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susancook
07-22-2013, 01:04 AM
So, how do you know that surgeon is competent, one who has patients with good outcomes and fewer postop problems? A spine surgeon is a member of SRS, attends meetings and has a certain percent of surgeries that are spine surgeries....but does that necessarily mean that he/she is a good surgeon? How can a person find out about the outcomes of the patients of any particular surgeon?
Susan

Pooka1
07-22-2013, 06:06 AM
After establishing the person has done enough procedures of the type you need, I don't think the number of complications is related to the talent of the surgeon. For example, Lenke, because he takes the most complex, extreme cases, probably has one of the highest complication rates among surgeons. But that is because of the patient population he works with, not any lack of technique on his part. Surgeons take patients as they come and some of these people probably have issues that prevent any surgeon on the planet from bringing them through complication-free.

In my opinion after reading testimonials, many patients invite complications by waiting too long for surgery. Then it is harder for everyone involved... the surgeon and the patient. I am not criticizing waiting and I think it is better to wait for many adults but then it is unseemly to turn around and blame the surgeon for complications when had they done it earlier, might not have happened. It's hard to know what to do but one thing NOT to do is shoot the surgeon on cases that waited very long.

The other thing is infection rate is not surgeon-related but rather hospital-related to my knowledge. So pick a hospital with low infection rates.

Nobody wants a surgeon who makes mistakes or who isn't very good at what s/he does. But it is not that hard to determine who does the most procedures. That's all you can rationally select on in my opinion.

susancook
07-22-2013, 02:18 PM
I have worked in various hospitals, and there were surgeons that I would not trust my cat to. As an insider in the medical system, I knew who to go to and who not to go to. It was interesting that the doctors that I choose had many staff patients also. There were a couple of doctors that seemed to regularly make bad decisions. As a staff member, I attended a monthly conference that reviewed bad outcomes. Everyone had some bad outcomes, but it was obvious which surgeon made an error in judgement that the average surgeon would not have made and which surgeons had bad outcomes that appeared to be unavoidable.

I am retired and no longer an insider, so do not have access to that informal insider network.

I understand that a revisionist surgeon or one that only takes major curves like Dr. Lenke would have a greater number of patients with complications. It is my impression from reading this blog that most of his patients are very happy with their results.

I would surmise that almost everyone has some kind of complication with this major surgery, especially those who have large fusions. Most complications are small and very fixable, such as my mild pulmonary atelectasis which caused severe chest pain and shortness of breath. Irina had abdominal fluid collection which necessitated a second surgery, but she is fine now. Some complications are patient caused, such as someone that does heavy lifting after surgery. Patients with osteoporosis are at higher risk for problems, so surgeons that operate on older persons probably have more complications.

But given the above information, how can a person who does not have an insider information source find a competent surgeon who makes very good decisions regularly?

Susan

LindaRacine
07-22-2013, 09:45 PM
There's really no way to know an individual surgeon's outcomes unless they've published them. (Almost all publications are for multiple surgeons at one site or at multiple sites.) All we can do is 1) pick someone who has been fellowship trained at a good complex spine center and 2) has done a lot of complex surgeries.

What Sharon mentioned about complexity if absolutely true. I can guarantee that the top 25 deformity surgeons in the country have far more complications that the rest of the surgeons, but that's because the patients they see often have many co-morbidities. So, even if you could know someone's complication rate, it wouldn't really be meaningful unless the surgeon happens to be someone who does a lot fewer or less complicated surgeries.

--Linda

susancook
07-23-2013, 02:22 PM
Thanks for everyone's comments. So how did I chose my surgeon? I started with the local spine surgeon at the local university hospital and saw him 4 times. i decided on a second opinion for many reasons. I was on this blog and read Sharon's entry about seeing Dr. Hu for surgery. Then I read that Irina saw Dr. Hu and liked her. I looked her up on the Internet and discovered her publications and reviewed other patients comments. Then I read her copy of her chapter "Adult Scoliosis Surgery" in an orthopedic book. I also noted that she specialized in degenerative disc repair. I also noted that she had lots of years of experience. Then, I met her and she spent about 50 minutes with my son and myself and I immediately knew that I could trust her. I felt like I had seen her for years. My son, a nurse practitioner, who was originally was very much against my having surgery was very pleased with Dr. Hu. Then, the final winner, was that I sent a message to her support person, a nurse, and she actually talked with Dr. Hu and got back to me quickly. That was my problem with my first surgeon, I really liked him but I could never access him between appointments. Dr. Hu's scheduler called me two days after my appointment and asked me if I wanted to schedule surgery. I said not yet, and then called 2 days later and scheduled surgery. Then it sunk in, that I barely know this surgeon and I have committed my life to her! Have I been rash in making such a quick commitment? Surgery was 2 months off, so I had time to think and I hate to admit it, but Irina had her surgery 2 weeks before mine and if hers had gone poorly, I probably would have cancelled my surgery.

