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How does one "find a good surgeon" ?
Old 10-17-2015, 08:09 AM   #1
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How does one "find a good surgeon" ?

An esteemed poster here wrote : << I'd advise researching the potential surgeons thoroughly, finding the right one is golden. >>

I'm having a difficult time finding a *good* surgeon for something urological. Seems like the review websites have all surgeons ranked at 3 or 4 stars (out of 5). Usually a mix of good and bad reviews. Never any board sanctions. And they're being reviewed for surgeries not exactly like the one you want. Then you find one you like but he's 74 and you fear he won't see well or remember something during the operation.... They say to ask a nurse who the good surgeons are for particular operations, but what if you don't know any nurses?

I found a place that specializes in urological surgeries, and their surgeons are ranked at 3 to 4 stars just like all the others.

*** What I want is a way to find a surgeon who has performed many operations the same as the one I may need, and the outcomes of all those surgeries. If I call up all the urologist offices and ask for this info, I don't think they will give it to me. ***

It's really tough to *find a good surgeon*. I do have a list of urologic surgeons, but so far am limited to sort of generic evaluations. I have no *insider information* . And I must admit I may secretly want to never find the right surgeon since I fear the surgery.
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Old 10-17-2015, 08:17 AM   #2
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A lot depends on your primary Doc and your health care system. I've had the same health care system and the same family Doc for 21 years. So, she knows the best ones and makes the appointments for me. Good luck!
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Old 10-17-2015, 08:31 AM   #3
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I agree with the importance of finding the right surgeon. Picking the wrong one almost cost me my life (not that this will happen to you; urological surgeries don't carry the level of risk that mine did). I'm not sure that "user reviews" on websites are all that helpful. They can be skewed by interpersonal or customer satisfaction issues that have nothing to do with surgical skill, complication rates, or outcomes.

I eventually found the right surgeon by talking with friends, one in particular, who knew this doctor, as well as nurses on the floor where I was recovering from my first surgeon.

That option might not be open to you, though. Some other ideas:

Do you have a primary care doctor you could ask?

Do you know anyone who has had the surgery you're contemplating?

I know it's a long shot, but you could also try talking to the nurse or office manager at the urology clinic (assuming the doctors work in a practice group ... if not, this won't work), explain your situation, and ask his/her opinion. "I know all your doctors are good, but if you had a family member undergoing this procedure, which doctor would you feel most comfortable sending them to?"

I know I'm being "age-ist," but I'd avoid the 74 year old. Usually by that time in their career, doctors tend to be on the decline, in the twilight years so to speak, and they've lost a few steps. You don't want someone too young, either. You want someone with at least a decade experience past residency, so roughly at least 40 years old.

That's all I can think of at the moment. Good luck!
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Old 10-17-2015, 08:38 AM   #4
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We are limited to in-network doctors, but that still leaves quite a few to winnow through, since we live in an area where doctors congregate. Here is how I analyze on-line information:

Do the doctors have credentials from a better U.S. or developed-nation university?

Do the online reviews contain substantive information, or are they just hitting "3 stars" and not saying why?

Are the criticisms more about the doctor's technique and results (stay away!) or complaints about his/her bedside manner, how nice the staff are, or issues with the billing department (not unimportant, but not as critical either)? I will say that I look very hard for evidence that the Dr. explains procedures carefully and patiently.

Then the only thing left is to actually consult with the Dr. and decide if you and he/she will get along. That costs us a co-payment, usually $35, and the time/trouble of a visit. If we aren't comfortable, we move to the next name on the list.

Best of luck. I totally 100% "get" not wanting to find someone so you don't "have" to go through with the surgery, but obviously you don't want to let a bad condition get worse, either.

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Old 10-17-2015, 08:43 AM   #5
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It's not ageist. It's realistic. Doctoring is hard work, and a lifetime of hard work will show on a person who's over 70. Even our wonderful dentist was forced to retire in her mid-50's because of the toll her profession took on her beautiful hands. The work she did for me in her final year, all failed and had to be replaced - at a cost to both me and the practice.

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I
I know I'm being "age-ist," but I'd avoid the 74 year old. Usually by that time in their career, doctors tend to be on the decline, in the twilight years so to speak, and they've lost a few steps.
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Old 10-17-2015, 09:05 AM   #6
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If you ask friends/acquaintances, invariably the response is either "my doctor is the best" or "my doctor was the worst." Either way, ask for some details as to why they felt that way.
Your family doctor may provide some guidance as well, but I've had mixed results with that method.
I tend to look at the doctor's educational background, the hospital affiliations, and the educational backgrounds of the other doctors in the practice. And I agree about avoiding a doctor that is getting up there in age. This may be politically incorrect, but I only go to doctors educated in USA.
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Old 10-17-2015, 09:19 AM   #7
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I am no expert on this topic, but I'll weigh in and tell you what I do. Everything I list below is in the "take it or leave it" category, and just a starting point to your own investigations, not the last word on this topic.

