Choosing a Surgeon

[Guest guest]

I hope at least somebody finds it helpful.

Tom....great document.

Would you mind if I provide it for new members of my support group? We have alot of people popping up that have no clue and I'm trying to put together a little bit of basic info for them. This would be a great asset!

~~* AJ *~~

BMI 59

INSURANCE: NW Washington Medical (Regence )

DR Heap, Richland WA

Denied due to exclusion, submited appeal 6/7/01

Bellingham Support for WLS

WWW.lookin2bthin.homestead.com

[Guest guest]

> Tom....great document.

>

> Would you mind if I provide it for new members of my support

group?

Please, feel free!

(:

Tom

[Guest guest]

Hi all:

I'd like, yet again, to bring up the topic of how to choose a

surgeon. The reason I do so is because, IN MY OPINION, helping pre-

ops choose the best surgeon they can get is the most important

contribution we on this list can make.

What follows is, of course, entirely my opinion on various matters,

but this does not mean I am being cavalier about it. I have read

everything I can get my hands on about different surgeons, methods,

etc., and I have thought long and hard about these issues. I do not

claim to be an expert by any stretch of the imagination, but I do

consider myself to be a fairly well informed lay person.

Now then, keeping in mind that these are only my opinions, here are

some of the conclusions I have reached about the DS and DS surgeons.

1. The DS is a very major surgery, probably quite near to a multiple

heart bypass in terms of the changes and stresses the procedure

itself places upon your body.

2. If performed incorrectly, or if something unavoidable " just

happens, " this surgery can leave the patient maimed for life, or

worse.

3. All DS surgeons are NOT created equal. In my opinion, here are

the three main goals every DS surgeon should strive to provide for

each patient, (in DESCENDING order of importance).

-- First and foremost, SURVIVAL and continued HEALTH;

-- Second, successful weight loss;

-- Third, a tolerable experience during and after surgery.

I rate the first and second goals as being much, much more important

than the third. Why? Because, in my opinion, life as a morbidly

obese person, in our society, is inherently intolerable, not to

mention brutally short. Because of this, I came to this process

fully prepared to tolerate several months of shear misery if that is

what it took to get the weight off. (Luckily, it didn't happen that

way.)

Now then, it is also my opinion that some DS surgeons are simply

better equipped to meet these goals than others, due to greater

skill, better technique, more customized methodology, better decision-

making ability, (especially under pressure), and a variety of other

factors.

I bring this up, and I intend to do so again from time to time in the

future, because I am so often appalled by the manner in which so many

pre-ops SEEM (this is my opinion, based on my impressions) to go

about choosing a surgeon for this life-changing and potentially life-

threatening procedure.

In my opinion, here are three of the WORST criteria a pre-op can put

at or anywhere near the top of the list in importance when choosing a

DS surgeon:

-- proximity of the surgeon to where you live;

-- how quickly you can get a consult;

-- how nice the office staff is.

Here is my reasoning:

PROXIMITY

You may live around the corner from an okay surgeon, but several

states away from a world-class surgeon. Isn't it worth traveling a

few hundred miles to get the best? This surgeon will, after all,

have your LIFE in his hands.

QUICK CONSULT

Guess what folks? World class surgeons, (particularly those located

in large urban centers), tend to be busier than their lesser

colleagues. (This does not mean, however, that all busy surgeons are

world class!)

OFFICE STAFF

This drives me NUTS! Just about every doctor's office I've ever been

to has a staff made up of poorly educated, poorly paid people, with

very high turnover. If there is one person on the staff who really

seems to know what is going on and keeps things running halfway

smoothly I consider myself lucky. The offices of DS surgeons

seem to be no different.

And here's the most important point. Judging by the comments I've

seen on this list, some of the best surgeons seem to have the worst

office staffs. Why is that, do you think? I think it's because the

best surgeons have the busiest, most overworked staffs. Some of

these people take their frustrations out on patients. This is

unfortunate, and something that should be reported to the surgeon

but, the question is, should it play an important role in which

surgeon you choose?

I think the answer to that question is simple. If you plan to let

the office staff cut you open and rearrange your insides then, by all

means, put the niceness of the office staff right up their at the top

of your list. Otherwise...

