sorry to read that you will have surgery. It has to be nerve-wrecking. I wish you the best of luck and a speedy recovery.

 

Luckily, here in NYX we have among the best doctors in the world! I would let a MD whom you trust do the qualification for you. It is very hard to do this yourself ...

[+ nycman]

"a good doctor will know the other good doctors."

 

This is the best advice of all. Indeed, good doctors know good doctors.

 

In general, they won’t bad mouth their colleges. But listen for very

strong words of praise like “He’s an outstanding surgeon”, or

“I would let him operate on my family members.

 

Also listen for faint praise like “he’s a good surgeon”, or “I’ve never

heard of any problems with his care”. That is damning with faint

praise and doctors do it all the time. Think about it. You don’t want

a “good” doctor....you want a GREAT doctor.

[Rudynate]

I heard a couple guys talking once in the locker room at my swim club. One was a guy looking for a surgeon and the other was a doctor. The guy looking for the doc was a member of Kaiser - an immense staff-model HMO that started here in the SF Bay area during WWII. The doc said "You can hardly go wrong with a surgeon from Kaiser. They all do so many surgeries in their specialties that it's safe to assume that almost any one of them will be very good. Where Kaiser falls down is on rehab and aftercare, which tends to be poor."

[+ FreshFluff]

@g56whiz I’m glad you found a great sub-spec for the stents. That is exactly the dilemma I’m facing—the 70 y.o. who does this very thing all day vs a younger surgeon who spends more time on an related but easier surgery.

 

@BaronArtz Thanks for the well wishes. I wish I could let doctors do the qualifying. Unfortunately, they can only make general recommendations, sometimes from secondhand info. As with escorts, painters tax accountants, etc, you need to find out for yourself.

 

@nycman You make a good point. When I asked my GP to ask his colleague about Dr Jones, he replied “My colleague also likes Dr Jones,” which wis not a strong recommendation.

 

@Rudynate , you’re right that for something like gall bladder surgery, it would b3 hard to beat Kaiser. interestingly, I have yet to hear of any names there . And I will definitely ask about how incisions are closed.

[Geriatric Otter]

I’m looking into a procedure that involves removing multiple things that are adjacent to important organs. This procedure, which is technically elective, is known for being extremely difficult, especially when done laparoscopically. As a result, my doctor has recommended that I seek out a subspecialist. I don’t care about location; I’ll fly anywhere. I’ve asked doctors I know for referrals, I’ve gone to FB groups to get opinions, and even looked at online reviews, but I have to do some of the legwork myself. I’ve already done a consult and plan to do several more. I’m willing to do this anywhere in the US.

 

What should I look for when assessing a surgeon? Of course, more experience in the specific procedure is always better, but what are other factors one should look for?

 

For example, should age be a factor? One surgeon I’m going to consult with is a leader in the field; he does this procedure alone all day multiple times a week. But he is 70 and will retire soon, which concerns my parents. Is the loss of hand eye coordination and manual dexterity is enough to cause problems with an exceptionally tricky surgery? Is being close to retirement an issue regardless of age? On the other end of the spectrum, doctors and some patients have expressed concern that a prominent 40 y.o. surgeon in the field is still a bit green and not as focused.

 

I know that there are physicians, including surgeons and anesthesiologists, of all ages here. Some of you have PM’d with me over the years and helped me. I hope I’m not offending any of you; I debated whether to post this. I’m just trying to understand and would definitely like to hear your thoughts. TBH, I’m scared and frustrated by the whole thing.

BTW, I’m being vague about the procedure because I hope this thread can be useful to others and in order to avoid getting too graphic.

 

As an MD in a University hospital, I would say that for many surgical procedures, surgeon volume and hospital volume count more than anything. Age alone is not an issue...most of us know when to quit, and good hospitals will vet their staff. Settling malpractice claims are nt in their best interest.

