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What makes a good surgeon?

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  • Drop it into MD Drop it into MD 
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    As a “medical professional” we can submit a form to DMV directly.  I do try to empower the family.  The worst is when I get the phone call the morning of Dad’s appointment and their kid want to tell me how they are concerns but they do not want me to tell there father how I know he is having issues.  I do strongly encourage family members to come to appointments to voice those opinions.  But I do let them know there is an anonymous way to let DMV know as well.

    #188504 Reply
    Liked by AZPT
    Avatar Ykcor 
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    Maybe not as revelant now, but when I was in training in the post Vietnam War period the best surgery residents were the ones that had served in the military combat hospitals. Nothing rattled them.

    #195676 Reply
    Avatar IntensiveCareBear 
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    First off, you obviously go to ABMS and find someone certified in the appropriate surgical specialty… and sub-specialty cert or society, if applicable. This sounds like a given if it is a surgeon on staff at a major hospital, but it is most definitely not. Many gen surg guys have “colorectal” or “vascular” or “pediatric” or gen orthos list “sports” or “total joint” or “spine” on their website or skills listing… without having done an actual fellowship training for that. You want the best, so take 10min and do your homework.

    …among board cert docs for the procedure you need, you basically want the cockiest guy you can find who is in his 40s or 50s. It is usually best to ask the senior surg residents or other surgeons who is good and who they’d want operating on their family if possible. Why cocky? Because good surgeons are busy, high volume, and work too much. That is almost universally true that they will have a sizable ego and be curt with most of their interactions out of necessity. Work is what’s standing between them and sleep on many days. Gladhanding and timid personality generally has little place in surgery.

    Surgeons in their 30s and fresh out of residency are generally not experienced enough and haven’t “learned from their mistakes” (both procedure technique and pre/post op eval/candidate mishaps). Most past 60 years old generally don’t have eyes and hands they once did, and their knowledge on latest techniques and implants might be dated (hence why they are forced to retire from the OR around that age in much of Europe).

    This isn’t a long term relationship for surgery; you just need a good technical result. That means finding a well trained, confident, and busy guy in his physical prime. GL

    #196817 Reply
    Avatar JWeb 
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    you basically want the cockiest guy you can find who is in his 40s or 50s. It is usually best to ask the senior surg residents or other surgeons who is good and who they’d want operating on their family if possible. Why cocky? Because good surgeons are busy, high volume, and work too much. That is almost universally true that they will have a sizable ego and be curt with most of their interactions out of necessity.

    Click to expand…

    Cocky, no. You meant to say confident. Truly cocky surgeons aren’t truly confident.  The most confident and skilled surgeons I know are NOT cocky.  There are cocky surgeons who are very good, of course. And someone who seems cocky is likely much better than one who does not seem confident.

    A cocky surgeon will not be realistic about the risks of any procedure.

    A confident surgeon will tell you exactly what you should know.

    Also, busy does not necessarily equal good.

    #196824 Reply
    mkintx mkintx 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    #196858 Reply
    Avatar veritablpenguin 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    Click to expand…

    Radiologists are also pretty good at telling who’s good post-operatively, especially ortho/spine.

    Hard to find one person who can tell you who’s good start to finish.  And also, you can be good in some domains and not in others.

    As an anesthesiologist I can generally tell you who’s decent in the OR and to some degree judge their pre-op decision-making.  OR nurses/scrubs probably even better judges of efficiency/technical skill.

    #196910 Reply
    Zaphod Zaphod 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    Click to expand…

    Radiologists are also pretty good at telling who’s good post-operatively, especially ortho/spine.

    Hard to find one person who can tell you who’s good start to finish.  And also, you can be good in some domains and not in others.

    As an anesthesiologist I can generally tell you who’s decent in the OR and to some degree judge their pre-op decision-making.  OR nurses/scrubs probably even better judges of efficiency/technical skill.

    Click to expand…

    Anesthesia is probably an easy judge of preop decision making, and who may be gruff in the OR. Much harder to tell who is ‘good’. Probably right about rads with Ortho, at least they can objectively notice over time if someone has poor union/placements.

    RNs/Scrubs will mostly tell you who they like personally and cant tell the difference, which can be but isnt really correlated to performance. There are some really bad docs out there that are quite likable and get away with a lot, and good ones that dont.

    There unfortunately isnt a simple heuristic, it doesnt exist.

