Awaiting Surgery? How to Choose the Surgeon

Surgery outcome is better if the surgeon is female.
– BMJ, number 2 in the list of top medical journals of the world

“Patients have a right to know how good a surgeon is,”
– Dr. Fiona Godlee, editor in chief of the BMJ

Surgeon Rating

The US has websites that rate the surgeons. A patient can use these to choose the surgeon. Also, in May 2015, three major hospital systems in the US implemented the “Take the Volume Pledge” that prevents surgeons and hospitals from doing surgeries in which they have “low volume.” Surgical “volume” is the number of times a surgeon/hospital has done a specific surgical procedure in a defined time period.

India will not have surgeon-rating websites for many, many years to come. And surgeons/hospitals do not have any guidelines to prevent them from doing surgeries that they have little experience or currency of doing. How may the patient in India choose the surgeon?

Surgeon’s Experience

For over two decades researchers have acknowledged that the outcome of a surgery is related to the surgeon’s experience. This was confirmed by a recent Harvard University study that analysed surgical performance in 14 countries with a total of more than 17,000 surgeons and 35 different procedure types. Analysis of data on more than one million surgeries has shown that the more procedures a surgeons has performed, the better her patients’ outcome, at least until she hits a learning plateau. The plateau is reached after 25 to 750 procedures depending on the complexity of the surgery.

“Low Volume” surgeons’ patients have higher mortality, morbidity, intraoperative and postoperative complications, readmissions to hospital, and mortality within 30 days of surgery, as compared to “high volume” surgeons: for example, in pancreatic cancer surgery, annual death rates were nearly four times higher; in certain other surgeries, death rates were three times higher; in endocrine surgery, complication rates and reoperation rate were about two times higher; in gastric bypass surgery, risk of serious complications fell by 10 percent for every additional 10 cases per year the surgeon performed.

Choosing the Surgeon in India

In India, search engines like Google, Bing and Yahoo may be used to find a better surgeon. But Google is the best and the most widely used search engine. Let us say you are looking for a Gynaecologic laparoscopy surgeon in Delhi. Search “Best Gynae laparoscopic surgeon in Delhi.” Take the first ten names on the list and look at their average ‘rating’ and the number of persons who have given it. The higher the average ‘rating’ and the greater the number of persons giving it, the better: a surgeon with a rating of 5/5 given by 100 persons is likely to be better than the one with 4.7/5 rating given by 40 persons.

Next, look at the Google search pages. Page 1 is usually full of ads and sites of big hospitals and agencies like Practo, Lybrate, Quora and so on. You will find surgeons at page two onwards. Visit their website and check:

a. Their performance in medical school and later. Academic brilliance is often indicative of good professional competence.
b. Whether they have done specialised training and whether they have done it at a reputed, highly selective, institute. Specialisation is even more important than “volume.”
c. Whether they are keeping current with the latest technology by visiting Centres of Excellence in developed countries like the US, UK, Germany etc.
d. Browse her Blogs

Next, schedule a consultation with the selected surgeon. At the consultation ask the surgeon:

i. How many years’ experience she has in doing the specific surgical-procedure. A minimum of five years’ is preferred.
ii. How many total specific surgical-procedure she has done. Depending on the complexity of the procedure, minimum of 25 to 750 is suggested.
iii. How many specific-procedure she has done in the previous two years. For complex surgery, a minimum of 30 per year is suggested.

A good surgeon will not mind such questions and will not give incorrect information.

And finally, surgeon’s communication skills and trust-building ability are of singular importance.

Now ask yourself: “Was I comfortable talking? Did she answer my questions well? Did she ask good questions of me? Was she caring? Is she someone I can trust my life with?”

If possible, ask the surgeon’s other patients about their experience; and other doctors about surgeon’s expertise.

Before taking a final decision, seek a second opinion. In complex cases, about 1 in 5 second opinions are different from the initial treatment recommendation.

Conclusion

Every surgery has the potential for life-threatening complications. “Even in the best of circumstances, bad things can happen.” Occasional bad outcome are inevitable; but many surgical injuries are avoidable.

Minimize the probability of bad outcomes by choosing the right surgeon and the right hospital.