Hi again,
I had some additional information that you may want to read regarding selecting a surgeon.
Some of the info does not completely relate to Vavle Replacement surgery, but you can formulate simularities.
So..... Here goes...
Re: How to research a doctor
by Richard999 (WebMD), 3/28/01 7:15 PM
Questions to ask:
How long has he been in practice?
Will he be scrubbed in during the entire procedure, or does a PA (physician assistant) open and/or close the patient?
** Note: This isn't a sticking point. I'd just like a board certified cardic surgeon opening my sternum) **
How many CABG (coronary artery bypass graft - pronounced cabbage) procedures does he perform in a year?
** I personally assist on 150-200 CABG and valve procedures a year **
Does he/his group perform off pump CAB's? (Is it an option for your mother?)
** This is something that is relatively new. There isn't a lot of long term data. However, in my opinion, off-pump patients just seem to "look" better. The problems with neurologic deficit seems to be virtually eliminated thanks to removing the heart/lung machine from the picture. It does however require practice. Anastimoses are slightly more difficult on a beating heart. Anesthesia support is also something to consider. (meaning more skillful perioperative pharmacological management.) **
How long are his pump runs?
** (1-2 hrs is acceptable) **
How long are his cross-clamp times?
** (30 min - 45 min is good) Less time the better. **
What is his patient mortality rate?
** In other words, how many patients have serious complications peri-operatively & post-op? ** Complications should include, but not be limited to, wound infections, stroke, and death. **
How long does an average CABG take him to complete? (On and off pump)
** From the time the patient enters the Operating Room, until the time she leaves. Expect anywhere from 3-5 hours. **
How long is the average hospital stay for his CAB patients?
** Varies quite a bit, patient to patient, but less is always better **
Does he try to get his patients up and about ASAP - post op?
** Old school thinking was that patients needed lots of rest, but research has found that getting patients up and out of bed helps get them home quicker. **
Does he or his assistant utilize a bridging technique for taking saphenous (pronounced saffenous) vein?
** The leg incisions will probably cause more pain than the sternum. Bridging cuts down on the amount of tissue that is incised, and promotes better healing. **
Does he or his assistant utilize an endoscopic vein harvesting technique?
** Another relatively new technique. Very little of the skin needs to be incised for this method. **
Of course, you may have some other questions you might find important, but these are questions that I myself would like to have answered if I were having a CABG.
THIS IS ALSO GOOD TO KNOW!
Insider Tips for Finding a Good Surgeon
One of the most important decisions you will make in life is choosing a surgeon to operate on you. However, most people know more about the quality of work done by their car mechanic than the quality of work done by their surgeon. And that is truly a scary thing. Unfortunately, there are many bad surgeons out there who are perfectly willing to do an operation on you without having the proper skills, training, and experience.
The picture is not totally hopeless, though. There are plenty of surgeons who have great results and excellent reputations, especially with other surgeons. Make no mistake, every surgeon knows who they would send their loved ones to if they needed an operation and, also, who they wouldn't send their dog to.
So how do you find out who these surgeons are that other surgeons go to when they need an operation? Read on to learn the steps that you can use to find a really good surgeon, even if you are new in town and don't know anybody you can trust to give you good information. I use these tricks myself when I need to find a surgeon for family members who live out of town.
1. Find the True Insiders
Who has the best insider information on who is a good surgeon and who is a bad surgeon? It's not the nurses in the hospital or doctors' offices or the town magazine that publishes the yearly good doctor list or the primary care doctor who is sending you to a surgeon in the first place. It is the surgical residents that work in hospitals. These are young doctors that have graduated from medical school and are doing five to seven years of intensive learning (up to one hundred hours per week) in one area of surgery before going out on their own to open practices. They spend most of their work hours assisting the more senior surgeons in performing surgery and taking care of the patients in the hospital during the night hours.
2. Make Contact with an Insider
This step calls for some boldness. Call the main telephone number of all the hospitals in your area where you might have surgery between 8 p.m and 9 p.m. on a weeknight. This is after the supper hour, but way before the residents turn in for the night. Ask the page operator for the name of the resident that is on call that night who is responsible for the patients who have had surgery similar to your upcoming procedure. Then ask the operator to page that resident to an outside phone line and stay on the line until the resident picks up his phone call.
3. Ask for Help
This calls for even more boldness. Take a deep breath and say the following, "Hello, Doctor So-and-so, I am new in town and I need surgery and don't know any good doctors. I'm wondering if you could help me? This conversation is strictly off the record. Who would you send your mother to if she needed surgery?" Doctors are naturally helpful and this will allow the resident to give you the name of the best surgeon in their own mind, without getting themselves into trouble for passing judgment on their superiors. Every doctor, no matter how junior, has the right to say who their choice of surgeon is for their mother without fear of getting in trouble for being "too uppity." Do not ask, "Is Doctor Blank a good doctor?" Or, "Who are the good surgeons?" as the resident will probably being afraid of his answer getting back to the wrong person and likely will not help you.
4. Prepare for Rejection
If the surgical resident you reach does not seem willing to help you or seems hassled and rushed, don't push. Apologize for interrupting him or her and say good night. You really want to talk with somebody who will take a minute and think over your request and not just blurt out some name to get rid of you. Remember, getting the name of a bad surgeon is worse then getting no name at all.
5. Prepare for Success
If, however, the resident seems friendly and open to talking to you and gives you his recommendation, tell him you really appreciate it. Then say again that your conversation is off the record and ask him for his second choice of surgeon. If he gives it to you, you have hit the jackpot. Make sure before you hang up that you have written down the correct spelling of the surgeon's name so you can call the hospital operator back later and get that surgeon's office phone number. Do not risk irritating the resident who has just helped you (and spoiling it for the next person using this strategy) by asking the resident to look up phone numbers for you.
6. Do it Again
Make calls on consecutive nights to each hospital you are considering having your surgery at. This will allow you to develop a list of good surgeons and will usually let you avoid getting a resident you have already talked to. If two or more residents give the same name to you as being good enough for their mother, you have hit the double jackpot. Although even the best surgeons have some bad results, it is a good bet that your chances for a good outcome with a surgeon recommended several times by the residents will be greatly increased and you will be in the best possible hands.
Aren't Choices Wonderful!
Rob
I then decided to ask my Cardiologist and Primary Care Physician for more details.
