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ProPublica - Choosing the right surgeon
Old 07-18-2015, 08:15 AM   #1
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ProPublica - Choosing the right surgeon

A fascinating article about just how important it is to choose the right surgeon, and also a database of complication rates for 8 procedures. https://www.propublica.org/article/s...urgeon-matters.

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But a ProPublica analysis of Medicare data found that, when it comes to elective operations, it is much more important to pick the right surgeon.
Today, we are making public the complication rates of nearly 17,000 surgeons nationwide. Patients will be able to weigh surgeons’ past performance as they make what can be a life-and-death decision. Doctors themselves can see where they stand relative to their peers.
./.
A small share of doctors, 11 percent, accounted for about 25 percent of the complications. Hundreds of surgeons across the country had rates double and triple the national average. Every day, surgeons with the highest complication rates in our analysis are performing operations in hospitals nationwide.
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Old 07-18-2015, 09:01 AM   #2
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Transparency is always good. I hope this gets expanded to other areas, and I hope the data drives hospitals to work towards performance improvement for Doctors with lower scores (more training, more supervision, etc).

I also hope their methodology is good, this can be a tricky thing to measure. People might be concerned that Doctors won't want to take the harder cases, but I imagine that what it actually will do is direct the harder cases to the best surgeons? That would help keep scores from becoming outside the middle range, where they get attention? That seems appropriate?

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Old 07-18-2015, 11:37 AM   #3
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Originally Posted by MichaelB View Post
A fascinating article about just how important it is to choose the right surgeon, and also a database of complication rates for 8 procedures. https://www.propublica.org/article/s...urgeon-matters.
It can be a very difficult thing to extrapolate, just like some clinical studies, when you have situations like this:

(from MichaleB's article)
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Dr. Misop Han, an associate professor of urology and oncology at the Johns Hopkins Hospital, did prostate removals on 86 Medicare patients in ProPublica’s analysis between 2009 and 2013. A dozen of them had complications, our analysis showed. Adjusting for his patient mix and other factors, Han’s complication rate was 7.6 percent.
Over 4 years the surgeon performed 86 surgeries. Not THAT many when you think about it. And when you have 12 complications out of 86, it's not really as useful of a trend as, say, 120 out of 860, since a large % of those 12 could have each had something different going on with them. So given that many surgeons perform a relatively small quantity of operations, it can be very tricky to really figure out just how 'good/bad' they are, since not only is the specific patient a variable, but there are dozens of other factors that can contribute to a patient's health and safety which are completely beyond the skill of the surgeon (nurses in the OR, hospital's sanitation procedures, etc.).

Of course, if I had to get a surgery, I would naturally/subconsciously lean towards a surgeon that had 0 or maybe 1 or 2 complications, vs one that has 12.

If a surgeon works at more than one location, I would also want to pay particular attention to how their stats are at one location vs another as well.
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Old 07-18-2015, 01:03 PM   #4
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The 86 surgeries were only those he performed on Medicare-covered patients. He may have performed many more on non-Medicare patients, who may have had more or less complications than the Medicare patients.
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Old 07-18-2015, 02:04 PM   #5
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Some of the problems discussed in this thread seem to me to be important, but don't mean that these ratings are not helpful

For example, if I were looking for a surgeon to do an operation that I needed, I would tend to pick one with a very low rate of complications. Perhaps this is affected by cherry picking patients to operate on. Who cares? If he accepts you for surgery, you must fall within his parameters and therefor you are in the same class that provided his data.

In any case, does it make any sense at all that some surgeons would not get consider4ably better results than others? That would only seems reasonable if there were no aspect of skill involved.

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Old 07-18-2015, 02:25 PM   #6
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In any case, does it make any sense at all that some surgeons would not get consider4ably better results than others? That would only seems reasonable if there were no aspect of skill involved.
Exactly. No matter what measure you use, your randomly selected doctor, plumber, financial advisor, teacher or any other professional has a 50% chance of measuring below the median. That's just math.

Outcome statistics have been floated and endlessly debated in the healthcare industry for many years. Surgeons are usually singled out because their work is procedural and more clearly linked to them as individuals. If you want to compare care given in the ICU, for example, you would be looking at a less well defined care delivered over a period of time by a multidisciplinary team, and it would be preferable to look at outcomes of specific diagnoses in large groups of patients in different hospitals. I often think the surgical outcomes comparisons are a bit unfair to individual surgeons because they do not account for non-surgeon related issues such as wait times, overworked nurses, transfusion errors, etc, etc. As previously pointed out, patient variables and small numbers often make apples to apples comparisons invalid. These limitations lead some physicians to criticize and disregard the data.

