by James D. Hundley, MD<\/p>\n
<\/p>\n
As a physician and surgeon, I\u2019m often asked who to choose to do someone\u2019s surgery.\u00a0 The frequency of these questions has grown since I retired from my orthopaedic practice.\u00a0 I don\u2019t have any advice about how to pick one\u2019s primary care physician or internal medicine specialist but here\u2019s what I think in terms of how to pick your surgeon.<\/p>\n
There are a few ways that we as surgeons can evaluate our peers but in terms of technical abilities, we may not be the best judges.\u00a0 Here\u2019s where I think we can be useful:<\/p>\n
1. Decision-making:\u00a0 It\u2019s extremely important to know not only how to operate but when to operate and when to not operate.\u00a0 When we discuss cases with others and hear that they operated on someone we thought would be better treated non-surgically, we learn something important about them.\u00a0 Likewise, when we think that they should operate but don\u2019t, we have an opinion on that, too.<\/p>\n
2. Second opinions:\u00a0 We learn a lot about other surgeons when we see their patients for second opinions.\u00a0 That\u2019s a very small number, however, so it\u2019s only a glimpse and not necessarily all that helpful.<\/p>\n
3. Complications:\u00a0 When surgeons\u2019 patients have complications it\u2019s not unusual for those patients to seek other surgeons for opinions and\/or resolution of problems.\u00a0 This is an opportunity to judge decision-making and technical performance.<\/p>\n
As for technical expertise, however, you may want to look to someone other than a surgeon.\u00a0 Although we see one another frequently in the corridors and locker rooms of the surgical suite, we don\u2019t spend a lot of time watching others operate.\u00a0 We\u2019re busy doing our own work so we\u2019re not necessarily the best critics of another\u2019s skills.\u00a0 That said, who do you ask?<\/p>\n
Here\u2019s my opinion:<\/p>\n
1. Operating room nurses (actually the entire OR staff)<\/p>\n
a. Pros:\u00a0 They work in the OR day in and day out and get a broad exposure to surgeons.\u00a0 They see how they prepare and how well they carry out their procedures.<\/p>\n
b. Cons<\/p>\n
i. People tend to be complimentary of those they like and\/or treat them well and derogatory of those who treat them badly.\u00a0 You\u2019ll have to work your way through this to get a useful answer but the answer is there if you can tease it out.<\/p>\n
ii. Questions like this really put them on the spot and some nurses may be reluctant to give you a specific answer.\u00a0 Again, it\u2019s up to your own communication skills to learn what you can.\u00a0 Sometimes you\u2019ll just have to move on and ask someone else.<\/p>\n
2. Product representatives<\/p>\n
a. Pros:\u00a0 In orthopaedics especially, manufacturers\u2019 representatives are often physically present during operations where their products are being used.\u00a0 Thus, they likely observe as many or more different surgeons who use their products as anyone else.<\/p>\n
b. Cons:\u00a0 They are conflicted in that they want surgeons to use their products so they might be incented to recommend those who do.<\/p>\n
3. Physical Therapists and Occupational Therapists<\/p>\n
a. Pros:\u00a0 Although they don\u2019t see the operations themselves they see patients in objective ways such as how the incisions look after surgery and the stability and function of the replaced joint.<\/p>\n
b. Cons:\u00a0 None that I can think of unless they work for a particular surgeon or group and then they would at least have a theoretical conflict of interest.<\/p>\n
4. Patients who have had surgery themselves and their families<\/p>\n
a. Pros:\u00a0 They have had surgery and thus experience with a surgeon.<\/p>\n
b. Cons<\/p>\n
i. Tunnel vision:\u00a0 Unfortunately their opinions are based on a cohort (i.e. a group) of one (i.e. themselves) so if they did well they may be overly happy and if they did poorly they may be unjustifiably unhappy.<\/p>\n
ii. Patient opinions can be heavily swayed by how kindly they perceive that they were treated by their physicians.\u00a0 Thus, their opinions of the quality of their surgery can be swayed by that perception.<\/p>\n
iii. Patient expectations are variable.\u00a0 If they think they should be made \u201cnormal\u201d by surgery they will be likely be disappointed.\u00a0 Realistic expectations go a long way toward satisfaction in the outcome which goes a long way toward satisfaction with the surgeon.<\/p>\n
iv. Rehabilitation is extremely important in orthopaedic surgery.\u00a0 Highly motivated patients tend to do better than those who are passive and unwilling to do what it takes to make themselves better.\u00a0 Rehab can be arduous and painful.\u00a0 The ones who want their orthopaedic surgery to be a magic cure are likely to be disappointed.<\/p>\n