Okay, enough of the negative stuff.

What follows below is my eleven point method for choosing a surgeon.

Note that the points ARE INDEED IN ORDER OF IMPORTANCE/PRECEDENCE.

That is, the points are intended to be considered in the order

listed, so, for example, if a doc flunks point three, I would not

bother to go further.

If you are a pre-op, take a look at it. It might at least give you

some stuff to think about. By the way, a Microsoft Word formatted

version is available in the Files section, under " A Guide to Choosing

a Surgeon. " Feel free to download it, change it, use it in any way

you feel will help you make a good decision.

Cheers,

Tom

---------------------------------------

1. MEDICAL SCHOOL ATTENDED: ________________________________________

I look for docs who attended medical school either in the US or at a

well-respected school in western Europe or Australia/New Zealand.

Rationale: These are the best schools, and they therefore are

hardest to get into, and thus get the best students. (An argument

can be made for schools in former British Commonwealth countries, but

none of the surgeons I looked at attended such a school, so I didn't

have to deal with that issue.)

2. CHIEF RESIDENT?

YES NO (circle one)

I give preference to those surgeons who had been appointed as Chief

Resident during their residencies.

Rationale: Cream rises to the top. The chief resident is chosen by

the faculty as the best among that resident group. I want the best

working on me.

3. POST-RESIDENCY FELLOWSHIPS, ETC. ________________________________

_____________________________________________________________________

_____________________________________________________________________

Rationale: Again, the cream rises to the top, so winning a

competitive appointment to a post-residency fellowship is another big

plus. In particular, I like to see a surgical fellowship after the

residency because it indicates just that much more training and

practice under the eye of experts.

4. PROFESSIONAL CREDENTIALS

a. Is the surgeon certified by the American Board of Surgeons (or

its British equivalent)? http://www.absurgery.org/home.html>

(NOTE: This is an absolute requirement! If the answer is NO, go no

further!)

YES NO (circle one)

Rationale: This is the basic, bottom line certification that

says, " You are now a surgeon. "

b. Is the surgeon a Fellow of the American College of Surgeons (or

one of the Royal Colleges of Surgeons in Commonwealth countries)?

http://www.facs.org/index.html>

YES NO (circle one)

Rationale: Membership in the ACS, (denoted by the initials F.A.C.S.

after " MD " ), is voluntary, and requires recommendations from fellow

members, plus what amounts to an investigation of the surgeon's

practice history.

c. Is the surgeon a member of the American Society of Bariatric

Surgery?

YES NO (circle one)

Rationale: This is a professional/educational organization for

bariatric surgeons. If a bariatric surgeon were not a member, I

would certainly wonder why not. Don't they care about keeping up on

new developments?

5. SURGICAL PRACTICE Comments: _____________________________________

_____________________________________________________________________

_____________________________________________________________________

I prefer a surgeon who has practiced as a general surgeon for at

least a few years before starting to do bariatric surgery.

Rationale: I want a surgeon who is prepared to deal with any

eventuality, both in the OR and in the post-op period. I figure that

a few years practicing as a general surgeon gives them more exposure

to all the different kinds of problems that can crop up.

6. BARIATRIC PRACTICE

a. When, Where, and from Whom did they learn to perform the DS?

______________________________________________________________________

______________________________________________________________________

Rationale: I don't want a surgeon who learned how to do the DS by

watching a videotape. (NOTE: All of the DS surgeons I have ever

looked closely at learned the surgery from someone quite qualified to

teach it, so this isn't a big concern. On the other hand, this kind

of thing does on all the time in cosmetic surgery, so it's not out of

the question as more and more docs move into this field in the

future.)

b. How long has he/she been performing the DS? ____________________

Rationale: I don't want to be one of their early DS patients, while

they are still learning how to do the procedure really well.

c. How many of his/her patients have died? When and under what

circumstances?

______________________________________________________________________

______________________________________________________________________

Rationale: If the doc is uncomfortable giving me this information, I

would get worried about why he/she was uncomfortable.