    #196914 Reply
    jfoxcpacfp jfoxcpacfp 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    Click to expand…

    Radiologists are also pretty good at telling who’s good post-operatively, especially ortho/spine.

    Hard to find one person who can tell you who’s good start to finish.  And also, you can be good in some domains and not in others.

    As an anesthesiologist I can generally tell you who’s decent in the OR and to some degree judge their pre-op decision-making.  OR nurses/scrubs probably even better judges of efficiency/technical skill.

    Click to expand…

    Anesthesia is probably an easy judge of preop decision making, and who may be gruff in the OR. Much harder to tell who is ‘good’. Probably right about rads with Ortho, at least they can objectively notice over time if someone has poor union/placements.

    RNs/Scrubs will mostly tell you who they like personally and cant tell the difference, which can be but isnt really correlated to performance. There are some really bad docs out there that are quite likable and get away with a lot, and good ones that dont.

    There unfortunately isnt a simple heuristic, it doesnt exist.

    Click to expand…

    Sigh, you had me at heuristic.

    Seriously, too bad financial planners and “advisors” don’t have a scrub nurse equivalent. I think it would be a good thing.

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

    #196924 Reply
    Liked by Zaphod
    ACPC ACPC 
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    IMHO, probably the most effective thing you can do to find the best surgeon in the region is to pay for a (non-referred) second opinion. During the visit, thank them for their time and explain clearly that you will not be using the surgeon you are seeing, nor one at their institution, but want their opinion about whether a procedure is absolutely necessary (or appropriate in the case of cosmetics). Then ask them who they would go to or send their family to. You can also ask them, with a promise of confidence, who to avoid (many will not disclose this, but its worth a shot).

    Many surgeons know who to avoid within their field because they see patients following the complications of others, and there is also word of mouth. The surgeon at my training program who saw (and operated on) the most other surgeons when they had an issue was not famous, well-published, young, most-senior, nor (tbh) most technically skilled. But his judgment was very well known, he always made the most reasoned decision, and he very rarely had complications (and those he had, he owned transparently and spoke about honestly).

    #197001 Reply
    Avatar Peds 
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    RNs/Scrubs will mostly tell you who they like personally and cant tell the difference, which can be but isnt really correlated to performance.

    Click to expand…

    thank you, this.

    #197006 Reply
    Liked by Zaphod
    Avatar Panscan 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    Click to expand…

    Radiologists are also pretty good at telling who’s good post-operatively, especially ortho/spine.

    Hard to find one person who can tell you who’s good start to finish.  And also, you can be good in some domains and not in others.

    As an anesthesiologist I can generally tell you who’s decent in the OR and to some degree judge their pre-op decision-making.  OR nurses/scrubs probably even better judges of efficiency/technical skill.

    Click to expand…

    Anesthesia is probably an easy judge of preop decision making, and who may be gruff in the OR. Much harder to tell who is ‘good’. Probably right about rads with Ortho, at least they can objectively notice over time if someone has poor union/placements.

    RNs/Scrubs will mostly tell you who they like personally and cant tell the difference, which can be but isnt really correlated to performance. There are some really bad docs out there that are quite likable and get away with a lot, and good ones that dont.

    There unfortunately isnt a simple heuristic, it doesnt exist.

    Click to expand…

    how does anesthesia know anything about preop decision making? I guess if you’re talking about if they’re likely too sick for the surgery or something like that. but knowing the kind of ostomy that would be appropriate or etc, they have no clue.

    like you said I don’t think anyone knows besides their peers.

    not related to your post but others in this thread:

    Not sure about the radiology and spine thing either? imaging doesn’t correlate with symptoms at all for spine stuff so I have no idea how I can make a judgement on the surgeon based on what the patient’s MR looks like, unless they’re putting hardware where it shouldn’t be or something like the dr death guy, which is obviously a very rare exception.

    some of the most negligent surgeons I have met are the most cocky. the really good ones can be pretty cocky too or be very laid back.

    I think numbers are the best way. someone who does 500 hernia repairs a year probably doesn’t suck at them. someone that does 50? definitely more leeway for them to suck.

    #197033 Reply
    Zaphod Zaphod 
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    I can tell you, as a pathologist, which surgeons always have good margins, which surgeons only need 4 tries to find all four parathyroids, and which surgeons truly understand how to take tissue for a lymphoma work-up.  Presumably, an anesthesiologist can tell you which surgeons perform well in the OR.  But the only doc who can tell you how these patients fare post-op are their primary care docs. Some of the surgeons the patients love the most are the worst around, but have a great bedside manner.

