Advice On Picking The Best Surgeon

[christine yng 0]

I want to share with you all this article I found while looking for advice on how to pick a weight loss surgeon. In my case I have done a great deal of research and found what I think are two excellent surgeons, both in Tijuana, Mexico. Dr. Ortiz, who has been all over the internet for some time and Dr. Gonzalez who has just recently appeared on the web. They both began at or about the same time performing lap band surgery 1998-1999. What draws my attention to Gonzalez is this: Ortiz is an excellent surgeon, no doubt, but during the last 10 or 11 years he has travelled extensively. In the meantime during the same 10-11 years Gonzalez has spent almost all of his working hours performing lap band surgery. Both instances are truly admirable. From what I have read and from patients of both surgeons that I have corresponded with they both are experts, and about the same age (mid 40's) they both have excellent bedside manner! It is a hard decision to make. However I have to decide soon. I'm sure some of you out there have been in the same situation especially when it's one's own body and life.

Here is the Article:

(I would greatly appreciate feed back and hope the article is helpful.)

How to pick a WLS surgeon by Ken Miller

Surgeons, surgeons, surgeons! They’re everywhere! You can’t turn on your TV or read a magazine these days without seeing an article or an advertisement about one of the hundreds of surgeons who are now performing some type of weight-loss surgery. News of the rising tide of obesity in America is being matched article by article and celebrity by celebrity by a rising tide of weight-loss surgeons and hospitals who recognize a gold rush when they see it. All that advertising and noise about different procedures and different surgeons can make for a lot of confusion.

It’s a mistake for you to simply go see the surgeon that cousin Jane went to, and undergo the same WLS procedure she did, just because Jane looks like she’s really doing well right now.

What are the important factors that you should consider BEFORE you put your life in the hands of a particular surgeon? I’ve been studying this question for about two years now and I’ve interviewed many WLS patients, both in person and through the forums at Bariatric Support Centers International (Bariatric Support Centers International :: Success Habits Of WLS Support) and I believe I’m ready to suggest a process that a WLS investigator, like you, can use to find the right match between your needs and the experience and surgical skills, and pre and post-op education and support programs, that a particular surgeon can offer you.

The FIRST, and perhaps the most important step, is for you to: Decide which of the various procedures being performed today is right for you. It’s a mistake for you to simply go see the surgeon that cousin Jane went to, and undergo the same WLS procedure she did, just because Jane looks like she’s really doing well right now. Each type of WLS procedure carries with it a unique set of advantages and disadvantages over the others. Even if Jane really studied and thoroughly understood what all of the advantages and disadvantages of each procedure are, her choice of the best one for her may not necessarily be the right choice for you. You are the one who will live the rest of your life with the benefits or consequences of your choice, not Jane, and not your surgeon.

Make sure you have the right procedure for you, even if you have to travel a significant distance to get it. There are hundreds of internet websites where you can study the various procedures and WLS patient forums where you can obtain advice from many different people who have had one of those procedures. Make sure you do your homework first. THEN go looking for the best surgeon to perform the particular type of surgery you believe is right for you. If you go looking for a surgeon first, you could easily end up with the wrong procedure and the wrong surgeon for your needs. Narrowing down the list of procedures to the one you really want will automatically narrow down the list of surgeons you’ll need to examine. If they don’t do the procedure you want, don’t waste your time investigating how good their skills or their program are because those things are secondary to getting the right procedure for you.

Second: Make a list of all the factors that are important to you as you consider surgeons.

Your list might look something like this:

• Price (and cost
  
• Insurance Coverage
  
• Close to home
  
• Hospital reputation and the qualifications and experience of its staff and facilities
  
• Bedside manner of the surgeon and nursing staff
  
• Years of experience in the WLS field
  
• Experience performing your chosen procedure
  
• Understands newest techniques and equipment
  
• Mortality and Complication statistics
  
• Who trained the surgeon in WLS procedures
  
• Nurses’ opinions
  
• Thoroughness of pre-op testing and education
  
• Scheduled post-op follow-up visits with the surgeon – is the price of these visits extra, or included in the surgeon’s initial fee?
  
• Scope and reputation of post-op education and support programs – are they available where you live?
  