7. RESEARCH AND OTHER STUDY OF OBESITY?

YES NO (circle one)

Comments:

______________________________________________________________

______________________________________________________________

I look at whether the surgeon has researched/studied the root causes

of obesity, as well as whether the surgeon has studied the digestive

tract in detail.

Rationale: As much as possible, I'd like to have a surgeon who

understands what obesity is all about, and WHY the surgery works (or

does not work) and not just the technical aspects of how to

perform our surgery.

8. AWARDS/OTHER

______________________________________________________________________

______________________________________________________________________

I also give points if a surgeon has won awards for excellence, as

well as any other signs that the surgeon works very hard to continue

learning and improving as a surgeon.

Rationale: Awards for excellence are, hopefully, further indicia of

just that -- excellence. And, learning is a life-long process, not

just something one does once.

9. ACCESSIBILITY

______________________________________________________________________

______________________________________________________________________

Am I going to be able to get in touch with my doc in an emergency?

Also, when I go to an appointment, with whom do I meet, the surgeon

or some underling?

Rationale: The world's best nurse hasn't been to medical school, let

alone received advanced training in complex surgical techniques. I

want to know that the person in whose hands I have placed my life

with be there when I need him/her.

10. PERSONALITY

____________________________________________________________________

Once I've found a truly excellent surgeon, it's time to consider

whether I can get along with this person. Truthfully though, if the

surgeon rated excellent in the categories above, I wouldn't reject

him/her based on personality unless he were really an ogre or

completely unapproachable.

11. OFFICE STAFF ___________________________________________________

Is the staff at least minimally competent in doing what they do,

i.e., pushing paper around and scheduling stuff?

Rationale: I'm not entrusting my health and safety to the office

staff, so who cares if they are morons and/or jerks as long as I get

my appointments when I need them?

[Guest guest]

> Hi all:

>

> I'd like, yet again, to bring up the topic of how to choose a

> surgeon.

>

> In my opinion, here are three of the WORST criteria a pre-op

> can put at or anywhere near the top of the list in importance

> when choosing a DS surgeon:

>

> -- proximity of the surgeon to where you live;

> -- how quickly you can get a consult;

> -- how nice the office staff is.

>

> Here is my reasoning:

>

> PROXIMITY

>

> You may live around the corner from an okay surgeon, but

> several states away from a world-class surgeon. Isn't it worth

> traveling a few hundred miles to get the best?

What you've done is thoughtful and well intentioned. Obviously,

you have the resources to be as flexible as you need to be to

insure the best possible medical care. However, you are not

considering the fact that some folks have HMO's which limit

them to networks. Others, without HMO's simply do not have the

money and resources to travel very far.

I myself have superb insurance (thank God!) but am on disability

and do not have the financial resources to travel very far from

home. I'm fortunate in that there is an excellent surgeon a mere

four hour train ride from where I live. Even so, it has become

quite a financial strain to take all the repeated trips I've had to

take for two office appointments, one psych eval., another two

day trip (for yet another office appointment and pre-admissions)

culminating in the final train trip for my big adventure.

Some of us MUST consider proximity when selecting a surgeon.

Perhaps the warning should be that it's best if the proximity factor

is given less weight than the quality of the surgeon. That's how I

handled it. I live in Seattle and knew I had to go with a Portland,

Oregon surgeon. I interviewed two and selected the better of the

two. Hopefully, all perspective patients will have some choice.

Self-determination is important in health care.

Thanks for a good post.

gobo

DS/Sched. 7/9/01

Dr.

[Guest guest]

Tom,

I couldn't agree with you more. I did 2 years of research for WLS before I

made a decision to have the DS. I was a hair away from having the RNY in San

Diego when I began. Thank goodness I decided to continue my research, rather

than having made the decision right away. Since I have had surgery, I have

several friends who are looking into it as well. I am disturbed by how some

are going after it, trying to find a local surgeon who can get them in as

soon as possible. I try to talk to them as much as possible without

preaching..... I just don't understand how people can make such a life

altering decision without researching, and trying to get the best surgeon

with the best credentials. Dr. Anthone was my surgeon and I think the world

of him. I tell this to anyone who will listen........ But I guess a quick

surgery with a doc they know nothing about is more important! Aaaargghhhh!

