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What makes a good surgeon?

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  • FunkDoc83 FunkDoc83 
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    Family member asked me about how to pick a surgeon for elective surgery and it got me thinking.   What metrics would you use and can any lay person without an inside connection in healthcare discover or find these metrics to make a well informed decision?

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    CordMcNally CordMcNally 
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    Somebody that you’re comfortable with during the pre-op visit. You can’t put too much stock into complications because some surgeons only do elective cases on healthy people while some will be more than willing to do the surgery on the high risk patient that nobody else will. In the ED, I don’t think a surgeon is bad when I see their complications. I know complications are unavoidable but how they handle the patient after those complications speaks volumes to me.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

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    Liked by Anne, LizOB, hatton1, AZPT
    Avatar SLC OB 
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    If they have any OR nurses to ask… as them! Its always the biggest compliment when the OR nurses come to you for surgery. They know when people are slashers or competent. However, this is kind of an insider track.

     

    #187668 Reply
    ENT Doc ENT Doc 
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    Results are most important. Results are part skill and part judgement. Comfort with them matters too – they need to have a reasonable bedside manner and be able to answer any questions asked without being irked. They shouldn’t be pushy about getting someone into an elective surgery. That decision is the patient’s, not the surgeon’s.

    If you know people and are at an academic place ask a senior resident who they would go to. For all else research what good results are, what complications there are, and ask specific questions about those. Ask about volume. All else equal, more is better. Make a few different appointments based on best available info and then decide.

    #187669 Reply
    Liked by Anne
    FunkDoc83 FunkDoc83 
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    Results are most important. Results are part skill and part judgement. Comfort with them matters too – they need to have a reasonable bedside manner and be able to answer any questions asked without being irked. They shouldn’t be pushy about getting someone into an elective surgery. That decision is the patient’s, not the surgeon’s.

    If you know people and are at an academic place ask a senior resident who they would go to. For all else research what good results are, what complications there are, and ask specific questions about those. Ask about volume. All else equal, more is better. Make a few different appointments based on best available info and then decide.

    Click to expand…

    Should a surgeon know their rates of the most common complications and how they compare to the national average?  I agree results ultimately matter and it should be clearly stated what the goal is of the surgery so a patient has the right expectations.

    #187674 Reply
    Avatar Tim 
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    For those without “connections “, is there any data available?
    Not many people have access to senior residents or OR nurses. The “Best Doctor” lists seem to be paid advertising features.

    #187681 Reply
    ENT Doc ENT Doc 
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    I think any good surgeon who cares about quality will have a sense of their complications for rare stuff, which is what people tend to get freaked out over. Indeed some of this is completely random and depends on the population you are taking care of. But that should also be stated to provide context.

    #187687 Reply
    Avatar Panscan 
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    That’s the scary thing about surgery. You have no way of knowing as a layperson. Even as another physician very little way of knowing besides if they are at your place of work and you can ask around. And asking around isn’t full proof either.

    I doubt a surgeon is going to come out and say “ya I have more leaks than the national average.”

    #187688 Reply
    ENT Doc ENT Doc 
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    No but if they are specific with their language rather than vague that’ll be telling.

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    Avatar Panscan 
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    I had some attendings I wouldn’t let operate on anyone I know. As in if they were in hospital and requiring surgery and it was those couple attendings I would go out of my way to say “I don’t think you should do this.” this is at a major academic center. So then imagine the people out in community. Man it’s scary.

    Not sure about the language thing. The ones who are truly bad are delusional and would probably rationalize it in their head in a way where they can come across as confident. If you ask someone if they do a good job idk anyone that is going to tell you no.

    #187694 Reply
    Liked by jfoxcpacfp, Zaphod, Tim
    Avatar G 
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    For those without “connections “, is there any data available?
    Not many people have access to senior residents or OR nurses. The “Best Doctor” lists seem to be paid advertising features.

    Click to expand…
    Family member asked me about how to pick a surgeon for elective surgery

    Click to expand…

    I always suggest asking an ER doctor and an anesthesiologist–that produces a good Venn diagram.

    But as you point out, most people don’t have that, so I recommend asking a PCP who they would send their child/wife to.  If they don’t know right away, they can find out.  Of course, this assumes you trust your primary doctor!

    I think that most/all metrics are inelegant; although they try to standardize, it is a challenge.  Plus how do you factor in the subjective stuff (judgment, bedside manner, responsiveness, competence of office staff)?  This is important too.

    #187700 Reply
    Avatar Tim 
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    @g,
    As mentioned several times that patient surveys sometimes aren’t the most accurate measures as well.
    Not sure the technical performance is really reflected in Webmd or Yelp either. PCP is one way, but might be out of network or might be very valuable. Depends. PCP’s will also be very careful to avoid any negatives.
    Yes, use the insurance company list. No very transparent of comforting.

    #187706 Reply
    ENT Doc ENT Doc 
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    The idea that academic centers necessarily have the best surgeons is not accurate. Some are the best I’ve ever seen. Others are hiding out and have complications protected by poor leadership. Same is true for the non-academic side.

    #187712 Reply
    Liked by Roentgen
    FunkDoc83 FunkDoc83 
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    All things being equal, wouldn’t you want the surgeon who achieves the desired results (less pain, improved mobility, etc….) with the lowest complication rate?  This data is out there, but I wonder if it were presented in some searchable database if it would cause more problems.  Surgeon X has a complication rate of 19.5% and surgeon Y has 20.4%.  Patient would say, well of course I want surgeon X even though the rates are pretty close.  Then of course case load matters as well.

    #187715 Reply
    Avatar Panscan 
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    Very hard to compare. Some people only will operate on super healthy people, other people will operate on anything breathing. Most people in the middle. Not sure you could ever find an effective comparison.

    #187716 Reply

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