I try to get referrals from excellent doctors of other specialties that I go to for other things, and that I respect and trust. That's the number one starting point for me, and bears a lot of weight with me since I (rightly or wrongly) think that doctors of equal caliber would recommend one another. If I knew any surgical nurses I would ask their opinions especially. Ask the doctor (or nurse) that you get a name from, specifically if the surgeon does a lot of these surgeries or not. I prefer someone who is doing a lot of that particular surgery, more than most surgeons, but who also has other facets to his practice that keep him on his toes.

I get online to research medical training (where and when, was it a top notch US medical school?), where he did his residency, and if the surgeon is on the staff of the best hospital around. I don't pay any attention to online ratings, myself. Bear in mind that some of the best surgeons have a lousy "bedside manner" but the latter doesn't really matter as much as the quality of the surgery. Find out what specialties the surgeon is qualified and trained in; is he board certified in that specialty, if you care? I DO care a lot, because my father was a surgeon and his opinion was that that was extremely important (others will argue with that until they are blue in the face but I'm not going to change my mind on that). Can't do any harm to check that out, at any rate. Is he so old that I would be concerned about his capability of doing surgery? Is he so young that I would be concerned about his level of experience? Is his office located near the hospital where he does surgery (which might indicate that he does a lot of surgeries). Does he share an office with other qualified surgeons (showing that they don't mind being associated with him)? And so on.

I keep my ears open even before I need such a surgeon. New Orleanians say that New Orleans is the country's biggest small town, which may or may not be true. But word gets around.
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Old 10-17-2015, 09:31 AM   #8
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If at all possible and you have a trusted connection, checking with a surgical nurse at the hospital where you intend to have your procedure done can be helpful. I've been working in an acute care hospital setting for decades now. Trust me - surgical nurses see it all and hear it all.

Of equal and IMO at times greater concern (and most surgeons will agree) is finding a good anesthesiologist or nurse anesthetist. Putting someone to sleep is the easy part......
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Old 10-17-2015, 10:20 AM   #9
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Some surgeons publish their results. I live in a medium size city, and there are hospitals basically dedicated to orthopedic work. These admit or see no trauma, which helps to avoid infections. A joint replacement is just a big foreign body, which can easily become a focus for infection. Also, joints have relatively poor blood supply.

I needed a hip. I went around for 6 months on crutches while I attended presentations at the major joint replacement centers nearby. I chatted with the surgeons, with the young women who were doing the scheduling and coordinating, with people who were post op- with anyone I could. Then I chose a guy who had a 6-month waiting list, so another 6 months of crutches.

If you don't expect a signed statement you can usually find out a great deal about how others view the surgeons, and what the given surgeons attitudes are are regarding conservatism and risk etc.

Joint replacement surgery is not a slam dunk, but it tends to be very successful. I would not have chosen to be operated on if daily life had not become pretty hard. I was over 70, so I figured that I would likely never need a second replacement of this (my only arthritic joint, secondary to trauma). My old college roomie who was a joint replacement ortho told me that the first replacement on a joint tends to be better than any revisions.

It worked out fine, and now 18 months later I am hardly aware of the joint.

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Old 10-17-2015, 10:39 AM   #10
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I get online to research medical training (where and when, was it a top notch US medical school?), where he did his residency, and if the surgeon is on the staff of the best hospital around. I don't pay any attention to online ratings, myself. Bear in mind that some of the best surgeons have a lousy "bedside manner" but the latter doesn't really matter as much as the quality of the surgery. Find out what specialties the surgeon is qualified and trained in; is he board certified in that specialty, if you care? I DO care a lot, because my father was a surgeon and his opinion was that that was extremely important (others will argue with that until they are blue in the face but I'm not going to change my mind on that). Can't do any harm to check that out, at any rate. Is he so old that I would be concerned about his capability of doing surgery? Is he so young that I would be concerned about his level of experience? Is his office located near the hospital where he does surgery (which might indicate that he does a lot of surgeries). Does he share an office with other qualified surgeons (showing that they don't mind being associated with him)? And so on.
Some valid points. There are some surgeons who have excellent technique but poor bedside manner. Some of them may simply be introverts, but others are narcissistic bullies who will never admit a mistake. Avoid these.

