by James D. Hundley, MD
As a physician and surgeon, I’m often asked who to choose to do someone’s surgery. The frequency of these questions has grown since I retired from my orthopaedic practice. I don’t have any advice about how to pick one’s primary care physician or internal medicine specialist but here’s what I think in terms of how to pick your surgeon.
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. Here’s where I think we can be useful:
1. Decision-making: It’s extremely important to know not only how to operate but when to operate and when to not operate. 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. Likewise, when we think that they should operate but don’t, we have an opinion on that, too.
2. Second opinions: We learn a lot about other surgeons when we see their patients for second opinions. That’s a very small number, however, so it’s only a glimpse and not necessarily all that helpful.
3. Complications: When surgeons’ patients have complications it’s not unusual for those patients to seek other surgeons for opinions and/or resolution of problems. This is an opportunity to judge decision-making and technical performance.
As for technical expertise, however, you may want to look to someone other than a surgeon. Although we see one another frequently in the corridors and locker rooms of the surgical suite, we don’t spend a lot of time watching others operate. We’re busy doing our own work so we’re not necessarily the best critics of another’s skills. That said, who do you ask?
Here’s my opinion:
1. Operating room nurses (actually the entire OR staff)
a. Pros: They work in the OR day in and day out and get a broad exposure to surgeons. They see how they prepare and how well they carry out their procedures.
b. Cons
i. People tend to be complimentary of those they like and/or treat them well and derogatory of those who treat them badly. You’ll have to work your way through this to get a useful answer but the answer is there if you can tease it out.
ii. Questions like this really put them on the spot and some nurses may be reluctant to give you a specific answer. Again, it’s up to your own communication skills to learn what you can. Sometimes you’ll just have to move on and ask someone else.
2. Product representatives
a. Pros: In orthopaedics especially, manufacturers’ representatives are often physically present during operations where their products are being used. Thus, they likely observe as many or more different surgeons who use their products as anyone else.
b. Cons: They are conflicted in that they want surgeons to use their products so they might be incented to recommend those who do.
3. Physical Therapists and Occupational Therapists
a. Pros: Although they don’t 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.
b. Cons: 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.
4. Patients who have had surgery themselves and their families
a. Pros: They have had surgery and thus experience with a surgeon.
b. Cons
i. Tunnel vision: 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.
ii. Patient opinions can be heavily swayed by how kindly they perceive that they were treated by their physicians. Thus, their opinions of the quality of their surgery can be swayed by that perception.
iii. Patient expectations are variable. If they think they should be made “normal” by surgery they will be likely be disappointed. Realistic expectations go a long way toward satisfaction in the outcome which goes a long way toward satisfaction with the surgeon.
iv. Rehabilitation is extremely important in orthopaedic surgery. Highly motivated patients tend to do better than those who are passive and unwilling to do what it takes to make themselves better. Rehab can be arduous and painful. The ones who want their orthopaedic surgery to be a magic cure are likely to be disappointed.
Dr. Hundley is a retired orthopaedic surgeon, a founder and the president of OrthopaedicLIST.com, a free, open access, resource website for orthopaedic surgeons and related professionals.