• etc

As you write down your list, it will become apparent that you’re going to have to make some tradeoffs as you put your list in priority order. For instance, which is more important to you; insurance coverage (price?) or the surgeon’s years of experience performing your procedure? Before you automatically answer, “Insurance coverage,” perhaps you should look a little deeper at this issue. Don’t assume that the “list of providers in your area” that your insurance company gave you is a complete list of all your choices. Sometimes insurance will cover the same procedure by many surgeons who are outside of your local area, and sometimes it can be less expensive to travel to another area of the country where you could receive the same procedure from a very qualified surgeon for significantly less money than it would cost to have surgery in your home town. Yes, insurance coverage may be near the top of your list, but it doesn’t necessarily have to be at the top of your list where it over-rules every other decision you will make.

If you’ve been paying attention, you have realized by now that no one can give you a pre-prioritized checklist so you can mark off the items as you move down the list and then the best answer for you will simply fall out at the bottom of the list. But, we can help you understand some things that might belong on your list that you may not have considered before. With that in mind, let’s briefly discuss each of the items on the above list and point out some details you should consider as you evaluate your options for a qualified surgeon. Obviously, these are not in any particular order, because the final order that’s right for you will be different than the list for many others

Experience performing the procedure I want.

Mark Twain said it best: “There are three kinds of lies: lies; damned lies; and statistics!” As you interview your prospective surgeon (or his office staff) about their experience performing weight-loss surgery, make sure you listen very closely to how they express their statistics. Don’t accept statistics that are jumbled together with a lot of other numbers that don’t really apply to your question. For instance, if you ask for the number of surgeries performed by the surgeons at a particular practice, don’t simply accept a total number for ALL of the surgeons who have ever worked there. A particular practice may have performed 10,000 gastric bypass operations, but none of the individual surgeons have performed that many. You aren’t going to be operated on by all of the surgeons. There is going to be one surgeon in charge in the operating room with a scalpel in his/her hand and they are going to be totally in-charge of what happens to you while you’re there. You need to know how many times each surgeon in the practice has performed your chosen procedure – not how many surgeries all of the surgeons have performed; and not how many total weight-loss procedures each surgeon has performed either. A surgeon may have been performing a particular procedure “open” for 15 years and has performed thousands of that particular operation during those years, but he may also have next to zero experience performing that same surgery laparoscopically. Valid, well researched, statistics show that it takes a lot of practice for a surgeon to become an expert at performing some of the more complicated WLS procedures laparoscopically.

You probably don’t want to be the first patient in line for a surgeon to practice on. Granted, somebody has to be first, but are you sure you want it to be you? Maybe you do, but at least you should know you’re one of the first; and if you ask the right questions you will know how much experience the surgeon actually has performing the exact procedure you want to have.

Surgeon’s Age and General Surgery Experience vs Recent Training and Ability to Manipulate Laparoscopic Instruments.

There is a very interesting tradeoff that you may encounter as you choose a surgeon. Older surgeons who may have been performing a wide variety of “open” surgical procedures for many years may have more experience than a young surgeon who is relatively new. The older surgeon may have much more experience dealing with the diagnosis and treatment of complications following the actual surgery than a new surgeon may have. But . . . a newly trained, young surgeon may be much more skilled in the use of laparoscopic instruments (that are used for the majority of WLS procedures these days) than an older surgeon might be. Newer, younger, surgeons might have much more experience mastering the type of eye-hand coordination that is required of a laparoscopic surgeon than the older surgeon has developed.

The rise of video games in the last 20+ years has produced a generation of people, including new surgeons, who have thousands of hours of practice watching a video monitor and matching the movements that occur on the screen with the movements of their hands that are not directly connected to the objects on the screen and are not directly viewable with their direct line of sight. Some older surgeons who are accustomed to looking directly at a patient’s internal organs through an open hole in their abdomen are not able to make the transition to performing laparoscopic surgery with a level of skill that can match many of the younger surgeons.

Only you can decide which is more important to you in choosing a surgeon; years of experience in general surgery or specific training and experience in the use of remote instruments and monitoring devices. Of course, there are younger surgeons who are very capable of handling post surgery complications and there are older surgeons who have skillfully made the transition from open surgery to laparoscopic surgery. But, how do you know who is skilled and who is not? That brings us to our next subject . . .

Mortality and Complication Statistics.

Let’s talk about what I personally believe to be the most important information you can use to evaluate a particular surgeon – their own personal mortality and complication rates. Some surgeons who have been performing WLS procedures for more than about ten years may not have kept statistics prior to that time, but every reputable surgeon keeps statistics these days. Not keeping statistics on the outcome of his patients’ complications, or not being willing to share those statistics with a prospective patient is a big warning sign that should set off alarm bells in your head.

The fact that a surgeon may not have kept statistics, or may choose not to publish them, does not automatically mean that he or she is a poor surgeon. But, it does mean that you have no way of accurately comparing how well their patients do compared to other surgeon's patients.