[+ FreshFluff]

I’ll be honest: One of my priorities is to minimize visible scars. I learned that one prominent lapo surgeon at a major research hospital has been doing this procedure with a single small incision in some cases. They’ve done only 25 cases this way but I’m ok with being a guinea pig. I meet their criteria except that the largest mass is 1 mm larger than their recommended size limit. It’s worth asking though.

 

Thanks, @Geriatric Otter , and welcome to the forum!. I think you’re right about volume trumping age. The only issue is that the guy I’m thinking of IS preparing to quit, from what patients say. .

[rvwnsd]

This is the best advice of all. Indeed, good doctors know good doctors.

 

In general, they won’t bad mouth their colleges. But listen for very

strong words of praise like “He’s an outstanding surgeon”, or

“I would let him operate on my family members.

 

Also listen for faint praise like “he’s a good surgeon”, or “I’ve never

heard of any problems with his care”. That is damning with faint

praise and doctors do it all the time. Think about it. You don’t want

a “good” doctor....you want a GREAT doctor.

 

This is so very true. I always liked my doctor in San Diego. When I spent the night in the chest pain unit 10+ years ago it became obvious that he is a great doctor. He was revered at the hospital (a highly-rated regional medical center) and the cardiologist who saw me knew him well. His comment was "he's brilliant and cares deeply." Any time I had to see a specialist they would say the same. THAT's the doc a patient wats to have.

 

@g56whiz...interestingly, I have yet to hear of any names there . And I will definitely ask about how incisions are closed.

You have to be a member of a Kaiser plan to user a Kaiser doc unless you get taken to their ER. That is probably why you have not hear about any doctors who work there. They only see Kaiser patients.

[thickornotatall]

I had what is considered a very common surgery, hernia repair. The surgery went fine. 6 months later the mesh used to correct the hernia was on an FDA recall list. The mesh ripped and the metal pin ripped through my intestines. I contracted Sepsis and MRSA while in the hospital. I was never ill and was considered quite athletic. 5 surgeries later with a loss of all feeling in my stomach, lower back and legs I recovered. Needless to say my life was quite altered. I sued the hospital.the surgeon and the manufacturer of the mesh.

As I discovered the mesh was recalled before my operation and the hospital never removed it from their inventory. The surgeon was informed but used it anyway.

6 years later I settled with all 3.

Always ask as many questions as you can think of. Trust is not an option until all sources are exhausted..

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/herniasurgicalmesh/default.htm

[+ MasssageGuy]

I had what is considered a very common surgery, hernia repair. The surgery went fine. 6 months later the mesh used to correct the hernia was on an FDA recall list. The mesh ripped and the metal pin ripped through my intestines. I contracted Sepsis and MRSA while in the hospital. I was never ill and was considered quite athletic. 5 surgeries later with a loss of all feeling in my stomach, lower back and legs I recovered. Needless to say my life was quite altered. I sued the hospital.the surgeon and the manufacturer of the mesh.

As I discovered the mesh was recalled before my operation and the hospital never removed it from their inventory. The surgeon was informed but used it anyway.

6 years later I settled with all 3.

Always ask as many questions as you can think of. Trust is not an option until all sources are exhausted..

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/herniasurgicalmesh/default.htm

My god, this is horrible.

 

Personally, I had three failed hernia surgeries. They were done by "general surgeons" who, frankly, were incompetent when it comes to hernia repair.

 

I can honestly say that the Internet provided me with guidance to find a surgeon who specialized in ONLY hernia repair. Basically, he fixes other surgeons hernia screw ups.

 

I'm now hernia free and the mesh that didn't work was removed.

 

Remember, 50% of all Doctors out there graduate in the BOTTOM half of their class. It's an old joke, but unfortunately true.

Edited February 18, 2019 by MasssageGuy

[instudiocity]

My surgical oncologist when asked about my brain surgeon responded, “He is a good man. A little short but a good man.”

 

When the neurosurgeon walked in the exam room, I nearly died laughing. He was all of 5’ tall.