I talked with many people about my decision.....should I wait and get to know the surgeon better? I had scoured the Internet and PubMed and had read most research articles about Adult Degenerative surgery. They all agreed with the doctor's approach. So, how was I thinking that I could get to know my surgeon better? Have her over to my house for dinner? I was being absurd! Everyone that I talked with said that they felt that I had done my "due diligence" in preparing for surgery. Other factors included: I had done 2 years of PT with minimal relief of pain; I say a chiropractor with very temporary relief; I was 66 and not getting any younger and risk increases with age; the pain management clinic at the university hospital where I was going for injections had done 2 rhizotomies or denervations both lumbar and thoracic, 2 steroid injections in L4, and now said that I could not have any more done for a while; I was in daily pain and could only walk half a block without sitting down and couldn't cook dinner without lying down with an ice pack on my back; I had just started Dilaudid three times a day for pain and thought that my use would only increase; and this was a convenient time in my life between planned vacations to do the surgery. Mind you, all of this was just 1.5 years from my diagnosis of scoliosis, so all of this is a surprise as I had recently retired and this was the last thing that I thought would happen. When the radiologist showed me my X-ray (he was a friend of mine, so I got an immediate read), he said, "Oh, you didn't know?".... That was after I said, "Oh shit...." On viewing the X-ray for the first time. One month before my scheduled surgery, I panicked and almost cancelled surgery. That thought lasted for 5 minutes. Then 2 weeks before surgery, a sudden calm came over me and I suddenly let go and sort of surrendered to TRUST in Dr. Hu. I made an appointment for the day before surgery to ask a few more questions which in retrospect wad a waste of her time since I knew that one way or another, that I was committed and would not cancel. She asked me how I felt and I said, "Wonderful". She said "Nobody feels great the day before surgery", but I truly did feel great and relaxed and confident.

In retrospect, while I had researched my condition extensively, I had chosen my surgeon based on knowing 2 people on the Internet who had success with her, she had many years of experience, was a co-department head at a major teaching hospital, was a SRS surgeon who had done a fellowship in spine surgery, and I liked her. So, should that have been enough? I remembered the words of my pain management doctor who said, "any surgeon would love to get their hands on your back". Maybe I met 2 people with good outcomes and maybe she had lots of patients with bad outcomes. When I posted in the other part of this blog about "who has thoughts about this surgeon", when I posted it, nobody responded. That worried me. Then, I figured that she would not be a co-department head if she was not an excellent surgeon. Two points for Dr. Hu.

Everyone knows the 4 month outcome, I am "mostly satisfied" with the results (on the questionnaire at the doctor's office). It also occurs to me that while I both had a very good surgeon and was very lucky, that their might have been a better process for vetting a surgeon, hence the reason the I started this thread.

For those who have read this entire entry, thank you for taking the time to laboriously read my decision making. It was helpful for me to write it down, kind of like therapy. Part of my intent in writing this was to help me to figure out how to chose a general surgeon to fix my incisional hernia, but it seemed to be a helpful thread for everyone in general on this blog. I am a medical researcher by profession and do evidence based research, mostly longitudinal women's health research. It did seem to me in retrospect that I made my decision on surgeon based on a "gut feeling".

