• How to Choose a Surgeon and Hospital for Major Surgery

    surgery Researchers suggests that over the years, patients have become better informed about medical issues. As a result, they increasingly use that information to help them make important healthcare decisions. One such decision is the choice of a surgeon and hospital when faced with the prospect of major surgery. Here’s some information that will help you make these important decisions.

    Choosing a Surgeon

    Whether your surgeon comes recommended by your primary care physician or you choose to select one on your own, don't take your surgeon's qualifications for granted. Here are some credentials to look for:
    • Board certification—A good sign of a surgeon's competence is certification by a surgical board that is approved by the American Board of Medical Specialties. Surgeons who are board-certified in a surgical specialty have completed years of residency training and demonstrated knowledge and competence by successfully completing a rigorous examination.
    • Fellowship in the American College of Surgeons—The letters FACS (Fellow of the American College of Surgeons) after a surgeon's name mean the surgeon has passed a thorough evaluation of both professional competence and ethical fitness. Fellows are board-certified surgeons who are committed to placing the welfare of their patients above any other consideration.
    • Recommended by a commercial evaluation service—Particularly when outcomes data is not available for your state, hospital, or type of operation, you might consider using one of several commercial, online “Best Doctor” services. (Try searching the Internet using the term “best doctors.”) One such service, http://www.bestdoctors.com, uses a national survey method to solicit doctor recommendations from other prominent doctors. While using a doctor found by such ways doesn’t guarantee excellence, it does allow you to use a surgeon who has received multiple votes of confidence from his peers. These services frequently charge a fee for their recommendations.
    • High surgical volume—Consider asking your surgeon how many of your type of operation she has performed in the past year. Many studies suggest that surgical outcomes tend to be better when surgical volume (the number of cases) is highest. A surgeon who does many of your type of operation each year will probably be a better choice than one who does few. But how many is “many”? Unfortunately, there is no definite answer. While some excellent surgeons can maintain their skills in doing a specific operation without continuing practice, if a doctor is not performing an operation like yours at least every few weeks, you have reason to consider whether a more practiced surgeon might lead to a better outcome. If your surgeon practices in a teaching hospital, be sure to insist that your chosen surgeon, rather than an intern or resident, performs the operation.
    • Practice at a reputable hospital—Choosing a doctor who practices at a highly reputable, accredited hospital, may improve the chances of surgical quality while, again, not guaranteeing it.

    Choosing a Hospital

    Research shows that some hospitals simply do a better job than others. So how can you find the best hospital for the care you need? Look for the following:
    • Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)—To determine if a hospital or ambulatory surgery center is accredited, contact your local or state hospital association, or call the hospital and ask if it is accredited either by JCAHO or by the Accreditation Association for Ambulatory Healthcare.
    • Rated highly by government, consumer, or other groups—Many government agencies and consumer groups rate hospital performance in one way or another. For example:
      • Your state health department may be able to provide you with information about a local hospital’s quality; Pennsylvania, New York, New Jersey, California, Maryland, and Virginia, for example, currently have high-quality information on hospitals available to the public. Consumerreports.org provides links to many of these sites. Healthgrades.com charges for some of their services, but does provide free comparisons of hospitals in a given region.
      • The prestigious Leapfrog Group has an online hospital reporting system that, while not limited to surgery, shows the degree to which included hospitals comply with Leapfrog’s evidence-based, patient safety recommendations.
      • US News and World Report publishes a widely received evaluation of US hospitals every year.
    • Has experience and a history of success with your surgery—Most states collect some kind of outcome measures on surgery, such as mortality rates, and much of this information is available to consumers. Many healthcare providers also offer this kind of information to members.
    • Checks quality of care and works to improve it
    • Your doctor practices at the hospital (if that's important to you)
    • Covered by your health plan

    Planning Your Surgery

    Getting a Second Opinion

    Getting a second opinion is a good way to make sure that having surgery is the best choice for you. Many people are uneasy about seeking another opinion. However, getting a second opinion is a common medical practice encouraged by most doctors. Furthermore, Medicare and many private health insurance companies will help pay for a second opinion because it is also in their best interest to avoid unnecessary surgery. Most Medicaid programs also pay for a second opinion.

    Giving Informed Consent

    Before having surgery, you'll be asked to provide official written consent. It's important to discuss all of your concerns about your condition and the surgery with your surgeon before you sign this form. In most cases, your surgeon will volunteer a great deal of information, but don't hesitate to ask any questions you still have. Your doctor should be willing to take whatever time is necessary to make sure that you are fully informed.

    Determining the Cost and How You Will Pay

    Before your surgery, ask about your surgeon's fees. Many surgeons volunteer this information; if yours doesn't, don't hesitate to ask. You can find out about hospital rates from the hospital business office. In addition to surgeons' fees and the costs of hospitalization, you will also be billed for the professional services of others involved in your care, such as the anesthesiologist and medical consultants.
    You will probably want to check your health insurance plan to see what portion of these costs it covers. If your insurance plan will not pay all of the anticipated costs and you cannot afford the difference, discuss this situation frankly with your surgeon.

    Making the Right Choice

    The most important criteria for choosing your surgeon is your ability to trust the doctor. When you meet with your surgeon, speak with her and listen carefully to her plans and explanations. You need to feel comfortable with what your surgeon says, how she says it, and how relaxed and confident you feel with the level of care.

    RESOURCES

    Agency for Healthcare Research and Quality http://www.ahrq.gov/

    American College of Surgeons http://www.facs.org/

    Joint Commission on Accreditation of Healthcare Organizations http://www.jcaho.org/

    CANADIAN RESOURCES

    BC Surgical Society http://www.bcss.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Birkmeyer J, Stukel T, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117-2127.

    Chen J, Radford MJ, Wang Y, et al. Do "America's Best Hospitals" perform better for acute myocardial infarction? N Engl J Med. 1999;340:286-292.

    Clancy CM. Do your homework before you choose a hospital. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/consumer/cc/cc061708.htm. Published June 17, 2008. Accessed July 11, 2012.

    Considering surgery? National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/considering-surgery. Updated April 12, 2012. Accessed July 11, 2012.

    Krumholz HM, Rathore SS, Chen J, et al. Evaluation of a consumer-oriented internet healthcare report card: the risk of quality ratings based on mortality data. JAMA. 2002 Mar 13; 287:1277-1287.

    Nugent WC. In health care, geography is destiny [editorial]. J Thorac Cardiovasc Surg. 2000;120(5).

    Who should do your operation? American College of Surgeons website. Available at: http://www.facs.org/public%5Finfo/operation/who.html. Accessed July 11, 2012.

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