Re: Choosing a Surgeon/tom

[Guest guest]

tom, excellent way to go about choosing a surgeon. kudos to you and

your analytical mind. you are a smart cookie!

mary y st.louis

> 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?