Susan

loves to skate
07-23-2013, 02:29 PM
This is a really great question - How do you know if a surgeon is a good surgeon? I too used to work in a hospital and talking to co-workers and working in a blood bank, it was pretty easy to find out who was good and who wasn't a good surgeon. Word really gets around in a hospital when things go wrong and who usually is responsible. Also, I used to ask the physical therapists who was the best Doctor to go to if you needed say rotator cuff surgery. Moving to a new area has made it much more difficult for me to find the best surgeons or even the best primary care physicians, but even then, word gets around town. I met with a group of ladies with spine pain issues and four of the ladies in the group had gone to the same primary care doctor that my hubby and I had just fired and they all had fired this Doctor. Too bad for me I hadn't met them before I went to this Doctor. Fortunately for me, our little community of over 1000 people have a yahoo group where we can get all kinds of feedback from people about just about anything, including Doctors and Physical Therapists. I know Susan really meant qualified spine Doctors and I don't think there is any better resource than this forum and the Scoliosis Research Foundation. Another great resource is Health Grades or any of the other groups who grade Doctors.
Thanks for reading my two cents worth. Sally

Irina
07-23-2013, 02:56 PM
I did all the internet research as well, met in person with one of Dr. Hu patients and spoke on the phone with three more. In our company, there is one man, who was an MD in the past and he is very well connected. He didn't know anything about Dr. Hu, but asked two other spinal surgeons about her and both of them highly recommended Dr. Hu. And I have to admit that gut played a big role in my decision making too. I am a very logical person and do not let emotions prevail, but somehow I had this gut feeling when I met Dr. Hu that this is MY doctor. I've seen three spinal surgeons and I didn't have any doubt that I wanted to go with her.

One thing people should keep in mind regarding complications is that quite often they are related to post-operative care and have nothing to do with the skill of the surgeon. So, don't let the percentage of complications be your main deciding factor.

I am only four months out and very happy with the outcome. I hope I'd be as happy in many years to come.

Confusedmom
07-23-2013, 10:28 PM
When I chose my surgeon, I had been seeing a local SRS surgeon for several years. He said it was time for surgery, so I started going for 2nd, 3rd, 4th opinions. He actually referred me to Dr. Bridwell (Lenke's partner) for a second opinion and mentioned in a kind of "oh by the way" remark that Lenke was "sort of a superstar" in the scoliosis community. I had been reading this forum for a while, so I started PMing people who seemed to know what they were talking about. I especially took Linda Racine's advice, as she is the most knowledgeable person I know about adult scoliosis. Then, I found a published study that compared complication rates at Washington U. (Lenke's hospital) with broader rates. If I remember correctly, Wash. U. reported a 10 percent complication rate in primary adult scoli surgeries, vs. 40% (yes, 40%!!!) overall. I met Lenke and frankly, didn't feel any overwhelming attachment to him. But that didn't matter to me. I wanted whoever I thought would do the best work in the OR, and I think I got it. In total, I saw five other SRS surgeons before I saw Lenke: three in Indianapolis where I live, one in Chicago (trained by Lenke), and Dr. Bridwell.

back2life
07-24-2013, 12:00 AM
I am a very logical person and do not let emotions prevail, but somehow I had this gut feeling when I met Dr. Hu that this is MY doctor. I've seen three spinal surgeons and I didn't have any doubt that I wanted to go with her.

.

Trusting my gut was something I had to do in the end. I had been under the care of an orthopedic surgeon for 10 years who I was first referred to for my bulging disk in my neck by a neurologist. When he took one look at my spine (my scoliosis was fairly obvious to the trained eye) his eyes turned into cartoon eyes(picture them bulging out of their sockets). He could not wait to get his hands INTO me, but not touch the disk. But I only suffered back pain when I over did things and it was easy to recover in a few days time. Through the course of ten years, my back progressed worse and when I finally realized surgery was a reality and sat with him to have the talk, his face was buried into his computer, he answered all the questions to MY HUSBAND and I felt as if I was just suppose to "do it. Big deal!" Yep! I knew I wanted a second opinion. I did not give a rats ass if he was a top surgeon and had multiple success stories. He was not the doctor for me!
My surgeon, Dr. Chang met with me on my first visit for over an hour. When I asked a question, he talked to me. No computers, no papers, nothing. Just me and him and my husband in the room. And hour! I told him I would think about it and we would meet again in three months and he asked if I needed anything from him to call. Anything! PT, doctors names, an earlier appt., whatever. It did take me the three months to come to the decision and I had two other doctors I planned to meet with, but I knew this doctor was the one for me. When I met again with him, he spent another hour going over more of the crazy stuff in my head.
It was only after surgery that I truly found out how amazing this man really is. He has been to a third world country to repair some incredibly deformed spines. Here in our own state he has fixed a woman who was bent in half for years and was told she would never recover and now she is out walking miles a day.
So in the end, sometimes you just gotta trust your gut. I THANK GOD I did not go with my first surgeon just because I had been under his care so many years. I think I would feel so alone and devalued. This is the man who told me that scoliosis does not cause pain.....yet he basically wanted to do surgery the day we meet. Grrrrrr! He knew he could get my insurance to improve and he could cut. Ah....scary! I walked out of that mans just shy of a year ago and I hope I never have to see him again. Shovinist poop!