Well thanks again for the post Tom, it really feels good to vent!

Kim B,

Dr. Anthone

surgery 4/18/01 BMI 69

6/17/01- BMI 59/ -60 lbs!

[Guest guest]

Thanks for the information. We need to hear all we can before we decide what

is best for each one of us.

[Guest guest]

Outstanding Tom...Thanks !

Sharon (NY)

__________________________________________________

[Guest guest]

Hi Chris:

> Of the Dr's that attended the special

> DS session of the 2001 ASBS meeting the

> winners in terms of most experience with

> the DS go as follows

Great work (yet again)!

By the way, where did you find the info?

Tom

[Guest guest]

Hi Chris:

> Of the Dr's that attended the special

> DS session of the 2001 ASBS meeting the

> winners in terms of most experience with

> the DS go as follows

Great work (yet again)!

By the way, where did you find the info?

Tom

[Guest guest]

In a message dated 8/18/01 7:14:54 AM Pacific Daylight Time,

psbilyeu@... writes:

> I know Dr. Baltasar from Spain is a member of ASBS, he must not of

> made it to the conference--he has done close to a 1000. There was

> one conference, where he sent video presentations on his suturing

> technique--he apparently does a special type of over suturing after

> stapling. He had cut the leak rate by more than half. There were

> several surgeons, including Dr. Hess (I beleive) who adopted this

> technique.

>

> He always operates with 2 other surgeons, I know one has gone on to

> develop his own practice in Southern Spain. So he is training new

> ones to follow, just as Dr. Hess.

>

>

>

Dr. Baltasar is doing a big conference this month in Madrid from what he was

saying when I had my surgery. He is a founder I believe of the Int'l

bariatric Society. He does know his stuff!!! I sure didn't give up

excellence by going out of the country for my care!

~~* AJ *~~

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the

Bellingham Support for WLS

WWW.WLSBellingham.homestead.com

[Guest guest]

In a message dated 8/18/01 7:14:54 AM Pacific Daylight Time,

psbilyeu@... writes:

> I know Dr. Baltasar from Spain is a member of ASBS, he must not of

> made it to the conference--he has done close to a 1000. There was

> one conference, where he sent video presentations on his suturing

> technique--he apparently does a special type of over suturing after

> stapling. He had cut the leak rate by more than half. There were

> several surgeons, including Dr. Hess (I beleive) who adopted this

> technique.

>

> He always operates with 2 other surgeons, I know one has gone on to

> develop his own practice in Southern Spain. So he is training new

> ones to follow, just as Dr. Hess.

>

>

>

Dr. Baltasar is doing a big conference this month in Madrid from what he was

saying when I had my surgery. He is a founder I believe of the Int'l

bariatric Society. He does know his stuff!!! I sure didn't give up

excellence by going out of the country for my care!

~~* AJ *~~

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the

Bellingham Support for WLS

WWW.WLSBellingham.homestead.com

[Guest guest]

Thank you, for sharing that. I often miss good info. because I'm

unable to get to it.

Joann in Mobile

[Guest guest]

Thank you, for sharing that. I often miss good info. because I'm

unable to get to it.

Joann in Mobile

[Guest guest]

I know Dr. Baltasar from Spain is a member of ASBS, he must not of

made it to the conference--he has done close to a 1000. There was

one conference, where he sent video presentations on his suturing

technique--he apparently does a special type of over suturing after

stapling. He had cut the leak rate by more than half. There were

several surgeons, including Dr. Hess (I beleive) who adopted this

technique.

He always operates with 2 other surgeons, I know one has gone on to

develop his own practice in Southern Spain. So he is training new

ones to follow, just as Dr. Hess.

Pammi

>

> > Of the Dr's that attended the special

> > DS session of the 2001 ASBS meeting the

> > winners in terms of most experience with

> > the DS go as follows

>

[Guest guest]

I know Dr. Baltasar from Spain is a member of ASBS, he must not of

made it to the conference--he has done close to a 1000. There was

one conference, where he sent video presentations on his suturing

technique--he apparently does a special type of over suturing after

stapling. He had cut the leak rate by more than half. There were

several surgeons, including Dr. Hess (I beleive) who adopted this

technique.

