On February 16th, The Washington Post and the Dallas Morning News had an article about a Texas neurosurgeon, Christopher Duntsch, nicknamed “Dr. Death,” who was taken to court after he performed a spinal fusion on a 74-year-old woman. Duntsch left one nerve root severed and another with a screw through it, causing the patient crippling pain.
He was found guilty of aggravated assault and now faces life in prison.
The real story, in my opinion, is that there were plenty of warning signs this surgeon was dangerous, including previously botched operations, being fired from a position after a week, being in an impaired physician program, and the misgivings of his colleagues.
So why did anyone go to him as a patient?
It’s crucial to fully research any surgeon that’s going to cut on you, and having done a stint in anesthetics, it’s easy to get skeptical about knife-happy surgeons. In fact, the anesthetist/anesthesiologist often sees it as his or her job to keep the patient alive and save them from the surgeon.
Below is a list of factors to consider when selecting a surgeon. These tips will help you save money and find someone who is competent. Many of these are applicable to other types of doctors, too.
Does He or She Take Your Insurance
It doesn’t necessarily reflect on the surgeon’s merit, but if you don’t want to pay over the odds, it’s important to find a surgeon who participates in your insurance. Many insurance companies have lists of participating doctors, but be aware that the best surgeon may not participate with your insurance company. If he or she doesn’t, you may be able to go “out of network” and pay a little more, splitting the expense with your insurance company.
Who Else to Ask to Find a Surgeon
A recommendations from friend or coworkers is a common way to find a new doctor. If you know and can ask a nurse or other healthcare professional, especially if they work with the surgeon, even better.
Another common referral source is your primary care doctor. Hopefully he or she will know if a surgeon you’re considering is a real doozy, but your GP may be tempted to refer you to someone who is not necessarily the very best. Reasons for this include: The surgeon is part of the same group and they want to keep the business “in the family;” they are biased because they are a friend/drinking/hunting buddy; the surgeon refers a lot of patients to your primary care doctor so you are referred to them as a quid-pro-quo.
Similarly, hospitals often have “physician finder” lists. These offer the names of area surgeons, but only those who use the facility.
There are various websites that will help you, like ZocDoc at www.zocdoc.com (which I found very user friendly), www.vitals.com, and www.angieslist.com. A lot of these have reviews – but beware because they may be very subjective. Someone may have had an unusually bad experience and unfairly condemn the doctor. Or vice-versa. If there are enough reviews, the results are likely more accurate.
Never forget the most basic test of any doctor: Is he or she licensed?
You can check out someone’s board status either at the American Board of Medical Specialties at www.certificationmatters.org/is-your-doctor-board-certified/search-now.aspx; the American Board of Physician Specialists at www.abpsus.org/public-inquiries; or at the Federation of State Medical Boards at www.fsmb.org.
The licensing body also usually tells you if a doctor has had any malpractice cases or claims made against him or her.
National Practitioner Data Bank
This is a site run by the DHSS, where people can find out if their doctor has been sued or dinged in some way. The problem, according to an expose by Consumer Reports (at http://www.consumerreports.org/cro/health/doctors-and-hospitals/what-you-dont-know-about-your-doctor-could-hurt-you/index.htm) is that doctors can be censored for dangerous practices but be on probation, and that information not be available.
The body that really knows the whole truth is the state licensing board – but if you are just a member of Joe Public (as opposed to law enforcement or some medical body) you usually can’t access that.
Where Your Surgeon Trained
If educated at a top college, medical school, or residency program they should be competent. You can find out where someone trained from the licensing board (see below). Plus, most doctors publicize this information in their online bios, and many have grandiose looking certificates on their office wall in gold and black frames telling you where they trained – especially if it was some prestigious institution (U.S. News and World Report at grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools shows institution rankings).
Are They an Appropriate Sub-Specialist?
Today, we are becoming ever more sub-specialized, so you need to know who to see and what, if any, kind of subspecialty training your surgeon has had.
A cartoon on the American Association of Neurological Surgeons of a surgeon saying to a patient, “I’m sorry I can’t help you with your subacute subdural hematoma. I only operate on pleomorphic xanthoastrocytoma of the third ventricle,” says it all about how specialized we’ve have become.
So, it is important to ensure your surgeon is an expert in the specific surgery you need. There are also different ways of doing operations these days. You may be much better off with someone who can do the operation through a laparoscope, or by robotics.
Similarly, certain hospitals specialize in different types of medical issues, such as cancer care, lung diseases, heart problems, kids, spinal surgery, etc. Try Googling “hospitals that specialize.”
A board-certified surgeon is one who has passed “the boards,” an exam in their specialty that is approved by the American Board of Medical Specialties. Board-certified doctors are likely better than those who are not boarded, although I, as the world’s worst exam taker, have found the family practice boards a non tooexacting standard (I managed to pass!).
A further indication of quality is that your surgeon is a Fellow of the American College of Surgeons. For this they must be board certified and have undergone an assessment of professional competence. They must also agree to a certain ethical standard and have their practice reviewed.
Where Your Surgeon Operates
If your surgeon operates in an accredited establishment, this also provides you with some safeguards. Accreditation is done by The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). They also certify free-standing surgical centers, as does the Accreditation Association for Ambulatory Health Care.
You can get a good idea of the quality of a hospital/institution from its complication rate at the Pro Publica site mentioned below. This site is useful for checking an individual surgeon’s complication rate also.
Teaching hospitals tend to have more highly trained and specialized surgeons and doctors.
Your Surgeon’s Experience/Complication Rate
Your surgeon’s experience is very important, especially if you need some particularly refined operation. There’s a lot of people who can do an adequate job of replacing your hip, but if you need a glioblastoma removed from your brain, find someone with a lot of experience with this procedure. New surgeons must start somewhere, of course, but better not on you!
Consumer Reports (http://www.consumerreports.org/cro/2012/04/how-to-find-the-right-surgeon/index) notes 5 specific operations as being particularly high risk. They are:
- Abdominal aortic aneurism
- Cancer surgery
- Carotid endarterectomy
- Hear bypass surgery
- Heart-valve replacement
Another good piece of information to have is the complication rate of your surgeon’s operations. You may be able to find out if your surgeon has a higher than average complication rate on the Pro Publica website at https://projects.propublica.org/surgeons/. They looked at records for admissions under Medicare for many surgeons doing several commonly performed operations and indicate their complication rate.
What to Ask Your Surgeon
Consumer reports (at the above address) has a list of specific questions they recommend asking your surgeon. They are:
- “Is surgery really necessary?” I always say, more important than your surgeon’s dexterity is his or her judgment and ability to assess the situation to know if surgery is really necessary. And if so, what surgery is needed. Bear in mind, “to a hammer, everything looks like a nail.”
- “Is your board certification up to date?”
- “What’s your experience?”
- “What are your success, failure, and complication rates?”
- “What’s the hospital infection rate?”
This article also has links to other helpful information and resources.
So, with a bit of effort and some know-how, you should be able to avoid the Dr. Deaths of this world.