How to choose a surgeon?

[Wheels]

I had an MRI that shows a 30mm benign tumor, acoustic neuroma, on the left side of my brain that most likely will have to be surgically removed. I have an appointment scheduled for next week with an otolaryngologist that my doctor recommended to discuss my options. He is well known in my area but the reviews I've found online are mediocre. The negative opinions seem to be from patients who weren't impressed with his bedside manner. I could care less about his communication skills if he is a talented surgeon. Does anyone know of a website or other means that offers honest reviews and would help in evaluating and choosing a surgeon? Thanks.


PS- This isn't my first post. I chose the new identity to remain anonymous.

[dpdan93]

where are you located

[scopes]

Sorry to hear - hope for a speedy recovery.

You mention you have read reviews - https://www.ratemds.com ?

I always take unsolicited online reviews with a grain of salt through.

[stackie]

Know any anesthesiologists?

I’d ask one of them. We know who’s good and not so much.

Jon

[Plum Hill]

The best recommendations I received came from case workers employed by my insurance company (I belonged to a self-insured union).
They knew all the doctors and facilities.
One steered me away from a teaching university hospital because my surgery date was only nine days after the new students started.
Good luck.

[OtayBW]

That sounds serious. Can't help you, but I wish you all the best of luck.

[Elefantino]

Sorry to hear this, really. But microsurgery is so amazing these days. Is there a major university or pro sports team in your area? If so, they'll often list the team doctors on websites and that is a good place to start. Team docs are superstars and know the other ones.

Best of luck!

[FlashUNC]

Sorry to hear this, really. But microsurgery is so amazing these days. Is there a major university or pro sports team in your area? If so, they'll often list the team doctors on websites and that is a good place to start. Team docs are superstars and know the other ones.

Best of luck!

I will echo this. Was the case for my elbow and it all worked out in the long run.

[VTCaraco]

I needed back surgery a number of years ago.
I worked with my primary care, then a physical therapist, and then a spinal specialist.
I didn't feel like he listened well. He felt overconfident in discussing my MRI, listening to my symptoms, and prescribing the best steps forward.
I did what I could to shake the trees and connect with nurses where he did most of his procedures.
It took some prodding, but I was able to uncover that his best days were behind him...he was once OUTSTANDING from a skills point of view, but that that was less consistent. In many ways, he had grown overconfident.

So I took some time to "shop" who I wanted to do the work. Once I found the person that seemed right, I found a doctor that had studied at the same school and asked if that person could do a little digging through any faculty or alumni networks that they could access.

In the end, my experience was exceptional.
Ironically, I got a little guff from the local hospital (a smaller, regional hospital) for seeking service through a different doctor/facility, but I think it's right to be an informed and active consumer with something so important.

[jtakeda]

ALWAYS schedule your surgery for the AM. You don’t want a tired surgeon doing your operation

[vqdriver]

i would caution the OP, and any others, from using online reviews for healthcare.
every healthcare pro i know considers online reviews to be a horrible way to choose a provider.

regardless, best wishes to you OP. that sounds like scary stuff and i truly hope for a good outcome.

[el cheapo]

Find a hospital that is a Level One Trauma Center. The best of the best are here.

[NYCfixie]

i would caution the OP, and any others, from using online reviews for healthcare.
every healthcare pro i know considers online reviews to be a horrible way to choose a provider.

regardless, best wishes to you OP. that sounds like scary stuff and i truly hope for a good outcome.

Exactly, the best way is through personal references and/or the referral of other doctors.


...Is there a major university or pro sports team in your area? ...

Find a hospital that is a Level One Trauma Center. The best of the best are here.

If you can get a Level 1 Trauma center/hospital that is also connected to (or affiliated with) a top rate medical school you will get amazing care.

[gasman]

Don't look at online reviews. They are worthless.

I agree with what some have said. Stackie and I are both anesthesiologists and know who to go to and who to avoid in our elective areas.

Another great resource is an OR nurse that works in in a neurosurgical/Ent area of an OR.

A Level 1 trauma center may or may not get you who you need depending on the staff. A level 1 trauma center associated with a medical school will likely have someone well qualified.

These tumors are pretty uncommon so you want to find somebody who has lots of experience and had good outcomes. What is lots of experience ? Hard to say since they are uncommon but I would look for a neurosurgeon who has resected at least 20 with good outcomes.

Some centers are using focused radiation to cause tumor necrosis and death. it's non-invasive but requires 3-D imagining of the tumor then multi beam radiation.

Good luck.

