Well, what are we defining as a good surgeon, to begin with? The obvious answer is the guy who will do your surgery without any complications, but that guy doesn't exist. So then you're looking for the guy who is most likely to do your surgery without any complications. But, what if he's an @$$hole? So then you have a complication, and he isn't really interested in holding your hand while you recover. That'd probably make him a bad surgeon. So now you're looking for a guy who can do your surgery who is unlikely to have a complication and who has a good bedside manner. And for some patients they also want someone who really fluffs their ego. Some people want a guy who spends a lot of time with them, other people don't care about that at all. Some people think a good surgeon only uses the most advanced techniques, and other people would prefer that he do whatever the gold standard is. Do you know how often I have patients ask me if I do a laser tonsillectomy? Happens all of the time, yet there's no real, significant, proven benefit to doing it that way.
I agree that you can't always (or even usually) trust it when a non-surgeon recommends a surgeon. The only evidence that they usually have is that they've sent a lot of people to said surgeon, and they come back in better shape. But that doesn't even cover all the bases I mentioned above. I also agree that the best bet would be to have another, competent surgeon who has seen your surgeon in action tell you that he thinks the guy is a good surgeon. But, you've got to know the guy giving the recommendation actually knows what he's talking about, don't you? And if he's working with your surgeon, he either knows the guy or he's his partner, so of course he's going to recommend him. I'd say it's much more accurate if a surgeon who has worked with your surgeon tells you that your surgeon ISN'T a good surgeon. That's probably something you should take to the bank, unless there's reason to suspect defamation.
My thought: look for a guy who doesn't have a bad reputation, who does the procedure you're going to have on a semi-regular basis (if possible), and who has complication rates within the acceptable average, and who you get along with personally. Assuming you can find his complications rates, and assuming you know what the average is. If you're a super-high risk patient, you're going to find your way to the only guy who will touch you either way, so it's a moot point.
What I also see a lot is that everyone wants to go to Mayo (or maybe not since they're ruthlessly kidnapping children now) or other (insert big name facility). And here's the thing about that:
- If you need an experimental neurosurgery, go to the guy who is doing those experiments.
- If you need a high risk, complex surgery that is otherwise established for your situation as a standard of care: go to a tertiary care center where they do the most of those cases
- If you need an appendectomy/inguinal hernia, etc.: go to the guy down the road who does hernias so that he can pay his mortgage and feed his kids. He's doing a ton of them. As long as he meets the criteria above (you get along with him, no bad rep, and his complication rates are wnl), then he's your guy. You don't need to dig up the guy who invented the hernia repair to have yours done. If you go to Mayo, the guy doing experimental surgeries isn't going to be the guy doing your hernia. Probably a resident. Maybe with very minimal supervision. And there's NOTHING wrong with that (it's kind of commendable), but only if you're going there because you want to enhance resident training. This idea that your bread-and-butter case is going to be done in a far superior fashion because you paid $5,000 to take a trip to Minnesota to have it done is just misguided.
From the perspective of someone in the medical field, I think there are other guiding factors in choosing a good surgeon (most of these aren't extremely relevant to the lay person):
One of my mentors always said “It’s better to be a good surgeon than it is a fast surgeon, but it’s even better to be a good, fast surgeon.”
In other words, yes you have to concentrate on doing things correctly, but once you’re there, why not try to be better than that? A good surgeon is always trying to improve. That includes staying up-to-date on treatments. So sometimes going to the ancient surgeon is a good thing. If he's keeping up on his research and he's not having the jitters, then there's a lot of experience to draw from there. BUT, sometimes it's not a good thing at all because he's doing things the way he always has even though it might not really be the standard of care anymore. This is especially noticeable when you're way out in the communities.
My mentor also said “the enemy of good isn’t great, its bad.”
Same general idea, but also: you can do a great job 10 times and make a bad impression once and be thought of as a bad surgeon. At least for a while and by certain people. So records do matter, but as mentioned above the guy who does routine procedures on the sickest patients will often have a higher complication rate than The guy who does complicated cases on routine patients. So you can’t take that data out of context, like many insurers try to do. Those complication rates can be stratified to an extent, but I don't buy the idea that even those numbers are accurate. There are a lot of intangibles that just don't show up. For example, I have one clinic in an area with a lot of GD hippies. That's just the patient population. They're not unhealthy, per say, but they are very non-compliant. I'll send them home with a medication, and they'll use it one time and then stop because they feel like it effected their aura or some BS. Well, turns out they do the same thing after surgery. And I try to adjust for that, but ultimately you're sometimes forced to treat them, and I really don't see a way that you can accurately identify non-compliance when stratifying risk in a research study. (and that's just one example).
