A decision to have surgery should not be taken lightly; nor should the selection of a surgeon. The quality of your life after surgery or even your chances of survival may hinge upon the choice you make. Unfortunately, many people simply accept their family doctor's referral without doing any research on their own. If you need to have an operation, take some time to shop around for the best surgeon. The tips below will help you get started.
Do You Really Need Surgery?
First and foremost you should be certain surgery is the best treatment for your condition. Remember that all surgery has inherent risks, so don't just accept that option without first making sure it is necessary. Have you gotten a second opinion? Have you explored the alternatives? In general, if time is not of the essence and there are both medical and surgical treatments available for your condition, you should try the medical options first. The Agency for Health Care Policy and Research publishes a booklet designed to help consumers decide whether surgery is the right choice for them. To get a free copy, call 800-358-9295 and ask for Questions To Ask Your Doctor Before You Have Surgery.
What to Look for in a Surgeon
Most people who need surgery get a referral from their primary care physician or the specialist who has been treating them. If you're in this position, request a few names so you can compare various surgeons' experience and qualifications. No matter how much you trust your doctor, you shouldn't let the selection of a surgeon rest solely on his or her shoulders. Ideally, referrals should be made on the basis of merit. However, like everything else in life, referrals are often based on other factors, such as friendships, economic considerations, social connections or simply not knowing who else is available. The following questions can help you make a well-informed choice:
* Is the surgeon board certified and, if so, in what specialty? A surgeon who is certified by a surgical board approved by the American Board of Medical Specialties (ABMS), has completed years of residency training in that specialty and has demonstrated knowledge and competence by successfully completing a rigorous examination. To find out if your surgeon is certified, call the ABMS at 800-776-2378 or look it up in the Directory of Medical Specialists, usually available at local libraries.
* Is the surgeon a Fellow of the American College of Surgeons? The letters F.A.C.S. after a surgeon's name are an indication that the surgeon has passed a thorough evaluation of both professional competence and ethical standards. To verify whether a surgeon is a F.A.C.S., see if your local library has a copy of the American College of Surgeons Yearbook. Or you can call the communications department at the American College of Surgeons (312-664-4050), and ask for a list of fellows in your geographical area.
* Is the surgeon a member of any other voluntary medical societies? There are many medical associations in the United States that support physicians in their profession. Most associations require continuing education of their members and provide peer review procedures to help maintain the quality of service. Many also provide consumers with a list of member doctors in their area. For example, the American Academy of Facial and Reconstructive Surgery is the world's largest organization of surgeons who specialize in facial plastic surgery. To find out if there is a medical society that specializes in your area of concern, check your local library for a copy of the Encyclopedia of Associations, which lists the address, phone number and a short description of every association in the country.
* Is the surgeon affiliated with an accredited health care facility? When considering surgery, where to have it is as important as who should do it. Click here for information on how to pick the best hospital for your needs .
* How many times has the surgeon performed this particular procedure? Finding a surgeon who is board certified and a F.A.C.S. is a good start, but these credentials only show general competence The surgeon you choose should be proficient in the particular type of surgery you need. And when it comes to complicated surgery, practice makes perfect. In fact, the American College of Surgeons advises patients who need open heart surgery to look for a surgical team that performs at least 150 such procedures a year. Other questions you might want to ask: How does a particular surgeon's results compare to those of other surgeons? What sort of complications has the expert encountered in the type of surgery you're slated for? How often do such problems occur and how are they managed?
* Has the surgeon ever been the subject of a professional peer review, been sued for malpractice, or had his license suspended? According to the Federation of State Medical Boards, the total number of serious disciplinary actions against doctors across the country was 3,375 in 1995óthat's about 0.5 percent of all doctors. To find out if a particular doctor has been disciplined by your state, call the agency that licenses physicians in your state. Call the Federation of State Medical Boards for the number to call in your area (817-868-4000). In addition, the Public Citizen's Health Research Group in Washington, DC, publishes a book titled Questionable Doctors (1993 edition), which lists physicians all around the country who have been sued for malpractice, had their licenses revoked or had some other type of action taken against them. It is available in many public libraries and you can get a state supplement for $15. To order a copy, call 202-588-1000.
Surgeons' Skills Do Vary
As in every profession, some surgeons are better than others. That might seem like plain common sense, but it often doesn't hit home until some concrete evidence emerges. For example, researchers published in the British Medical Journal (June 22, 1991) found that physicians' surgical skills had a lot to do with how patients fared after an operation, even after 10 years. The study looked at the survival rates of nearly 650 patients who underwent surgery for colorectal cancer. It was discovered that depending upon the individual physician, surgical rates varied anywhere from 8 to 30 percent in the 30-days following surgery, and from 20 to 63 percent in the 10 years after the operation. The researchers also compared complications from the surgery, such as infection and leaking from cracks in the incision, and noted that they varied as much as 0 to 35 percent, depending on the physician. In addition, wound dehiscence (the splitting open of the incision), varied from 0 to 20 percent from one surgeon to another. The study's authors noted that the normal rate for wound dehiscence is less than 2 percent, and rates as high as 20 percent are completely "unacceptable".
Two other studies published in the Journal of the American Medical Association (August 14, 1991) also analyzed the variation in patient outcomes from one doctor to another. Both of these research teams expressed shock and dismay at the range in quality of medical care they found.