Picking A Good Surgeon

After 20 years as a neurosurgery RN, NP and first assist in the hospital system, here is what I have learned. 

Every surgeon has lots of impressive credentials, years of experience, and they’ve all written tons of articles in academic journals.  Then certain surgeons have flashy marketing and a disproportionate amount of media attention and yes surgeons even have lawsuits.

But do any of these things actually tell us if the surgeon is any good at their job?

Well, no.

None of these variables give you any indication of whether your surgeon is actually any good AT ALL.

It's like the joke, what do you call a medical student who graduates dead last in his class?

Doctor.

Now, I'm not suggesting academic performance defines a surgeon's ability, because it doesn't.  GPA doesn’t factor in clinical skill, bedside manner or assimilation of complex information.  GPA evaluates rote memorization of chemical compounds that are clinically irrelevant.   The point is when all the surgeons look the same from the outside how can you weed out the good eggs from the bad eggs?

I had a surgeon try to impress me with the hundreds of articles he had written.

Am I impressed?

No.

Why? Because I know from working in academics and in the operating room that the surgeon either:

1.       Has a team of medical students working off a template to churn out articles, which are invariably iterations of each other on some minor point  
 

2.       If the surgeon spent all that time writing the articles by him/herself, then they ain’t spending much time in the operating room. 

 

Writing is intensive and writing and surgery are not synergistic or complementary.  Just because a surgeon is good at one thing doesn't mean they’re any good at the other.

Hmmmm..

Personally, I look for a surgeon who is several years out of residency who is too busy operating to write quite yet or have academic fame because that surgeon is on the top of her game.  But it’s still only one variable and not a terribly strong one to depend on.

Am I impressed by the Top Docs in every glamorous magazine I see?

Nope.

In fact, I scratch those surgeons off my list immediately.

Why?

You should know that media attention is NOT earned, it's bought.   A surgeon with tons of media attention has spent tons of time courting journalists.   Again this is a case where marketing and surgery aren't interchangeable.  Time spent on TV shows, radio shows and in the media limelight dancing with the stars is time NOT spent with patients, in the operating room nor prepping for a big case.

Big spreads in magazines are well, impressive, but don't reassure me that surgeon is any good.  In fact, they make me think the surgeon is full of himself and obsessed with all the attention. Having lots of media attention doesn’t make a surgeon bad, but it certainly doesn’t help with making a decision if that surgeon is any good.  Beware of glitzy marketing.

Ahh.. I know, here's one...

You’ve discovered your surgeon has been in a lawsuit, so he or she must be bad, right?

Wrong!

If a surgeon is actively practicing and is any good, then they will inevitably be involved in a lawsuit. Surgery is inherently risky and there is always the looming high probability that a low probability event that will occur.

A low probability event is an incident that occurs during surgery - a mistake, an error, a complication, an issue, an unforeseen challenge. Surgeons carry malpractice because there is a high probability they will be involved in a low probability event during their careers. This is not a direct reflection of their skill.

And in fact I would argue surgeons who haven't been involved in lawsuits probably aren't operating very much.  Don’t rule out surgeons because of the presence of a lawsuit.

So if we can't go on any of the obvious variables on how to judge a surgeon on his or her skill, then what can we go on?

In my 20 years of working with surgeons, the good, the bad and the downright dangerous, I can tell you to focus on these 3 things:

1.       Testimonials.  Ask for names of 5-10 patients who have been operated on by the surgeon and actually call them.  If your surgeon can't or won't provide you with real people who he or she has operated on, it's red flag. 

There should be a place online to find reviews.  No one has all glowing reviews and if they do, they are probably fake OR the bad ones were suppressed – RUN! 

Real testimonials will have good and bad experiences, but the majority of the should be good.  You will always find one person who is unreasonably angry at the surgeon who writes a scathing review and I would ignore those.  Look for the 3-4 star reviews and put more emphasis on those.  They tend to provide a more accurate picture of what it was like to work with the surgeon.  They give pros and cons that you can decide if you can deal with.
 

2.       Personal Interactions.   Now this is critical.  Watch how the surgeon interacts with the team, not with you.  If a surgeon has rotten bedside manner, leave immediately.

Most surgeons have sense enough to keep it together in front of a patient.  If the surgeon has a mean office staff, or they don't along, the surgeon is nasty to them, demeaning or talks down to people or speaks poorly of them, this is a huge insight into their world.

Maybe you think it's just office politics or an isolated issue. But the fact is culture comes from the top down.  If a surgeon has a nasty staff, it's the culture that comes from the surgeon.

Why is this a problem?

Because the surgeon carries that culture to the operating room and to the hospital team. A team that argues, fights, is mean, back-stabbing or simply afraid of the surgeon - is Dangerous!

As a first assist I've been in the operating room with a team that was dysfunctional and when we had an "issue" come up, it was unnecessarily stressful, demoralizing and it paralyzed people with fear.

If a surgeon rules by fear, it's a red flag. And it starts with the office staff. The only caveat I would add here is that this insight doesn't necessarily hold in large, academic medical settings where bad employees tend to be shuffled around instead of fired.  The surgeon may little control over office politics in a large department, but he or she does have control over what they say about their colleagues.  Keep your ears open.
 

3.       Instinct.  Go with your instincts.  I can’t emphasis this enough.   If something feels wrong, you don't have to prove anything.  Trust your instincts. Your senses process more than the mind can understand.  Your subconscious might pick up on something you can't explain.

The problem is a lot of people choose a surgeon from a glitzy magazine ad and then become fixated on getting that surgeon at all costs.  In this case your instincts get squashed by your emotional connection to insisting on a particular person.  My advice is to set up consults with a minimum of 3 surgeons and be open to all of them.  I would encourage you find at least 5 surgeons and interview them all prior to making a choice of who to go with.  This will allow your instincts to help you make the decision.

The good news? The bad eggs are few and far between and good surgeons are plentiful.  Most surgical cases are straightforward and routine for surgeons. 

If you are having an extremely complex or difficult surgery, these criteria might not apply.  For instance, I would tolerate a crazy surgeon with a mean office staff and bad bedside manner if he or she is highly skilled on a particular technique that no one else does. 

But if you aren’t having a complex surgery stick with surgeons with a good reputation in the community, who can prove results, who work well in teams and who give you a good feeling.

Catie HarrisComment