Previous research has suggested that public access to these data do not change patient choices very much. (If they did, the surgeons with the best outcomes would quickly develop long waiting lists). Where such data can be really useful is in the hands of chief surgeons, who can work with their staff to analyze the data and develop strategies to improve both processes and outcomes. Strategies might include having a buddy assist in the OR, and developing following and monitoring evidence based clinical guidelines.
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Old 07-18-2015, 06:50 PM   #7
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My doctor thinks an old electric stimulator in my leg might need to be removed. If so, his physician of choice is a surgeon with a specialty in plastic surgery. At first I was hesitant about this choice but as I thought about it a plastic surgeon probably handles many sensitive cases such as burn victims, accident victims, etc. and might even have more occasions calling for removal of a implant. Healthgrades indicates that the state of Washington does not permit them to report malpractice, etc.
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Old 07-18-2015, 07:05 PM   #8
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Ask a Registered Nurse who has worked with patients of surgeons you are considering. They will know more about your personal chances for a good outcome than any statistic.

Seriously.
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Old 07-18-2015, 09:31 PM   #9
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Ask a Registered Nurse who has worked with patients of surgeons you are considering. They will know more about your personal chances for a good outcome than any statistic.

Seriously.
How do you find a registered nurse who has worked with patients of Dr X?
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Old 07-19-2015, 07:15 AM   #10
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How do you find a registered nurse who has worked with patients of Dr X?
Marrying one works pretty well.
DW is an OR nurse, which is even better. And if she doesn't know about a particular doc, she can also talk to her coworkers. This is a benefit we will miss when she retires and we move.
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Old 07-19-2015, 10:48 AM   #11
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How do you find a registered nurse who has worked with patients of Dr X?
Home care registered nurses are a great resource. They see patients of all local physicians, and often post surgery. That is when the complications start to become apparent, unless they are severe and the complications delay discharge from the hospital.

RN's working in the OR or on a surgical floor at the local hospital are also a great resource, and will have personal experience working with the surgeon.
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Old 07-19-2015, 11:38 AM   #12
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Wow, this is so timely for me.

I was diagnosed with Basal Cell Skin Cancer (BCC) recently. I have a mole on my nose bridge close to my right eye that has been growing. The dermatologist said during the biopsy that it was BCC and that her partner in same office can perform Mohs surgery as outpatient.

I received a call 10 days after my biopsy confirming that I have BCC and the lady said that the I should make an appointment with my dermatologist's partner. During the 10 days of waiting I did some research on Mohs surgery. I also looked up the bio of the surgeon that I was supposed to make an appointment with and found that he had no Mohs training. Since the lesion is so close to my right eye I want somebody with experience and training specifically for Mohs surgery.

Finding a good surgeon is very difficult, through the internet, I found American College of Mohs Surgery with a "find doctor" feature, I found several listed in my area. The problem is which one should I choose? There are no reliable reviews of these doctors? Believe it or not, Yelp is the only website that has reviews with description. Other websites such as Healthgrades and others like it do not have much description of their ratings.

So, am I supposed to rely on Yelp?
One doctor listed that she has done thousands of Mohs surgeries, but are they all with good results and no complications?
I feel it to be very difficult to choose a surgeon for myself, so far I have met with one and not entirely comfortable with her. I have two more appointments coming up next week and hope that I can find one that I am comfortable with.

Websites such as Cancerforums.net can be very helpful (for prostate cancer), however, skin cancer forum is not very active and is not as informative.

Very frustrating.
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Old 07-19-2015, 01:59 PM   #13
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One good thing is that this surgery is cut and check, it is superficial, and BCC is not an aggressive cancer. So likely you will do very well no matter what.

Ha
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Old 07-19-2015, 02:35 PM   #14
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Thanks Haha, from your lips to god's ears.




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Old 07-19-2015, 02:51 PM   #15
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Home care registered nurses are a great resource. They see patients of all local physicians, and often post surgery. That is when the complications start to become apparent, unless they are severe and the complications delay discharge from the hospital.

RN's working in the OR or on a surgical floor at the local hospital are also a great resource, and will have personal experience working with the surgeon.
Silver...