[srcarter]

I recall an article a while back that had tried to find the optimal experience level for surgeons. Here is one such article. For most procedures, you want a surgeon who has at least 10-20 years of experience for optimal outcomes. https://journals.lww.com/annalsofsurgery/pages/articleviewer.aspx?year=2015&issue=04000&article=00006&type=abstract (I also recall another article that ranked based on number of procedures). In short, experience matters, so the number of procedures performed previously is a key factor.

My father had acoustic neuroma surgery 25+ years ago at Yale. They were not able to preserve his hearing in the affected ear (though they tried), but did preserve face nerve function so he had limited impact on his face. The recovery was a bit slow because of swelling. He found the Acoustic Neuroma Association materials helpful. It also can facilitate local information about surgeons (as with other online reviews, the anecdotal evidence may not be helpful).

As I recall, the surgery was very long, so the anesthesiologist is also a very critical part of the team (always is, but more so for a very lengthy procedure). Good to have someone experienced on that front as well.

Good luck.

[metalheart]

I have had my share of surgeries in the past 10 or so years and in all but one instance I had the opportunity to select the surgeon to do the work. The one instance I did not was a lights and sirens event that left me with no choices.

I have since had one additional cardiac surgery event, two knee replacements, and two different operations for a torn bicep tendon. It took me almost a year and appointments/interviews with 5 different knee surgeons to decide on the right doc for me. I asked every medical professional I knew about who were the established and preferred surgeons for knee replacements and kept looking for the same names to be suggested. I asked around for friends of friends who had similar surgeries and I talked to folks about their experiences and outcomes with particular physicians. I learned some things about what I should be looking for in a surgeon from these folks

OR nurses, and other medical types who have direct experience with docs were, in my experience the most helpful. I visited the OR ward and asked for the charge nurse and asked simple questions such as, "what are the best days and times for surgery, are there times of year I should avoid, etc... just easy things to initiate a conversation. Then I asked their opinion about surgeons and anesthesiologists since the later, in my experience, make a difference in how things go. I also asked each doc as well as every other doc I see (primary care etc...), "If you had the problem I have, who would you ask to do your surgery?"


Eventually, I had a list. Before I talked to any of the docs I educated myself within the limits of my ability to understand about the different procedures and what happens and what are the usual outcomes. It helped some when talking to docs, but I had to be careful not to let them just quickly use a bunch of medical terms that I did not understand. Some tolerated my questions better than others and that was an important data point for me: if you are going to cut into my body, it is a good thing to be able to communicate in a way we both understand what is going to happen.

Almost any one of the docs would have been ok for the surgery, but some had more specific experience and(i.e., number of procedures done) and some clearly communicated better than others and I would not underestimate the importance of communication, the ability of the doc to listen to you, hear your issues, and explain to you in terms that are meaningful to you what is going to happen, what are the likey risks and potential averse outcomes, and why the surgical procedure being used is the best thing for your condition. Bedside manner is another issue and I agree that surgical proficiency trumps being nice, but communicating well is essential in my book.

I guess the short answer is from my experience is you have to find people who know the surgeons who are good at the surgery you need and then find the right fit between you and the doc. If your need is immediate, that may mean you will have limited opportunities to do the groundwork, but I would start asking folks and doing some homework. In my experience, the online review stuff has too many issues to make it truly useful when you are selecting a doc.

Good luck and godspeed.

ps: you need any help in all of this, pm me and I will do what I can.

[EPOJoe]

The best thing to do is to try and get your oncologist to refer you to a large brain tumor center/clinic. He should know the best place that's near you. Near me on the west coast, UCSF is one of the best (I'm going to say THE best). When my younger brother was diagnosed with a brain tumor ten years ago, a local surgeon put him through a nine hour surgery and did almost nothing. He was thankfully referred to UCSF, and the docs there, after questioning what the original surgeon did or rather didn't do, did a fantastic job (he's fine now).

[Louis]

Related comment / rant:

I find it ridiculous that for something as critical as important medical care there are no easily accessible, reliable, objective and impartial outcomes-based assessments so potential patients / medical consumers can make informed decisions.

You can do it for all sorts for stuff from toilet paper to stocks, but try to do it for medical care and you hit a brick wall.

Good luck to the OP.

[Wheels]

Thanks everyone for the suggestions and encouragement here and in private messages. The specialist I have an appointment with teaches at the local med school, has over 30 years experience, and is associated with a level 1 trauma center in the area. He is also mentioned favorably in discussions on the Acoustic Neuroma Associations forums. I've contacted a local support group as well and will see a friend who is an MD for feedback and suggestions.

[clyde the point]

Was that the first and only MRI?

