How do you choose a surgeon

28th January 2016 Simon White 877 Views
lego surgeon

Last Summer my Mum became acutely unwell and needed some urgent treatment. She was admitted as an emergency to her local hospital in Southampton and underwent some tests which culminated in her being referred for major surgery under a local specialist. 

Prior to her operation there was a lot of discussion between myself and my parents about her specialist. Was he the best person for the job? My mum had made friends with the lady in the bed opposite who was under a different specialist and both of them thought that their surgeon was the best and were comparing notes, but how could anyone really know? My Mum and Dad were naturally worried as they wanted to have the best result possible. 

The internet allows a lot of information gathering nowadays. It is possible to read profiles about Consultants, learn about their experience and training, prizes won etc. NHS Choices allows you to check the number of procedures and the mortality rate for a surgeon in England (not currently up and running for Wales). This itself has some drawbacks as mortality may be related to the complexity of the surgery performed, the performance of the whole department in the hospital rather than just one person (for instance the intensive care unit, the anaesthetists, the junior doctors, the nurses), the general health of the patient prior to surgery etc. For instance a heart surgeon working in a very deprived area of the country where patients have more medical problems, may be disadvantaged as his or her patients may have higher risks of complications or mortality as a result.

There are websites that seem to promote certain specialists, and magazines in waiting rooms, or newspaper articles promoting certain specialists, but remember that many of these are nothing more than advertisements, often with a hefty fee paid to have a bigger spread in the magazine, and often have no reflection on the outcomes or results of that specialist. One article in a national newspaper a few years ago listed the best surgeons for various operations, but the shortlist was determined by asking 40 Consultants who they would recommend, and it seemed to be the case that those asked voted for each other and no-one knows how the 40 were determined. Newspaper articles generally only promote new or exciting procedures, which time and time again do not seem to have such good success rates as tried and tested established procedures, particularly when talking about hip or knee replacement implants. No newspaper would want to report a reliable hip replacement that has been used for 15 years as it does not make a good story for journalists.

The most important thing for you as a patient is to have utmost trust in your surgeon, that you are being guided correctly down a route that both of you are comfortable with. That is a two way thing, as both you and your surgeon have to agree the procedure is correct for you, trust each other that you will both do your part of the bargain (for instance you will need to do lots of physiotherapy for a knee replacement), and that your surgeon has the requisite skills and experience to perform that procedure. You don't want a surgeon who thinks he can do everything but actually does some things so rarely that they are no longer good at that procedure. You want a surgeon who can talk with you and inspire confidence, who has time to explain everything in language you understand. My Mum's surgeon always had time to speak to us whatever time of day. He would spot us in a waiting room and make a point of coming over to say hello even if he was busy. Once my Mum had told him that I was trying to get across from Cardiff that morning to visit, and he magically appeared even though I hadn't arranged to see him.

A surgeon should not just operate all the time, but make time to become an expert in their field with research, teaching of other surgeons and healthcare professionals. They should be a member of their specialist societies, and attend meetings to keep updated in their particular field. Of course experience is important.  These days the number of operations performed during training is much less than it was a few years ago. As a result, a newly qualified Consultant may have performed much fewer operations than a predecessor 10 years ago and therefore there is much more experience to be gained during the first few years as a Consultant. However because most surgery has become highly specialised a specialist surgeon may have performed a large number of just 1 or 2 procedures during their final years of training and still have much more experience than Consultants that perform a large variety of general cases. My Mum's surgeon had performed over 100 of the procedure she needed in his final 2 years of training whereas some established Consultants in smaller units only perform one or two of that procedure per year. That would take them over 50 years to amass the same experience as he already had. In Cardiff we are highly specialised, only focussing on one or two areas of the body. Studies show time and time again that outcomes such as dislocation of the hip joint, infection rates etc are related to the volume of surgery, with surgeons perfoming large numbers of procedures having better results. 

Your surgeon should monitor their own results and be able to quote you their results if you wish to ask. In orthopaedic surgery, results such as the redo or revision rate, or infection rate, deep vein thrombosis rate are important. A good surgeon should be regularly reviewing their results and making adjustments to improve the results if necessary.

Titles and numbers of qualifications do not always correlate with surgical skills. Sometimes highly academic surgeons are not so good at communicating or operating which is why they move into academic fields. 

My Mum's surgeon made a comment about the length of the operation and it sounded like he took a lot longer than a colleague of his. However I see that as a plus point. You don't want a surgeon rushing things, the result needs to be as perfect as possible so that have the best result. The case takes as long as it takes, as does the consultation. If an extra 5 minutes spent making some little corrections or tweaks to get a bit more bend from your knee is necessary then that has got to be a good thing, or if we need to spend a few more minutes discussing whether an operation is correct for you then that is important. Rushing makes things sound like conveyor belt treatment, whereas each patient needs individual personalised care. 

The best way to choose is probably from recommendation from a previous patient. Perhaps someone in your street, club, church has had a successful operation and can recommend their surgeon. Your General Practitioner may be able to recommend a specialist, but it is getting difficult for GPs to know every specialist in every field in most cities now. However they may have been impressed at the results of surgery in another of their patients and know about a specialist that way. Be wary of insurance companies directing you to certain specialists. More and more companies are contracting Consultants and tying them to rigid terms and conditions about methods of reimbursement, limiting their surgical choices and implants. Often they tie in the newer Consultants to these contracts who are trying to make a name for themselves in the private market and dictate the treatment choices to them. So patients are told on the phone 2 or 3 specialists that they are allowed or recommended to see, but I have seen examples of patients being recommended to see a shoulder surgeon for a knee problem because the data on file is inaccurate. This also goes against Good Medical Practice as insurance companies should not override a GP recommendation regarding referral of a patient.