OT: Picking a surgeon

[DiverCTHunter]

I have to go under the knife and am trying to get everything set up before the end of the year.

BCBST is being their usual opaque selves when it comes to price, and my final choices are well recommended on at least one site. Of course it'd be a lot easier to choose if we had outcome-based reporting, but since that's part of the "e-vile obamacare", the state's doing their best to keep those numbers opaque.

So, everything else being equal, which of these 3 options would you choose and why?

[LSAT]

I would ask for references from friends that have used surgeons recently. I also ask my primary care doctor who he would use.
Older doctors have experience, but younger doctors are more aware of newer procedures.

[Julie]

Voted for #2, but agree with LSAT as well - it depends on the individual after all.

[oak]

I picked number 2 but for me it would depend on the type of surgery. I might pick number one if I felt a specialist would be in my best interests.

[Lambeau]

What is a "generalist" when surgery is involved? I would not chose a proctologist to do a heart transplant.

As to choosing a surgeon, I just had that dilemma for heart surgery. I was consulted by the head doctor of a large cardiac surgeon group of 60 heart surgeons. He was a man of my age. I asked him if he would be doing my procedure.

His reply, "Oh heavens no! I'm too old to be standing on my feet for 10 to 12 hours wearing a lead apron. I have 60 very highly qualified cardiac surgeons on my staff who have a lot of experience, have steadier hands, and more stamina now than I do at the age of 73". I can still make the sound diagnosis and recommendations for what you need to have done, but a younger fellow than me will actually do your procedure".

The surgeon he assigned to me was a heart surgeon who was 50 years old, and my outcome could not have been better.

[chunkyfrog]

I would look up the profiles/ratings online. I would also do a search of news articles with his name.
I escaped having unnecessary knee surgery due to an article about sepsis deaths of some of the surgeon's patients.

[wardmiller]

I have to go under the knife and am trying to get everything set up before the end of the year.
. . . . .
So, everything else being equal, which of these 3 options would you choose and why?

I've had some experience selecting a surgeon and also spent several years as an American Cancer Society counselor where I talked with many patients who faced the same problem. From my experience, I would personally not use only those three options to determine my choice.

First, I would seek 2nd opinions from several centers of excellence for the particular surgery I'm facing. I went to Sloan-Kettering, Columbia-Presbyterian and Mount Sinai all in NYC, and Johns Hopkins in Baltimore. Fortunately for me, Medicare covered them all. But if it had not, I would have paid out of my pocket.

Next, I let each one give his pitch. Then I asked why that was better than procedure B or C or D? And I listened carefully to the responses. Then I asked about side effects. Having done my homework, I knew what to expect, but I wanted to hear it from their mouths. Some minimized side effects, so that doctor lost some points in my scoring.

Then I asked how many of this specific procedure he/she had done. How they answer is as important as the numbers. In the case of the da Vinci robotic procedure, I had been previously warned by a close friend who is a surgeon, "Don't be among the first 300 for a given doctor!"

I asked more questions, but I think you get the point. Eventually, you get a gut feel about each one you talk to. Finally, I add up the scores and sometimes one is a clear winner. Sometimes, the gut feel is the tipping point.

Before I visit each doctor, I make a folder for him to keep. Transparent cover, with cover page an executive summary of my medical history, brief family history, list of meds, list of prior doctors, etc. Then copies of all lab reports and such, separated by index tabs. I made sure they get that folder just before they see me. In almost all cases, the first thing they talk about is that folder and how it is making their job to advise me easier. It shows them I am managing my own health care and I often get a better consult as a result.

Remember the tenor sings tenor....the alto sings alto.... etc. That means the surgeon usually want to cut, the oncologist want to radiate, etc. There is nothing wrong with that, but it must be considered in your evaluation.

I must run now, but will be glad to respond to any questions of comments later.

[DiverCTHunter]

What is a "generalist" when surgery is involved? I would not chose a proctologist to do a heart transplant.

It's orthopedic surgery to repair my ankle. Peroneal subluxation / dislocation probably from repeated strains and sprains. ICD-9 code 726.79.

All 3 docs are orthopedic surgeons. The 20-yr generalist has a focus in sports medicine of the leg and foot, esp. ACL and knee injuries. The 30-yr's focus is joint repair and replacement, and the 10-yr specialist is strictly foot and ankle procedures.

I started out going to the podiatrist with swelling and pain that was making it difficult to exercise or walk on uneven surfaces. At the time I was hoping I just needed better orthotics than Dr. Scholl's.

Podiatrist ran X-rays and ultrasound. IIRC, there was no "fleck" sign on the x-ray (will confirm when I pick up my records). The ultrasound just showed swelling throughout the tendon sheath near the joint. The conservative treatment was bracing and a round of cortisone injections which brought down the swelling.

When I went in for the followup appointment, I had the classic "pop", so there was no repeat ultrasound.

[Sheriff Buford]

I had been previously warned by a close friend who is a surgeon, "Don't be among the first 300 for a given doctor!"

I have podiatrist a son inlaw who just finished his residency and has joined a practice a few months back. He performs 3 surgeries a day... so do the math... it doesn't take long to rack up 300 surgeries. He said people are anxious to get the surgeries they need in before O-bama care "really" kicks in. When it "really" kicks in - all hell is gonna break loose.

Sheriff

[Slartybartfast]

I have to go under the knife . . . So, everything else being equal, which of these 3 options would you choose and why?

None of the above.

I just popped my biceps tendon off my radius as the result of lifting something I shouldn't have and had to have surgery to reattach the tendon to the bone. My wife is an RN and knows all the sturgeons and the anesthesiologists. She had very strong opinions about which ones to use. So she scheduled me with her favorite Orthopod and the most attentive gas-passer (the one whose patients don't spend hours recovering, barfing their guts out in the PACU (post-anesthesia care unit). It worked great! I woke up with no pain singing the refrain from "You Picked a Fine Time to Leave Me, Lucille," and everyone joined in. But that's not abnormal coming out of anesthesia.

So I recommend wooing, or preferably marrying, an RN. And be good to her, or she might set you up with a Dr. Kevorkian!

[edit: OK, for an orthopedic problem, especially one involving a joint, go with the specialist. A sturgeon with 10 years experience is no noob, and is young enough to still have good eyesight.]

[chunkyfrog]

My surgeon for my gall bladder op was referred by my PCP--in network (no real choice)
When I met him, I asked, "Are your hands steady?"
He held them out, shaking them wildly, and laughing. I knew it would be all right.

[DiverCTHunter]

So I recommend wooing, or preferably marrying, an RN. And be good to her, or she might set you up with a Dr. Kevorkian!

How about being born into a family of RNs?

Unfortunately, my Floor nurse grandmother and ICU nurse mother died years ago, my uncle's retired, and everyone else is either in PEDs or at Out-of-Network hospitals.

[Slartybartfast]

There's lots of single nurses out there. Come to Washington and my wife will fix you up with a good one!

[SMenasco]

I have a knee replacement scheduled. I have selected a 44 year old ortho surgeon that averages 50 a month.

[LSAT]

I have a knee replacement scheduled. I have selected a 44 year old ortho surgeon that averages 50 a month.

Must be a very rich surgeon....