Modern medical facilities, like every other serious business in today's world, know that the only way to really tell if you are making progress in refining your techniques and practices is to keep statistical track of what happens when you make changes to the way you do things. If a surgeon is simply processing bodies and is not seriously keeping track of what happens to those bodies after he operates on them, he is not responsibly keeping track of the results of his “practice”. In today’s scientific world, its not enough to just THINK your results are OK; the means is available to every surgeon and hospital to track and evaluate their outcomes against national norms. If the surgeon you are investigating does not keep personal statistics and willingly share those numbers with investigators like you, I believe you should seriously consider finding another surgeon.

What kinds of things should you look for in a surgeon’s statistics?

• How many WLS patients has that surgeon operated on and what time period have those patients been spread out over?
  
• How many of his patients have been “open” and how many have been laparoscopic?
  
• What percentage of the surgeon’s practice is devoted exclusively to WLS?
  
• How many of his patients have died?
  
• What percentage of his patients are released from the hospital during the time period that he describes as a “normal hospital stay,” and how many of them have to stay longer? It doesn’t take very many days in the hospital to add up to a very big bill if you are one of those who have to stay longer than normal because you had complications and neither the hospital nor the surgeon are going to discount their fees for services if you have to stay longer than you originally planned.

Check to make sure that all of the statistics you get are telling the whole story, not just the parts that an ad man decided to tell you about in an advertisement or brochure. For instance, do the mortality and complication rate statistics cover ALL of the patients the surgeon has operated on, or did someone reset the statistical clock at some point in time so the numbers only include the last year of the surgeon's practice? Are you getting mixed numbers that indicate that the surgeon has performed 2,000 surgeries in the last five years, but the mortality statistics only cover the last year, because the surgeon had a string of deaths that occurred a little over a year ago and his numbers look better if he quotes the total number of surgeries that he's performed, but only quotes the percentage of patients who have died in the last year. I know, this sounds very skeptical and implies that there are surgeon's out there who would intentionally mislead you. We'd all like to believe that every surgeon is honest and reputable, but the fact is that surgeons are like every other group of human beings. Some are truthful and some are not. I believe that the vast majority of surgeons are reputable and would never consider doing anything that even remotely resembles the situation I've just described, but I believe I have an obligation to describe some worst case scenarios so you'll know what to watch for. Remember, the purpose of this article is to suggest ways that you can sort out which surgeon is right for you and which one(s) are not right for you.

What kinds of factors might influence you to choose a particular surgeon even though his statistics might not be as good as another surgeon’s numbers? Alice Vodicka, a former patient and bariatric support coordinator for a very well known bariatric surgeon, expressed it this way: “Pick a surgeon based on his/her ability to take care of you if problems arise . . . choosing the right surgeon means finding the one that can handle the complications. Make sure your surgeon has been performing bariatric surgery for quite some time and that he has been able to competently handle the problems that arise, as opposed to sending you to a more experienced surgeon to resolve problems.”

All weight-loss surgeons have patients with complications. All weight-loss surgeons, who have been performing WLS for very long, have had patients who died from complications that arose during or following surgery.

Many complications are not the fault of the surgeon; they are a normal part of the risk that goes along with the intensity of a particular type of surgery and with the general size and health of WLS patients. I know Alice’s surgeon takes on patients who are much larger than many other weight-loss surgeons will accept as candidates for surgery. Working with larger, more fragile patients will negatively affect his statistics. He knows these are higher risk patients when he accepts them, and they understand that his statistics are naturally affected by his willingness to operate on higher risk patients. Many of them also understand that by choosing to operate on more difficult patients (who many other surgeons have turned down) also means that he will naturally have more experience knowing what to do when his patients experience difficult complications during or after surgery. Alice, who was not one of the super-morbidly obese patients we’re talking about here, believed if there’s a good chance that she might have a serious complication, she wanted to be in the care of an experienced surgeon who had lots of experience saving the lives of patients who knew their personal health problems had already stacked the odds against them before they went into the operating room.

Complication and mortality rates can be difficult to compare because not all surgeons are required to keep the same statistics and they can choose how they present those statistics to the public. If you are not familiar with how to interpret statistical numbers, don’t just give up and decide you can’t use them to evaluate a prospective surgeon, find someone who is knowledgeable and who can interpret them for you – perhaps a relative or your family practice physician can help you with them.