*Jen
Fusion Surgery May 7, 2013
Pre-T50:L48
Post-T20:L0
Dr. Chang: Sonoran Spine Center, AZ
Degenerative disk disease: bulging disks: facet degeneration

kennedy
07-24-2013, 12:16 AM
Well from my prospective someone who is highly skilled in orthopedic spine surgery and scoliosis. World renown and really nice

susancook
07-24-2013, 01:11 AM
I read something recently that when you are seeking the care of a highly specialized doctor, to forget personality and go with the expertise.
Susan

back2life
07-24-2013, 01:37 AM
I read something recently that when you are seeking the care of a highly specialized doctor, to forget personality and go with the expertise.
Susan

I know this was the case for my brother who battled brain cancer. He had the best surgeon and everyone in the field and previous patients raved about his amazing results. BUT his bed manner was horrendous. He rarely looked you in the eye and anything an assistant could take care would take care of. It was all business for him. But from what I was told, he was the top neurosurgeon my brother could have ever been blessed with and the bedside manner never bothered him. He found it humorous. Only my brother-facing death- would!

Sometimes is it too much to ask for both though? I mean my surgeon wasn't lighting up the room with one-liners but he knew how to keep the conversation going and could redirect if we got off topic. He treated me like a person, not a patient and a number. I think a good surgeon knows how much of a risk we are taking and sacrificing and would be willing to take the time to listen even though they go through it day in and day out. But that is their calling. It will be someone's fit.

susancook
07-24-2013, 02:44 AM
I know this was the case for my brother who battled brain cancer. He had the best surgeon and everyone in the field and previous patients raved about his amazing results. BUT his bed manner was horrendous. He rarely looked you in the eye and anything an assistant could take care would take care of. It was all business for him. But from what I was told, he was the top neurosurgeon my brother could have ever been blessed with and the bedside manner never bothered him. He found it humorous. Only my brother-facing death- would!

Sometimes is it too much to ask for both though? I mean my surgeon wasn't lighting up the room with one-liners but he knew how to keep the conversation going and could redirect if we got off topic. He treated me like a person, not a patient and a number. I think a good surgeon knows how much of a risk we are taking and sacrificing and would be willing to take the time to listen even though they go through it day in and day out. But that is their calling. It will be someone's fit.

I just entered the post before this and read your post. It is ideal if the surgeon has great expertise and personality. If not, go with the expertise.

At one place that I worked there was a surgeon who had a very friendly personality but poor surgical skills. After multiple bad patient outcomes, he was asked to leave. He went to another country and managed to not only have bad outcomes, some of his patients died. He lost his license and is in jail now.

It was his example that prompted me to rethink just how does a person who is not in the surgeon's facility, know how to choose a competent surgeon?

Susan

back2life
07-24-2013, 01:50 PM
I just entered the post before this and read your post. It is ideal if the surgeon has great expertise and personality. If not, go with the expertise.

At one place that I worked there was a surgeon who had a very friendly personality but poor surgical skills. After multiple bad patient outcomes, he was asked to leave. He went to another country and managed to not only have bad outcomes, some of his patients died. He lost his license and is in jail now.

It was his example that prompted me to rethink just how does a person who is not in the surgeon's facility, know how to choose a competent surgeon?

Susan

You are very right, Susan. With my brother, we relied on our small town doctor to do a lot of investigating for us and we also talked to a lot of staff, nurses, etc. you never know who will talk. When I scheduled my surgery I had four hospitals to choose from that my doctor was contracted out of. I did a ton of Internet researching but nothing says more then someone's experience. I asked the scheduler two questions, first, what was my doctors first choice and two, if she were to have surgery which place would she choose. Both were the same. And I had a friend who swore I should have surgery at the place she had hers done (one of my choices) but she had a staph infection. And you never know if it's the surgeon or the hospital.

