Doctors go to school for a long time. After their formal education they also have intense training in clinical settings. If a doctor choses to specialize, they have chosen to more than double their clinical training. This means that by the time a surgeon operates on their first patient they have many years of surgical experience. This, however, does not mean all surgeons are created equal . Studies show that the majority of complications come from a small number of surgeons with complication rates higher than their peers1. So how can a patient know if their surgeon is the best?
There are a few questions patients can ask their potential surgeons to further vet them and the suggested operation. In this series, we will touch on four questions we think define a surgeon’s ability, passion, and experience with a specific specialized procedure:
1. How often do you do this procedure?
If you agree with Malcom Gladwell and the 10,000 hours philosophy you want these surgeons doing the same operations day in and day out. Published data also supports this philosophy associating lower complication rates with surgeons who perform higher volumes. From cancer treatment to total joint surgery, data suggests surgeons who do more of a certain procedure have decreased complication rates than their lower volume peers.
You are looking for standardization. It may sound bad but, you want the assembly line model for your operation. Think Six Sigma and Quality Control. Atul Gawande famously implemented standardization in the form of checklists to decrease human error during surgery. So, how do you tactfully investigate your potential surgeons?
Some example topics and follow-ups:
- How many [insert specific procedure] do you perform annually?
- Have you seen your volume increase or decrease recently?
- If they have seen fluctuations in volume what would they attribute that to
The data also suggests there is a plateau in both volume and experience suggesting surgeon performance may taper off towards the end of their career. A study in Visceral Medicine suggests a sweet spot in both years in practice and annual volume with specific procedures. While we would normally consider more years in practice a positive indicator, you want to ensure your doctor is staying current on the latest trends in their respective specialties. Increased years in practice alone is not a barometer for outstanding care.
A negative correlation exists between years in practice and how up-to-date a surgeon is on current concepts in their field. The 2nd question you should ask is:
2. What is the most significant change you have made in the last 5 years in how you manage patients like me?
There is no right or wrong answer to this question. The reason for asking is to make sure your doctor is current on the latest clinical data. It is called medical Practice for a reason right? If a surgeon has made a significant change in how they perform your procedure then dig a little deeper. When and why did they make the switch? How are patient outcomes different pre and post change? The change does not have to be a huge disruptive force. It could be a simple alteration in how they manage patients receiving anesthesia. The important thing is that your doctor is aware of their outcomes and constantly trying to improve. Do not settle for the answer “I have not changed anything”. Or if that is the final answer, proceed with caution.
Word of caution, surgeons may be slightly defensive to this line of questioning. There is some negative stigma around patients who “doctor shop”. Do not be deterred. You are becoming an educated patient and a prudent consumer of your healthcare. Stay tuned for the final couple questions …