    I definitely have my favorite surgeons in town, but when I needed an appendectomy I had the on call surgeon, whom I had never met or worked with, do the job.  Patients don’t really get a choice in this situation.

    Click to expand…

    Radiologists are also pretty good at telling who’s good post-operatively, especially ortho/spine.

    Hard to find one person who can tell you who’s good start to finish.  And also, you can be good in some domains and not in others.

    As an anesthesiologist I can generally tell you who’s decent in the OR and to some degree judge their pre-op decision-making.  OR nurses/scrubs probably even better judges of efficiency/technical skill.

    Click to expand…

    Anesthesia is probably an easy judge of preop decision making, and who may be gruff in the OR. Much harder to tell who is ‘good’. Probably right about rads with Ortho, at least they can objectively notice over time if someone has poor union/placements.

    RNs/Scrubs will mostly tell you who they like personally and cant tell the difference, which can be but isnt really correlated to performance. There are some really bad docs out there that are quite likable and get away with a lot, and good ones that dont.

    There unfortunately isnt a simple heuristic, it doesnt exist.

    Click to expand…

    how does anesthesia know anything about preop decision making? I guess if you’re talking about if they’re likely too sick for the surgery or something like that. but knowing the kind of ostomy that would be appropriate or etc, they have no clue.

    like you said I don’t think anyone knows besides their peers.

    not related to your post but others in this thread:

    Not sure about the radiology and spine thing either? imaging doesn’t correlate with symptoms at all for spine stuff so I have no idea how I can make a judgement on the surgeon based on what the patient’s MR looks like, unless they’re putting hardware where it shouldn’t be or something like the dr death guy, which is obviously a very rare exception.

    some of the most negligent surgeons I have met are the most cocky. the really good ones can be pretty cocky too or be very laid back.

    I think numbers are the best way. someone who does 500 hernia repairs a year probably doesn’t suck at them. someone that does 50? definitely more leeway for them to suck.

    Click to expand…

    yes, that they are taking suboptimal pts for surgery. For rads, also agree it would only show outliers, and tbh you dont need perfectly beautiful fixation to be a good surgical outcome. Some will do k-wires and others plates with equally good outcomes, but wires look awful (thinking hand here). So again, it just aint easy.

    Agree volume is one of the only indicators. At least you’ll know theyre facile with the surgery and have seen many variations and complications. Im pretty ideological that its impossible to know without being a peer. Along the same line of reasoning I dont believe you can actually have true informed consent. Its impossible and any half decent doctor can convince a pt to do anything, even when they dont realize thats what theyre doing.

    Agree with other things. Everyone simply wants there to be a way to easily see if someone is “good”, its just hard.

    #197037 Reply
    Liked by q-school
    FunkDoc83 FunkDoc83 
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    Zaphod, let’s come up with our metric for this and become famous!!!

    #197042 Reply
    Liked by Zaphod
    MPMD MPMD 
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    I would think that anesthesia would have quite a bit of insight actually.

    You’d have a hard time getting me to believe that demeanor in the OR isn’t pretty well correlated w/ technical ability. Usually in the hospital when someone is being unreasonable or angry one of 2 things is going on.

    1) They are being asked to do something they can do at an uncomfortable time of day (e.g. being woken up at 2am on call)

    2) They are advertising their lack of confidence in their skill set.

    So a surgeon who is a total dick in the OR and loses their mind easily, sorry I’m not going to follow anyone down the path of justification that it’s b/c they are some kind of tortured genius.

    I tend to look for what special forces soldiers call “quiet professionalism.” Confidence w/o being cocky. When I think of the most highly respected surgeons at my current shop (some of whom are world famous) they tend to be middle aged and extremely professional in their interactions. Actually most of them are frankly just really nice people, warm, friendly, etc.

    There is IMHO an entirely unhelpful and unnecessary mystique about surgeons and many obviously have the attitude that non-surgeons are not able to meaningfully assess surgeons. I reject this paradigm completely.

    #197044 Reply
    FunkDoc83 FunkDoc83 
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    So a surgeon who is a total dick in the OR and loses their mind easily, sorry I’m not going to follow anyone down the path of justification that it’s b/c they are some kind of tortured genius.

     

    Click to expand…

    LOL.  I’d expect that more at a teaching institution, or tertiary care center.  Don’t you work at one of those?

    #197045 Reply

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