I hope I'm not asking too much here but since I'm looking into some elective surgery right now I'm really interested in proceeding with your suggestion but can't get a handle on how to do it.......

I don't have a clue how I could get in contact with either a home care registered nurse or an OR nurse who would be familiar with a particular surgeon's work. Especially as a stranger looking for inside info on a particular doc. Wouldn't they be worried about liability or their reputation in the profession?

It seems like first I'd have to get a name and contact info. Then I'd have to introduce myself, explain what I want and make him/her feel at ease passing out info on the doc confidentially to a stranger.

I don't have a friend or relative in the profession and, while I like your idea, can't fathom how to identify and approach a contact.

More clues please.


EDIT: BTW, I did try the tool that Michael posted. The surgeon I'm considering using is listed as not having done enough (20) Medicare operations of this type to qualify to have their data posted.
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Old 07-19-2015, 03:41 PM   #16
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Silver...

I hope I'm not asking too much here but since I'm looking into some elective surgery right now I'm really interested in proceeding with your suggestion but can't get a handle on how to do it.......

I don't have a clue how I could get in contact with either a home care registered nurse or an OR nurse who would be familiar with a particular surgeon's work. Especially as a stranger looking for inside info on a particular doc. Wouldn't they be worried about liability or their reputation in the profession?

It seems like first I'd have to get a name and contact info. Then I'd have to introduce myself, explain what I want and make him/her feel at ease passing out info on the doc confidentially to a stranger.

I don't have a friend or relative in the profession and, while I like your idea, can't fathom how to identify and approach a contact.

More clues please.


EDIT: BTW, I did try the tool that Michael posted. The surgeon I'm considering using is listed as not having done enough (20) Medicare operations of this type to qualify to have their data posted.

I understand the issue. It's most helpful to know someone who knows someone, but I can tell you that when I worked clinically as a surgical RN and wore scrubs after work at the grocery store, I was approached a few times by total strangers asking for physician recommendations.

Sometimes I needed to prompt them to get them to ask the right question. (Substitute your own health problem as appropriate below)

"If you needed a hip replacement, who would you most likely use?"

If they are hesitant to respond then perhaps they are uncomfortable answering. But most RN's are very interested in people getting good care, and will respond with whomever they know are clinically proficient. And when asked about their own health care providers preferences, will be honest.
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Old 07-19-2015, 03:50 PM   #17
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when I worked clinically as a surgical RN and wore scrubs after work at the grocery store, I was approached a few times by total strangers asking for physician recommendations.
Oh..... Didn't realize you were in the trade. I think your suggestion might be great for someone in the trade, married to someone in the trade or having a friend or relative in the trade. Kinda tough for us outsiders......

I'll be on the lookout for surgical RN's wearing scrubs in the grocery store though!

Otherwise, I think I'm going to press my GP doc harder for a recommendation and his reasons for any names he gives me. I'm also using whatever Internet info I can find. Don't know what else to do.
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Old 07-19-2015, 03:55 PM   #18
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EDIT: BTW, I did try the tool that Michael posted. The surgeon I'm considering using is listed as not having done enough (20) Medicare operations of this type to qualify to have their data posted.
If there is no qualitative data available, and no knowledgeable friend with a view from the inside, a surgeon with more experience is probably a safer risk than one with less experience. The Medicare payment data base shows reimbursement by physician by procedure. It takes some time to crawl through all the data but it does give you a good quantitative look, which is better than nothing. I used this approach last year for cataract surgery. The data base helped a little to select the doctor but it was very helpful eliminating candidates.

Medicare only data is a subset of the total population, but a very large one, and for surgeries as well as many other conditions, useful.
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Old 07-19-2015, 09:31 PM   #19
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..............

One doctor listed that she has done thousands of Mohs surgeries, but are they all with good results and no complications?
.....
You could ask her. I suspect ethics require an honest answer.
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Old 07-19-2015, 09:42 PM   #20
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If there is no qualitative data available, and no knowledgeable friend with a view from the inside, a surgeon with more experience is probably a safer risk than one with less experience. The Medicare payment data base shows reimbursement by physician by procedure. It takes some time to crawl through all the data but it does give you a good quantitative look, which is better than nothing. I used this approach last year for cataract surgery. The data base helped a little to select the doctor but it was very helpful eliminating candidates.

Medicare only data is a subset of the total population, but a very large one, and for surgeries as well as many other conditions, useful.

Thanks! I'll dig into that.
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