One last thing about statistics; carefully consider the source of those numbers. The best place to get them is from the hospital(s) where your prospective surgeon operates. The second best place to get them is directly from the surgeon’s office. The worst place to get them is from someone in an internet chat room or from cousin Jane. If the hospital will give you complication statistics for individual surgeons, they will be presented in the same way for every surgeon operating at that hospital; they won’t be presented in a way that makes one surgeon look better than his numbers really are. If you get them from the surgeon’s office, they will likely be presented in a way that minimizes the problem areas of his statistics, but the numbers you get will probably be true because it would be a total disaster for a surgeon to present false numbers to patients and then have those numbers be revealed as false in a malpractice lawsuit. If the surgeon has performed both “open” and laparoscopic WLS procedures, get their statistics for each category of surgery listed separately so you can see what the surgeon’s patients’ outcomes are for the type of surgery that you are considering. An individual surgeon can hide poor laparoscopic stats in the midst of good “open” procedure stats, just as a group of surgeons can hide poor performance by one surgeon on their staff amidst the better statistics of his more qualified partners.

Do not trust or believe “statistics” that you hear in internet chat rooms; no matter who you hear them from, including the surgeon himself. We work with patients and surgeons from all across the United States so I've had the opportunity to see first-hand some situations that most prospective WLS patients never get to see. I’ve personally witnessed groups of patients gush many times about how great the statistics were for a particular surgeon’s practice, while the surgeon himself was there in the chat room, listening to the false numbers, and remained silent while inaccurate statistics were passed along to unsuspecting patients and investigators. Patients commonly pass along glowing statistics about mortality, complication and success rates to new investigators . . . who then pass them on to others. Be careful where you get your numbers, and if you can’t get any accurate statistical numbers from a responsible source, be even more careful about choosing that surgeon or practice.

Bedside Manner

Which is more important to you, a surgeon’s skills in the OR, or their personality skills in the examining and recovery rooms? You don’t always have to choose one or the other, but many times there is a tradeoff you must make. Some people are comfortable placing their life in the hands of a surgeon who has lots of experience and great statistics, but who is arrogant or standoffish in discussions with them prior to surgery; and others cannot seem to trust a surgeon’s technical skills unless they feel comfortable with him outside the OR. Of course it’s quite possible to find surgeons who possess both skills, but some surgical nurses tell me that surgeons seem to be particularly prone to developing one skill or the other. Many doctors become surgeons because they have great technical operating skills but they lack the personality to be good pediatricians or family practice docs. Others may not have the surgical skills, but they are able to make a living as a surgeon because their personality or bedside manner skills are highly developed and many patients naturally trust their surgical skills because the surgeon is such a nice guy.

Again, in my estimation, the best way to cut through the real questions that arise from this issue is to examine their statistics. The last thing you want to do is choose a surgeon who has thoroughly honed his people pleasing skills at the bedsides of patients who have spent months in the hospital recovering from complications that were the result of his inadequacies as an actual surgeon. I know of one particular surgeon who really excels in this area. His patients, many of whom have spent months in the hospital or have returned to the hospital for many additional surgeries to repair the complications that came as a result of their initial WL surgery, sing his praises far and wide. With the hint of a tear in their eye they tell their friends and WLS investigators that they would have died if it weren’t for their doctor who “saved” them. This is one of the major reasons NOT to simply accept cousin Jane’s opinion about who is the best surgeon. All surgeons have successful patients; even the least qualified surgeons have a certain percentage of patients who recover nicely. Because a particular patient came through surgery without complications is NOT a reason to believe that the next patient will do well with that same surgeon. Again, look at their statistics. Their proven statistics will give you the best understanding of what your odds are of being complication free when you leave the OR.

Nurses Opinions.

Perhaps the best group of people who can answer your questions about surgeons is the nurses who work in the O.R. and on the recovery floor in the hospital where your potential surgeon operates. These nurses are exposed daily to the immediate results of a surgeon’s skills. They know who the best technical surgeon is in their hospital and they also know who has the best bedside manner. In my estimation, the best way to choose a surgeon is to obtain the statistics of the surgeons you are investigating and then compare the results of those statistics with the opinions of the nurses who work with them on a daily basis. Nurses’ opinions can be hard to obtain however. A hospital is a very highly charged political environment and the last thing a nurse needs is a prospective patient running around telling everyone that “Nurse Smith told me that Dr. Suess has the best bedside manner, but Dr. Welby is the best surgeon.” Most nurses will refuse to answer your questions if they feel there is any possibility that you will pass on what you heard from them to others. Also, most nurses will avoid giving you a clear answer if you ask them directly, “Who is the best surgeon here?” Hospital rules may prevent them from answering that question, but they may be able to answer what amounts to the same question if its phrased a little bit differently. After explaining who you are and asking some preliminary questions, make the last question you ask them be this one: “If you were going to have weight-loss surgery at this hospital, and you were going to have (state your chosen type of surgery), who would you chose for a surgeon.” This question does not require the nurse to place them self in the position of being the ultimate judge of one surgeon vs another, but simply asks for a recommendation based on what the nurse feels would be best for them personally. I believe you can trust this recommendation above the recommendation of your primary care physician, or your cousin Jane, or any advertisement you might see.