[George_H]

I agree with stackie and gasman, partially. My recommendation would be to ask as many neurosurgeons as you can who they would get to fix this problem. If you do not have access to multiple medical professionals across a broad spectrum of perspectives (surgeons, anesthesiologists, residents, operating room techs, nurses, insurance people, plaintiff attorneys, rehab people, pathologists) and are a civilian, then metalheart is right on. An anesthesiologist may have bias toward a surgeon they work with because the cases referred to that surgeon provide income to that anesthesiologist. But if you know an anesthesiologist who works with 15 different neurosurgeons, then I would trust that opinion more than if the anesthesiologist only works with two surgeons. Surprisingly, I've found pathologists to be a good source of determining who is good. They look at the finished product (explanted tumor) and can tell who is precise, and who cuts something out with a chainsaw. Radiologists are also aware of who is conscientious because surgeons work so intimately with them, but they don't see who has good hands.

Working at a major teaching university does not equal being a good surgeon. I've seen outstanding surgeons in university settings, private practice, sports teams, the VA and all forms in between. I've seen hacks robotically, laparoscopically, microscopically, at the VA, in private practice, in academics, and working for sports teams. Good surgeons and the environment they operate in are independent. And while someone may be a superstar in academics, put them in private practice and they flail. The converse is true as well. What I have seen is that if you are good, you are good. I've seen physicians motivated to go into academics because they feel that they are at the pinnacle of their profession. But I've also seen them go into academics because they couldn't make it in private practice (couldn't get referrals, a few bad outcomes destroys the referral base, poor at marketing, poor at running an office). Private practice anything (architect, snowboard shop owner, physician, taco truck owner, restaurant owner, landscaper) reminds me of Dave's post #64 here. (I don't know how to insert a link).

https://forums.thepaceline.net/showthread.php?t=115818&page=5

I've seen folks try to be the team doctors for professional sports teams because they use the title for marketing, ego inflation, or other non altruistic motives. One set of goals (academics, team doc) does not necessarily correlate with another set of goals (being a good surgeon). As a private practitioner, you better be able to market, take good care of the patients, generate cash flow and cultivate referrals. The University of Whatever will market for you, the residents will round for you, fellows will see your clinic, the university will run the business, and referrals will be funneled to you based on your niche. A lot of those obstacles are taken care of for you in academics, so maybe a private practice surgeon may be better or may be worse. The bottom line is to be aware of bias that may not get you to the best surgeon for your problem.

Regarding a surgeon who operates at a level one trauma center, I would hope those surgeons are good at level one trauma. Your acoustic neuroma is not a trauma. The skill set for elective surgery is completely different than it is for trauma surgery. For surgery, there are two distinct parts to any operation - dissection and reconstruction. For heart surgery, there is the dissection (opening up the chest, putting someone on bypass, harvesting a leg vein or internal mammary artery, etc) and the reconstruction (doing the actual bypass). For kidney transplants, there is dissection (exposing the iliac vessels and bladder), and reconstruction (connecting the vessels to the kidney, connecting the ureter to the bladder). For spine surgery, there is dissection (exposing the spine, decompression, laminotomy / foraminotomy, discectomy) and reconstruction (rods, screws, intervertebral cages, etc). Plastic surgery is almost all reconstruction. Orthopedic oncologic surgery is almost all dissection (cut it out). Vascular surgery and joint replacement surgery are reconstruction heavy. Some are both dissection and reconstruction heavy (liver transplant, heart transplant, Whipple). Trauma surgery in general is nonoperative, and if they do go to surgery the trauma surgery is VERY RECONSTRUCTION HEAVY. THE TRAUMA DOES THE DISSECTION so you lose those dissection skills. Ask any trauma surgeon if they can do a dissection and they will say yes, but having watched them operate back to back vs a busy hepatobiliary surgeon, I guarantee a busy elective hepatobiliary surgeon can take apart a pancreas better than any trauma surgeon. A busy elective skull base surgeon can do a craniotomy better than any trauma neurosurgeon. These days I would say most trauma surgeons don't even do their own vascular exposures because it is a skill they have lost over the years. For a trauma skull base surgeon, when a gunshot wound to the skull does the dissection, preserving the facial nerve just isn't a priority. Just to give an opposing view for the surgeon who operates at the level one facility, imagine a surgeon so good that they are so busy with their lucrative elective practice cutting out acoustic neuromas that this person doesn't have to take level one neurosurgery call. On top of that, when you get your neuroma cut out, this surgeon won't be post call after being up all night dealing with a gun shot wound to the head.

There are just so many aspects to being a good surgeon that are hard to understand. Who makes good decisions under pressure? Who plans the operations so well that they don't have to make any decisions under pressure? Who makes good decisions with incomplete information? Who has good hands? Who uses consultants well? Who communicates well? Who do you like? Just like a job interview, who do most people hire? People hire folks they like and people who are interesting. People you like and people who are interesting may not always be correlated to who is competent to cut out a tumor.