How does one "find a good surgeon" ?

[John Galt III]

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.

 

[jerome len]

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!

 

[ER Eddie]

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!

 

[Amethyst]

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.

Amethyst

 

[Amethyst]

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.

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.

 

[mystang52]

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.

 

[W2R]

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.

 

[candrew]

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......

 

[haha]

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.

Ha

 

[Meadbh]

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.

 

[6miths]

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.

 

[eytonxav]

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

 

[Meadbh]

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!

 

[2017ish]

...

*** 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/surgery-risks-patient-safety-surgeon-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.

 

[2017ish]

... 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.)

 

[Meadbh]

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.

 

[Meadbh]

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.

 

[lampshade]

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.

 

[Disappointed]

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.


Sent from my iPad using Early Retirement Forum
Mp

 

[Totoro]

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.

 

[MRG]

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.

Weekends, Fridays or holidays. Buddy's wife had a tubal ligation on Christmas day, and bleed to death. Any surgery can be deadly, best to improve the odds anyway you can.

 

[ivinsfan]

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.

Yes and check out the practice group as a whole, best laid plans and all that. My DH needed some cardiac work done on pretty short notice. Mitral valve repair, started to become a problem and they recommended sooner rather then later. Research 3 locations and sets of doctors. Pick the practice that he started with when it became a problem. (very highly rated), Has a conference in the hospital with a cardiac surgeon who he likes a lot. I research the gentleman and it's all good. Start the ball rolling, insurance, pre-test, and all that stuff. I get called a week later by the scheduler for a completely different surgeon ..I'm like WTH, what about Doctor A who worked with my DH, well Dr A says Dr B is the expert on valve repair around here and Dr B should do it.MY response was, why do we have to hear this from the scheduler because it's kind of a big deal.

We proceeded with Dr B and things went fine, however the day of admission I had to make a stink about actually talking to the doctor in person, they said he was busy. I said we have never even talked to the man and I am going to see him in person before the surgery. The PA do a lot of the opening and closing and all the support staff is crucial to good outcomes. I don't think they get enough credit for what they do.

 

[Bamaman]

Our neighbor is an anesthesiologist. I don't ask her who to get, but she will tell me who not to get as a surgeon.

And she knows she's good since she's a gas passer--watching every surgeon in our area perform their skills.

Good internal medicine doctors and good family practice docs will use good quality surgeons.

My urologist has a sign in front of his office with a dripping faucet applique. I'd think twice about using him for anything serious.

 

[Katsmeow]

Lots of good suggestion. A few years ago we moved to an area about 60 miles from where we lived before. So, we've needed to find some new doctors up here. We did a mix of things.

DH found his urologist by asking a former co-worker in the area. He gave us two names and I researched both.

We recently found a family practice doctor by asking the orthopedic surgeon who he recommends. He actually wrote out a list of several making comments on them.

DH found an ophthalmologist by looking for in network doctors in our area and they he had me research them.

In terms of researching, I will say that I do pay attention to online reviews. I don't go by any one review and don't go by rating overall. I look at the substance of the comments. I take it as a given that every doctor will have some unhappy patients. What is important to me is when I see a pattern of negative comments about things that would bother me. If it really looks to be pervasive then I will go to someone else unless I actually know someone who has good personal experience with the doctor.

I do realize reviews can be faked but I think I'm pretty good at spotting that kind of things. And, again, I'm looking more at patterns than individual reviews.

I also, in addition to checking where the doctor when to school, did his/her residency, etc., will do a Google search. For example, for one doctor that had been recommended to me by another doctor's office, I found a newspaper article about a reprimand of the doctor that gave a lot of details and resulted in me just deciding to take a pass on that doctor.

 

[swakyaby]

I sympathize with the OP's question of how a non-insider finds a good surgeon. Unless you know a surgical nurse or anesthesiologist in your area, it takes quite a bit of questioning and researching to rule out the marginal ones and narrow it down to the top recommended surgeons for the particular procedure you're most likely to have. I think W2R's suggestions are all excellent.

Also, there is a time and a place to do one's research, and it is well ahead of when it is anticipated that the surgery may be needed. In more than one occasion, I was asked by the patient only 5 minutes before going into surgery whether he had made the right choice in his particular surgeon. Not a good time and place for a completely unbiased opinion. I know some people just want some reassurance for their nervousness, but it's past the time for consideration of a different surgeon with better reputation.