Post-Op Education and Support Programs.

There are three major keys to long-term WLS success:

• Choose the right procedure for you.
  
• Choose the right surgeon to perform that procedure with the right hospital staff to assist them.
  
• Choose the right after care education and support program to assist you with all the hundreds of issues you will have to deal with long after the surgeon and hospital have moved on to their next surgery patient and you are out there in the world by yourself where the surgeon is assuming you are successful because he really doesn’t have any method of knowing otherwise unless you are sick or admitted to the ER.

Thoroughly examine the surgeon’s aftercare program to see if it provides real quality education, training, and support for you and that those three things will be available to you where you live, not just in the city where the surgeon performs surgery. Education; Training; and Support are three separate and distinct things.Many surgeons assume that they are all the same thing and they are all adequately covered by one or two patient led support groups that meet once each month in cities near their office. They are not.

“Education” means providing multiple methods of teaching you WHAT you need to do to make permanent changes to your lifestyle and habits. There are many facts you need to know so you'll understand what to do with your new body to keep it strong and healthy and so you can lose all the weight you should and then be able to maintain your ideal weight.

“Training” means providing you with instruction and opportunities to practice HOW you can make those changes you learned about through the education classes and written materials. True lifestyle changes require practice, not just knowledge. What methods does your surgeon have to teach you HOW to make those changes, not just what the changes should be?

“Support” means providing you with access to technical people, like nurses and dieticians who can respond to your medical issues. It also means providing you with opportunities to be helped and assisted by other WLS patients who have been through what you are going through and who can offer numerous solutions to your problem so that you can find a solution that is right for you. Once a month support groups are essential to the success of any quality WLS practice, but there are few patients who can schedule their needs for support so that it falls on a particular day of the month.

A high quality program will also provide you with an opportunity for daily interaction with other patients through online programs like chat rooms and forums for discussion of your problems. Chat rooms and forums can be found in hundreds of locations on the internet, and you can get lots of information from those sources, but the danger that exists is that many of the sites that provide these services do not have any standards for the support and advice that is offered there and they have no means of monitoring the information that is exchanged there. The best aftercare programs will not only have these resources available for you, but they will operate them as a specific function of the surgeon or hospital and they will constantly monitor the advice that is presented to you to make sure that no one is giving you bad advice that will harm your weight-loss progress or maintenance. Some surgeons and hospitals choose not to operate these services themselves, but choose to make sure their patients have access to them through third party providers who they know they can trust.

Making an informed choice when you choose a surgeon is not a simple task. It requires some work on your part. You need to study and ask lots of questions: some are factual questions that others can answer, and some are emotional questions that only you can answer. In the end, if you’ve done your homework, you’ll make a decision that’s right for you and you’ll know that you made the best decision you could make with the knowledge you had available at that time.

Does that mean that you won’t have any complications? Not necessarily, but it does mean you will have done everything you can do to eliminate them if possible.

There are a lot of bariatric surgeons out there and I’m sure there are several who would be just right for you. It’s my sincere hope that this article helps you find them and know them when you see them.

Ken Miller

Bariatric Support Centers International

Please share your thoughts about this article, or read what others think, here:

How to Choose a WLS Surgeon.

Copyrights to this article are owned by Bariatric Support Centers International. This article may be reproduced and distributed to prospective WLS patients, free of charge, provided that the following conditions are met*:

• The article must be published in it's entirety. Do not condense it.
  
• Proper credit for the source of the article must be included with the publication so that anyone who reads it can find its original source, here at BSCI.
  
• This notice must also be published together with the article.
  
• The following contact information must be published with the article.

Bariatric Support Centers International

- Home of The Success Habits of Weight-Loss Surgery Patients -

www.bariatricsupportcenter.com

4001 South 700 East

Salt Lake City, UT 84107

Office (801) 327-6500

Fax (801)327-0600

* BSCI reserves the right to deny publication privileges for this article to anyone who violates these requirements.