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What makes a good surgeon?

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  • FunkDoc83 FunkDoc83 
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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.

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    Ok what about a way to input your medical history into a searchable database to see outcomes and complications rates for people most similar to you and your medical problems?  I don’t know, I feel like there has to be a better way for people to decide than having to know a guy, who knows a guy who said this surgeon is good.

    #187719 Reply
    MPMD MPMD 
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    I have almost no insight into my surgical colleagues technical abilities. I will often provide feedback to other residency leaders about their resident’s performance as a consultant but I’m always aware that I have no way to judge their performance in the OR.

    I’ve known particularly poorly behaved surgeons who had reputations for clinical excellence but this always strikes me as low-level Stockholm syndrome.

    My wife is anesthesia, that’s who you should ask IMHO.

    #187721 Reply
    Liked by jfoxcpacfp
    Zaphod Zaphod 
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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.

    Click to expand…

    Ok what about a way to input your medical history into a searchable database to see outcomes and complications rates for people most similar to you and your medical problems?  I don’t know, I feel like there has to be a better way for people to decide than having to know a guy, who knows a guy who said this surgeon is good.

    Click to expand…

    It just doesnt exist. That way doesnt tell you who is a good surgeon but rather if you’re a good candidate.

    It would be great if there were a way but its just not possible. There is no way for someone to be able to tell, even if that someone is another surgeon in that field. You have to work with them through all phases of care to actually know.

    Talking and being comfortable may make you feel good, but its not a gauge of skill or outcomes. Some of the worst are going to be the best at selling themselves, and if you ask a pointed question, they’ll just feed you a line of BS and you’ll thank your lucky stars you found them. It’s all in the delivery and tone, and a more self critical doctor who maybe has far superior results might just sound less sure of themselves.

    I dont think OR nurses have a good handle on this either, the good surgeons usually correlate strongly with those that are nice or they personally just like. This would also depend on their volume with different people in that same specialty to be able to comparatively know much.

    Your best proxy is going to be some combination of good reputation by pts/docs (its all you have) and then how much they do the procedure. Probably the most important is volume. Of course if you do enough surgeries you’re going to have complications.

    My favorite is when someone comes equipped to the consult with one of those society approved list of questions. They ask, but of course have zero tools or reference to be able to interpret the answer given, if the person is even being honest. Worst of all, the people who you’d most benefit from asking these questions are also the mostly likely to lie about them.

    This truth fascinates me. Its basically an impossible gap because you’re asking someone to become a physician educationally, and have the knowledge of experience found in residency and practice. Its a gap that will never be fully bridged. I can think of a couple ways to get some data to start, but that will be nearly impossible to obtain.

    Next we should discuss how thses truths obviously lead to no such thing as “informed consent”.

     

    #187724 Reply
    CordMcNally CordMcNally 
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    Unfortunately, some of the biggest a-holes are some of the best surgeons. My goal is to never be in a position to need surgery. We’ll see how that works out for me in the long run. From here on out, at least. I’ve had one non-elective orthopedic surgery in high school that seemed to go well and then another elective eye surgery that went well but was also done by a world-renowned surgeon.

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

    #187727 Reply
    Liked by Tim
    Avatar Dusn 
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    The people who know best are the residents and fellows who operate with them.

    It’s not just surgery skill that matters. It’s taking the time to make sure the operation is necessary and is the correct operation. This sometimes means reviewing records and images and unfortunately many surgeons just act like technicians and mindlessly perform whatever operation the referring physician (or NP, PA or optometrist) sent the patient to them for.

    “World renowned” really is does not always mean anything. Most of my attendings in residency and fellowship were “world renowned.” Most were very good but some of them frankly sucked.

    #187735 Reply
    Avatar skp 
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    IMO the surgery is only part of the equation. I work with what I would consider an excellent surgeon.  But I have qualms about letting him operate on me.  Why?  Because IMO medical management post op is just as important and he consults the worst physician at my hospital to medically manage his patient post op.

    #187720 Reply
    Liked by jfoxcpacfp, Tim, Dusn
    Avatar SValleyMD 
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    Surprised so many care about the bedside manner of a surgeon.

    Another good resource is industry. Ask a Stryker rep. I trust many of those guys more than an OR nurse As they have the most reference points.

    In the cardiology world, stent reps are our biggest resource on who’s good and who’s a chump. They see it all.

    #187745 Reply
    Avatar Panscan 
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    Rep or anesthesia don’t know if the procedure is indicated. They also never see the patient post op when complications would develop. I guess they can tell you if the surgeon stays cool and collected which is important.

    #187749 Reply
    Avatar AR 
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    Zaphod, pretty much hits the nail on the head.  It’s extremely difficult, bordering on impossible for a patient to figure this out.  The only docs of any kind I feel confident of making any kind of judgement on are ones that I have known well for years.

