Here’s what to ask to find out.
Going under the knife is a big decision for any patient. But almost as important is assessing and selecting the best surgeon. Selecting a surgeon can be challenging. Patients need to find a surgeon who is available, accepts their insurance, has a likable bedside manner and operates at a conveniently located hospital.
Evaluating whether a surgeon is good at what he or she does is one of the biggest challenges within the United States healthcare system! Surgical quality is a relatively new area of interest and research. In years past, surgeons were often assessed by “word of mouth” or reputation based on other patients’ experiences or doctors’ referral patterns.
Say for example, your doctor knows a surgeon from medical school, professional organizations or even the golf course (!). Your doctor may recommend a certain surgeon without much insight on the surgeon’s experience or outcomes.
Hospitals now report surgical volumes, outcomes and complications. This information is becoming more accessible to patients and the general public. However, this information is generally not easily found with a web search or a call to the hospital.
The seven most important questions to ask a surgeon
1. Do I need surgery?
This is the single most important question to ask and the patient’s most important decision to make. Many conditions are treated through lifestyle changes, medication or surgery (or a combination of the three). Go with a surgeon who offers medical and surgical procedures. If you find yourself being pushed into surgery without discussing all your options, that is a red flag. There are a lot of reasons a patient should consider surgery, but also many reasons not to. Lifestyle, age, BMI (body mass index), fertility plans and recovery time are just a few reasons your doctor should discuss all the possible treatments and which are a good fit (or not) for you.
Once you decide that surgery is the answer, here are a few questions you may want to ask your surgeon to judge whether he or she is the right surgeon to operate on you.
How many of these procedures do you do every year?
Typically, “high volume” surgeons who regularly execute a type of operation at least once a week on average will do a better job than “low volume” surgeons who perform the surgery less frequently. Surgeons who perform a procedure more frequently tend to have lower complications, less blood loss and shorter hospital stays for their patients. A surgeon who is not able to estimate how often she or he completes a certain case should raise a red flag that this may not be his or her area of expertise.
2. What if I have a complication?
Most surgeons should be prepared to discuss any possible complication that occurs more than about 1 percent of the time. For example, hysterectomy complications include a blood transfusion, infection or unintended damage to other organs. Surgeons should be forthcoming about the risk of complications and should also be able to tell you how they would fix it.
Be wary of any surgeon who tells you she never has complications—this may be an indication that she either doesn’t do enough surgery or is trying to falsely reassure you. After surgical competence, honesty is the second best quality in most surgeons!
3. How frequent are your unexpected procedures?
Having an unexpected change in the surgical procedure is one of the scariest complications of surgery. For example, say you were in for laparoscopic outpatient surgery and you wake up with a larger than expected incision—or even additional organs removed. A surgeon who frequently has to convert the planned procedure to something more invasive should raise a red flag that his ability to successfully complete the planned procedure may be questionable.
4. What is the typical hospital stay associated with this procedure?
Many minimally invasive surgeries (performed with a small camera) can be completed as an outpatient surgery or with a one-night stay in the hospital. If your surgeon recommends a longer stay in the hospital than you expected, you should definitely ask why. This could be an indication that the surgeon has had some unexpected complications in the past.
5. What is the infection risk?
Infections as a complication of surgery can turn life threatening. Ask your surgeon if he or she typically uses antibiotics for the procedure if indicated. Make sure you are clear on the symptoms of infection after the procedure, how patients can help prevent infections, and whether your surgeon knows his or her infection rates. Readmission for infection should be a fairly rare complication of surgery, and you should feel comfortable that you will be in good hands if this occurs.
6. Who do I call if I have a problem in the post-op period?
Most surgeons provide detailed instructions on what to do in the post-op period. This may include restrictions on activity, how long you need to take off from work, how long you will need to take pain medications and who to call if you have a problem. An experienced surgeon will have a firm plan in place to help you deal with any post-op issues. You should know exactly who to call if the issue is minor (fever, pain) or have a plan to go to the office or emergency room if the problem is major (bleeding, chest pain).
7. What is the follow-up plan?
Most surgeons will schedule a follow-up, with either themselves or an assistant, one or two weeks after surgery to see how you are doing and to review your pathology. During the pre-op visit, you should feel comfortable with your follow-up plan and the accessibility of your surgeon if you have questions or concerns.
Surgery can be a time of uncertainty and anxiety for patients and families. Making sure you feel comfortable with your surgeon is paramount to success in the pre- and post-op period. In the coming years, we are likely to see more transparency from hospitals and surgeons that will help patients find the surgeon who is right for them. Stay tuned!