Also, please bear in mind that the best surgeon may well be a woman.
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Old 10-17-2015, 10:55 AM   #11
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Agree with Meadbh's observations. Also bear in mind that 'poor bedside' manner also often means that pre-surgical and short and long-term aftercare is not what the surgeon sees as an important part of their role. They see themselves as 'Cutters' and all that other stuff is unimportant when in fact it is important to good patient outcomes. Also, agree that the best all round surgeon may in fact be a woman. Caution, introspection, and awareness of limitations seem to be more common traits in women who often seem to find it easier to use the entire 'team' to optimize outcomes. And they are often just excellent technicians as well.
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Old 10-17-2015, 10:59 AM   #12
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I am not sure if this website of top doctors might help in your selection, but it might al least give you another data point to see if someone you are interested in shows up on their list:
Where America Goes to Find a Doctor | Top10MD
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Old 10-17-2015, 11:11 AM   #13
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Agree with Meadbh's observations. Also bear in mind that 'poor bedside' manner also often means that pre-surgical and short and long-term aftercare is not what the surgeon sees as an important part of their role. They see themselves as 'Cutters' and all that other stuff is unimportant when in fact it is important to good patient outcomes. Also, agree that the best all round surgeon may in fact be a woman. Caution, introspection, and awareness of limitations seem to be more common traits in women who often seem to find it easier to use the entire 'team' to optimize outcomes. And they are often just excellent technicians as well.
+1
Well put!
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Old 10-17-2015, 12:44 PM   #14
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...

*** What I want is a way to find a surgeon who has performed many operations the same as the one I may need[, a facility that also has a high volume of that procedure], and the outcomes of all those surgeries. If I call up all the urologist offices and ask for this info, I don't think they will give it to me. ***

...
Facility experience is also of importance. The non-physician staff can be crucial.

I didn't see anyone mention the searchable database of surgical complications, by doctor name, compiled from medicare data, which is both the source for this article and linked from within it: https://www.propublica.org/article/s...urgeon-matters As with any data, this compilation is not definitive. But, if you don't have easy, "first name basis" access to a lot of physicians, it is probably the best source. (And, it has some big surprises in out-of-the way places--Helen Keller Memorial in NW rural Alabama for knee replacement?!?)

E.T.A. underlined phrase.
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Old 10-17-2015, 12:50 PM   #15
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... Also, agree that the best all round surgeon may in fact be a woman. Caution, introspection, and awareness of limitations seem to be more common traits in women who often seem to find it easier to use the entire 'team' to optimize outcomes. And they are often just excellent technicians as well.
or, just as easily, it may not be. (DW has yet to choose another female surgical doc for herself or her family--in her mind, the right person in the right specialty has, so far, always been a guy.)
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Old 10-17-2015, 01:19 PM   #16
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Facility experience is also of importance. The non-physician staff can be crucial.
Absolutely. For example:
Nursing care especially: Hand washing practices. Pain control. Medication safety.
Housekeeping staff: Clean environment
Pharmacy: Mediication safety.
Management: Organizational culture of safety.
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Old 10-17-2015, 03:22 PM   #17
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or, just as easily, it may not be. (DW has yet to choose another female surgical doc for herself or her family--in her mind, the right person in the right specialty has, so far, always been a guy.)
That is a statistical probability since the majority of surgeons are male.
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Old 10-17-2015, 03:41 PM   #18
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I've always found that asking a nurse is the best way to find a doctor or hospital. If she/he doesn't know the answer, they usually know someone who does.
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Old 10-18-2015, 04:43 AM   #19
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There is this interesting book, informative and easy to read, The Patient's Playbook, that just came out recently. Your library should have a copy, check it out.


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Old 10-18-2015, 07:04 AM   #20
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Not much useful to add, just some things I wanted to share.

There is a movement towards publishing statistics on how well hospitals and surgeons perform on stats that actually matter such as:
* How often one needs to go back
* Medical errors
* Time to recover

I believe in Denmark and Sweden they are the furthest. You might want to ask around if there are similar stats being available in the field where you need an operation. Sometimes they are shared between hospitals but not the public.

Barring that information, there is very clear evidence indeed that the best results come from surgeons and hospitals who do the operation themselves, and do it often. So not the surgeon supervising or signing off on the young surgeon, but actually doing the whole thing.

In addition the actual day where you get the operation also is a factor. Don't go in on the weekends or friday evening.
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