[+ FreshFluff]

I had what is considered a very common surgery, hernia repair. The surgery went fine. 6 months later the mesh used to correct the hernia was on an FDA recall list. The mesh ripped and the metal pin ripped through my intestines. I contracted Sepsis and MRSA while in the hospital. I was never ill and was considered quite athletic. 5 surgeries later with a loss of all feeling in my stomach, lower back and legs I recovered. Needless to say my life was quite altered. I sued the hospital.the surgeon and the manufacturer of the mesh.

As I discovered the mesh was recalled before my operation and the hospital never removed it from their inventory. The surgeon was informed but used it anyway.

6 years later I settled with all 3.

Always ask as many questions as you can think of. Trust is not an option until all sources are exhausted..

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/herniasurgicalmesh/default.htm

 

I’m so sorry this happened to you. That is absolutely awful that your surgeon ignored the warming. I’m glad you were able to settle with them.

 

I’m in a similar dilemma regarding a device used in this procedure. If you have stage 1 cancer, this device sprays it around and turned it into stage 3. The cancer can sometimes be detected in advance but not always. Depending on whom you believe, chances are between 1/500 and 1/1000. In any case, most of the prominent surgeons are still using the device but with precautions. Even without the device, the surgery carries some risk. I’ve spent 3 1/2 years trying to avoid it but I’m left with no choice.

 

[uSER=10623]@MassageGuy[/uSER] , glad you got it right with your hernia surgery. I’m hoping to find that very type of surgeon.

 

@rvwnsd “Brilliant and caring” is ideal. Maybe I’ll be that lucky.

 

@instudiocity That’s hilarious.

[+ Pensant]

I’m 74. I’m about to get stents from a cardiologist who’s my age. He’s more alert and energetic then my own cardiologist. Unlike my small town cardiologist he practices in a larger market which gives him the luxury to specialize only in stents. I’ve had a low platelet complication. He called in a hematologist who’s also our age. Unlike his younger colleagues, he heard my voice and checked it to discover that the meds I was on caused thrush which he treated immediately.

 

I agree with concerns about the age of providers. I’m just glad I got lucky.

 

BTW the cardiologist is from China and the hematologist from South Africa.

When it come to cardiovascular issues, the Cleveland Clinic is as good as it gets.

[+ g56whiz]

When it come to cardiovascular issues, the Cleveland Clinic is as good as it gets.

Granted especially for complex procedures. But because you can’t make an appointment to have a heart attack it’s wise to have a local cardiologist. Stenting is now a standard treatment and my local cardiologist referred me to a regional specialist in part due to the platelet issue. I think I’m in good hands. Should know Friday.

[Stormy]

I was referred to a surgeon and searched for reviews for him I decided to okay the operation even though I didn’t much care for his bedside manner He was a competent surgeon and my procedure was successful His problem was personality. He didn’t have one

[+ FreshFluff]

Is it true that laparoscopic surgery is easier on bigger patients? A surgeon on Quora said that while anesthesia might be more challenging, the extra space helps with instrument placement. I had hoped that being smaller might help.

Edited February 20, 2019 by FreshFluff

[Rudynate]

I was referred to a surgeon and searched for reviews for him I decided to okay the operation even though I didn’t much care for his bedside manner He was a competent surgeon and my procedure was successful His problem was personality. He didn’t have one

 

I used to think a docs personality didn't matter as long as he was competent, but I ve changed my mind. Having had the good fortune to be under the care of some docs who are friendly and likable in addition to being competent, I can say it makes a big difference.

[+ g56whiz]

Granted especially for complex procedures. But because you can’t make an appointment to have a heart attack it’s wise to have a local cardiologist. Stenting is now a standard treatment and my local cardiologist referred me to a regional specialist in part due to the platelet issue. I think I’m in good hands. Should know Friday.

Well Friday came and I’m now 4 stents richer and feeling great. Answered prayer really.