    About once a year, I’ll ask a colleague in my specialty if I can spend a week just observing them.   It’s probably one of the most educational things I do and I’ve learned a ton from doing it.  I see every case, lots of pre-op, post-ops, and everything else.  Also, I have a good bit of experience myself, so I know exactly what to look for.  After doing that I generally have a good idea of how good someone is, but even then I’m not always certain.

    If after doing that, I’m not always sure how good someone is, a regular patient has basically no chance.

    #187778 Reply
    Avatar notadoc 
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    Interesting, , Thursday the 24th I had to pick a surgeon for an operation tomorrow and had no clue if the guy was any good or not.  Actually I didn’t “pick” him he just showed up.  One of two that do the operation I’m getting, aortic valve transplant 🙁  Was clueless how to find any source of information and was wondering if I would be able to intelligently interpret the information in a meaningful way.

     

    One board I hang out on (non medical) has a guy who is an oncologist so I threw the guys name and the hospital out there asking for input.  Someone said that the board was probably not the best place for the question to which he agreed.  He later contacted me with this info:

     

    His ratings on the Medicare database are very good..his complication rates are well below the national average. So, by any effective measure he is a great surgeon.

    The medical center also does well on complication rates but gets low patient satisfaction scores in discharge process. That makes their overall score look lower than it should. As a physician, I care more about the quality of the surgery, postop infection rate and mortality, all of which they do very well on. I care little about the quality of the food.

    Looks to me like you are in great hands. I would do what Dr X says.

    It is difficult to find info I was lucky he responded.

     

     

    #187783 Reply
    Liked by Tim
    jfoxcpacfp jfoxcpacfp 
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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.”

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    Same with CPAs and financial planners, but we don’t kill and maim people.

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~ 270-247-0555
    https://fox-cpas.com/for-doctors-only/

    #187785 Reply
    Liked by Tim
    jfoxcpacfp jfoxcpacfp 
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    Interesting, , Thursday the 24th I had to pick a surgeon for an operation tomorrow and had no clue if the guy was any good or not.  Actually I didn’t “pick” him he just showed up.  One of two that do the operation I’m getting, aortic valve transplant   Was clueless how to find any source of information and was wondering if I would be able to intelligently interpret the information in a meaningful way.

     

    One board I hang out on (non medical) has a guy who is an oncologist so I threw the guys name and the hospital out there asking for input.  Someone said that the board was probably not the best place for the question to which he agreed.  He later contacted me with this info:

     

    His ratings on the Medicare database are very good..his complication rates are well below the national average. So, by any effective measure he is a great surgeon.

    The medical center also does well on complication rates but gets low patient satisfaction scores in discharge process. That makes their overall score look lower than it should. As a physician, I care more about the quality of the surgery, postop infection rate and mortality, all of which they do very well on. I care little about the quality of the food.

    Looks to me like you are in great hands. I would do what Dr X says.

    It is difficult to find info I was lucky he responded.

    Click to expand…

    Prayers and well wishes that your surgery is a success. You were fortunate to have a relationship with a doctor on the internet who would go to such trouble to help. 🙂 Hope to see you back here soon after!

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~ 270-247-0555
    https://fox-cpas.com/for-doctors-only/

    #187786 Reply
    Liked by Tim
    ENT Doc ENT Doc 
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    Notadoc, best of luck with your surgery and recovery.

    #187787 Reply
    Liked by Tim
    Avatar pulmdoc 
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    Complication rates are a poor metric of quality because surgeons will cherry pick patients and avoid high risk surgeries. To me the single best metric (still imperfect) is case volume. Practice doesn’t make perfect but it helps. Some surgeries are just rare and nobody will have a huge volume, but the surgeon with 50 cases under their belt is not going to be as facile as the one with 5000.

    For those with insider knowledge, I would ask surgical floor nurses (they will be the ones to know complications and how the surgeon deals with them), anesthesia (they know if the surgeon stays calm under pressure) and ER in that order. Outpatient docs are generally a poor source.

    #187808 Reply
    Liked by hatton1, Zaphod
    Zaphod Zaphod 
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    Rep or anesthesia don’t know if the procedure is indicated. They also never see the patient post op when complications would develop. I guess they can tell you if the surgeon stays cool and collected which is important.

    Click to expand…

    Exactly. This is only something you know by literally being a surgeon. Lots of very respected surgeons do surgeries very technically well on people that dont need it, or needed another surgery altogether. Its a complex thing, and while some measures are useful, they really dont tell us much especially when hospital data isnt exactly robust or of similar quality hospital to hospital.

    I figure it would take 3-6 months of direct observation to really know if they’re excellent. Much less if theyre terrible. Its basically impossible for pts, its just the way it is.

    #187812 Reply

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