Searching for a Surgeon
Having surgery is very serious, but sometimes people concentrate so much on the surgery they forget or overlook the fact that the quality of their life may be drastically altered post-surgery, and not always altered for the better. We often assume that “routine” surgeries are always successful, but when you are the surgical patient there is no such thing as a routine surgery, nor is there such a person as a nameless surgeon, and finding the right one to perform your surgery can make the difference, literally, between life and death.
Many people take the word of their primary care doctor, but such a decision can not possibly be left to another person, trusted doctor or not. If you need surgery, take the time to find the right surgeon—for you procedure and for you.
Is Surgery Really Necessary?
Before you begin the search to find the right surgeon you first need to be sure that surgery is in fact the best treatment option for you and your condition. Every surgery, even the most ‘routine’, carries certain risks; ones you may not be willing to test in the event you have another treatment option. Therefore, if your doctor has recommended surgery, ask if the doctor has exhausted all other avenues of treatment. If so, this is when you should seek a second opinion.
The Agency for Health Care Policy and Research can help you in this decision. They publish a booklet that is designed to help consumers and patients make an informed decision regarding whether or not surgery is the very best option. Call the Agency at 800-358-9295 and request a free copy of Questions To Ask Your Doctor Before You Have Surgery.
Qualities To Look For
Surgical referrals from primary care physicians are fine; presumably you trust your own doctor and you trust that he has considered your condition and concluded that this surgeon is the best option available. But can you trust such important issues as this solely to someone else’s judgment? Ask your doctor to give you more than one name so that you can compare the surgeons in experience and qualifications.
Referrals ought to be made on merit alone, but this is not how it works. Rather, referrals are typically based on unrelated factors, including friendships, associations, economic considerations, or social connections. This is no way to walk into an operating room.
In order to make an informed decision about finding the right surgeon, consider asking the following questions:
Is the surgeon board certified? What is the surgeon’s specialty?
The American Board of Medical Specialties (ABMS) requires a surgeon to have completed a specified number of years in residency in that specialty, and the surgeon must also have demonstrated knowledge and competence by successfully completing a rigorous examination.
Check out the ABMS at their website, www.abms.org, or give their hotline a ring at 800-776-2378. You can also go to your local library and look them up in the Directory of Medical Specialists.
Is the surgeon a Fellow of the American College of Surgeons (FACS)?
When you see “F.A.C.S.” following a surgeon’s name, this indicates that he or she has passed a comprehensive evaluation of both professional competence and ethical standards. To double-check on these qualifications for any surgeon claiming to be a Fellow of the ACS, call the American College of Surgeons at 312-202-5000 and request an updated list of fellows in your area, or visit them at www.facs.org
Is the surgeon a member of any medical societies, fraternities or professional associations? A large number of professional associations exist for surgeons in the US, and many of them have as a requirement for membership that the surgeons complete continuing education programs in addition to offering peer review procedures in an effort to keep the quality of care at the very highest levels.
Typically, these associations will aide consumers by providing them with membership lists. One example is the American Academy of Facial and Reconstructive Surgery, considered the world's largest professional organization of surgeons who specialize in facial plastic surgery.
If the doctor’s biographical information is available on the internet you can find out where he or she is a member and then check with that organization to ascertain the surgeon’s membership standing.
Is the surgeon affiliated with accredited hospitals or other health care facilities?
When contemplating a surgical procedure, the hospital you choose is just as important as the surgeon. To find out more on this topic, please see our article on choosing the right hospital.
Is the surgeon experienced in performing my procedure? It is strongly recommended that the surgeon you choose be board certified and be a member in the F.A.C.S. However you can not stop there, because these two criteria only display a surgeon’s so-called ‘general competence’, meaning he is, for lack of better terms, generally competent as a surgeon. Does that sound sufficient for you? Of course not.
The right surgeon for you is a surgeon who has a substantial amount of experience and proficiency in performing the procedure that is of interest to you. The bottom line is, the more often they’ve done it, the better they are likely to be. ACS typically informs patients who need open heart surgery that they need to find a surgical team that performs, at minimum, 150 open heart surgical procedures every year. Let that be your guide.
Has the surgeon been subject to professional peer review?
… sued for malpractice
… had his license suspended?
The Federation of State Medical Boards reports that nationwide, about one half of one percent of doctors in the US have been the subject of serious disciplinary action. You will want to determine if the surgeon you are considering is among that .5%.
To find out, call the Federation of State Medical Boards at 817-868-4000 to get the phone number for the licensing board in your state. You can also call the Public Citizen's Health Research Group in Washington, DC at 202-588-1000. They publish a book entitled Questionable Doctors, which many doctors and other health care professional claim is the physicians nationwide who have been the subject of disciplinary action, and it says why. A state supplement is available for $15.
Skills from Surgeon to Surgeon
It is unrealistic to assume for even a moment that all surgeons are built and trained and have gained experience equally. Of course the opposite is true, and 1991 studies published in the British Medical Journal determined that the skills of a particular surgeon can substantially affect a patient’s post-operative health for as long as ten years following the surgery.
The study examined survival rates among 650 patients of surgery for colorectal cancer . For the first month post-surgery, survival rates varied from 8 - 30 %, and in the ten years after the surgery, survival rates varied between 20 - 63 %, figures that were all dependent upon which surgeon performed the procedure.
Additionally, two other studies appeared in the Journal of the American Medical Association in 1991, which examined patient outcomes from one surgeon to the next. The authors of both studies were abhorred to see just how variable the patient outcomes could be for the same procedure. The reason? It all depended on the surgeon performing the procedure.
With just that much in mind, are you ready to take this business of finding the right surgeon seriously? We hope so!