I would LOVE to have a friend like you on my side when things like this occur in life. You know, when my husband had his surgery, he did not have a choice in surgeons, it was life or death. When you have control it makes things much harder.

susancook
07-24-2013, 11:01 PM
You are very right, Susan. With my brother, we relied on our small town doctor to do a lot of investigating for us and we also talked to a lot of staff, nurses, etc. you never know who will talk. When I scheduled my surgery I had four hospitals to choose from that my doctor was contracted out of. I did a ton of Internet researching but nothing says more then someone's experience. I asked the scheduler two questions, first, what was my doctors first choice and two, if she were to have surgery which place would she choose. Both were the same. And I had a friend who swore I should have surgery at the place she had hers done (one of my choices) but she had a staph infection. And you never know if it's the surgeon or the hospital.

I would LOVE to have a friend like you on my side when things like this occur in life. You know, when my husband had his surgery, he did not have a choice in surgeons, it was life or death. When you have control it makes things much harder.

You are so sweet! Consider us friends! I also need mutual support! I will send you my email in the PM.
How is your brother?
Hugs, Susan
Staph infections unfortunately happen, but it would be great to check the infection rate of a hospital. I asked Dr. Hu about how to prevent a staph infection, she said to get out of the hospital fast!

back2life
07-25-2013, 02:03 AM
You are so sweet! Consider us friends! I also need mutual support! I will send you my email in the PM.
How is your brother?
Hugs, Susan
Staph infections unfortunately happen, but it would be great to check the infection rate of a hospital. I asked Dr. Hu about how to prevent a staph infection, she said to get out of the hospital fast!

He bravely battled his cancer for 10 years and then it was time to say goodbye. There are only so many treatment options when dealing with the brain. We feel blessed that he had left behind a little 'mini-me' so his son is now 21 and a spitting image of his father. My brother taught me so much over those years that I carry through my trials in life, especially now. Wow, a few tears found there way out. Wasn't expecting that! But he was my big brother and could really do it all. He should not have been diagnosed at 19 with brain cancer and pass away within 10 years. Life isn't fair.

I think that infection from that hospital has a high rate from what I recall in doing my research. But even just knowing one person from within the last 8 months was too much for me.

Thanks Susan, my friend!

susancook
07-25-2013, 02:44 AM
He bravely battled his cancer for 10 years and then it was time to say goodbye. There are only so many treatment options when dealing with the brain. We feel blessed that he had left behind a little 'mini-me' so his son is now 21 and a spitting image of his father. My brother taught me so much over those years that I carry through my trials in life, especially now. Wow, a few tears found there way out. Wasn't expecting that! But he was my big brother and could really do it all. He should not have been diagnosed at 19 with brain cancer and pass away within 10 years. Life isn't fair.

I think that infection from that hospital has a high rate from what I recall in doing my research. But even just knowing one person from within the last 8 months was too much for me.

Thanks Susan, my friend!

So sorry about your brother. You have him as your role model on how to tackle tough situations. That is something that nobody can take away from you. Keep him in your heart. Life is unfair. I think that our friends and relatives that have passed are really with us. Remember his strength and passion and celebrate it with your recovery!

Infection really scares me too!

I will call you, take care Jen! Hugs, Susan

aileens
11-01-2013, 09:30 AM
I remembered reading this thread a while back and it came to mind when I read this NY Times article: http://well.blogs.nytimes.com/2013/10/31/a-vital-measure-your-surgeons-skill/?partner=rss&emc=rss&_r=0 (hope everyone can read it, I have a subscription but this may be a free article). It's a little scary to read how much skill influences patient outcomes but that there's no reliable way to determine the skill of your surgeon. Hope the profession figures out a way to address this and share the information with the public.

susancook
11-01-2013, 10:50 PM
Thanks Aileens for the article. So how does the consumer check out a surgon's skill? How can a patient find out a surgeon's post-op complication rate, complications rate, re-operation, read mission, and infection rate? When I worked for Kaiser NW most of the staff saw 1 or 2 surgeons as we knew that they were the best. Now I am a consumer in another health care system and I want to know how to evaluate a surgeon!
Susan