He always operates with 2 other surgeons, I know one has gone on to

develop his own practice in Southern Spain. So he is training new

ones to follow, just as Dr. Hess.

Pammi

>

> > Of the Dr's that attended the special

> > DS session of the 2001 ASBS meeting the

> > winners in terms of most experience with

> > the DS go as follows

>

[Guest guest]

wrote:

> Dr. Anthone wnd Dr. Rabkin with 500 procedures each share the Bronze.

I wonder where these numbers came from. (Could Rabkin's number be

reflecting only his open DS series?) Dr. Rabkin's website states that he

has done over 800 DS surgeries -- much more than the 500 shown on your

chart. Since he has done 200+ Lap DS now, and had been doing open DS

since 1994, I think the 800+ number stated on the website is probably

more correct.

_________________________________________________________

[Guest guest]

wrote:

> Dr. Anthone wnd Dr. Rabkin with 500 procedures each share the Bronze.

I wonder where these numbers came from. (Could Rabkin's number be

reflecting only his open DS series?) Dr. Rabkin's website states that he

has done over 800 DS surgeries -- much more than the 500 shown on your

chart. Since he has done 200+ Lap DS now, and had been doing open DS

since 1994, I think the 800+ number stated on the website is probably

more correct.

_________________________________________________________

[Guest guest]

Tom,

The info came to me curtosy of Dr. K.

Chris

>

> Hi Chris:

>

> > Of the Dr's that attended the special

> > DS session of the 2001 ASBS meeting the

> > winners in terms of most experience with

> > the DS go as follows

>

> Great work (yet again)!

>

> By the way, where did you find the info?

>

> Tom

[Guest guest]

Tom,

The info came to me curtosy of Dr. K.

Chris

>

> Hi Chris:

>

> > Of the Dr's that attended the special

> > DS session of the 2001 ASBS meeting the

> > winners in terms of most experience with

> > the DS go as follows

>

> Great work (yet again)!

>

> By the way, where did you find the info?

>

> Tom

[Guest guest]

,

Dr. Anthone also talks about 600 suregies at USC but reports 500 for

htis informal survey. Does Dr. Jossart do any suregies as well. Dr.

Crooks reported his suregeries serparate from Dr. Anthone, but they

usualy combine them for statistical purposes.

Maybe these numbers are effective January 1st or something like that,

or maybee they all rounded down. I don't know. It came from an

informal evening session after a full day of ASBS seminars.

I have some interesting notes from their meeting which I will share

when I get a chance.

Hull

>

> > Dr. Anthone wnd Dr. Rabkin with 500 procedures each share the

Bronze.

>

> I wonder where these numbers came from. (Could Rabkin's number be

> reflecting only his open DS series?) Dr. Rabkin's website states

that he

> has done over 800 DS surgeries -- much more than the 500 shown on

your

> chart. Since he has done 200+ Lap DS now, and had been doing open DS

> since 1994, I think the 800+ number stated on the website is

probably

> more correct.

>

>

>

>

>

> _________________________________________________________

>

[Guest guest]

,

Dr. Anthone also talks about 600 suregies at USC but reports 500 for

htis informal survey. Does Dr. Jossart do any suregies as well. Dr.

Crooks reported his suregeries serparate from Dr. Anthone, but they

usualy combine them for statistical purposes.

Maybe these numbers are effective January 1st or something like that,

or maybee they all rounded down. I don't know. It came from an

informal evening session after a full day of ASBS seminars.

I have some interesting notes from their meeting which I will share

when I get a chance.

Hull

>

> > Dr. Anthone wnd Dr. Rabkin with 500 procedures each share the

Bronze.

>

> I wonder where these numbers came from. (Could Rabkin's number be

> reflecting only his open DS series?) Dr. Rabkin's website states

that he

> has done over 800 DS surgeries -- much more than the 500 shown on

your

> chart. Since he has done 200+ Lap DS now, and had been doing open DS

> since 1994, I think the 800+ number stated on the website is

probably

> more correct.

>

>

>

>

>

> _________________________________________________________

>