There are some things that are helpful that they will answer that have steered me away from a surgeon:
How many of these surgeries do you do per year? An answer of 50 or above is good.
What is YOUR rate of <specific complication mentioned in the consent>? Keep pushing until they tell you their rate, not the overall rate.
They almost universally don't know their own rate. I don't know my own rates of complications. But, if I want you to go away because you seem to be the kind of guy that will come back to bite me, I'll gladly tell you I have a huge rate of complication.
For a colonoscopy I asked about the risk of a perforated bowel. Their first response was, “that is meaningless, if it happens to you the rate is 100%.” I said if the chances are 50:50, then I am not doing it. They said it has happened twice in their career and based on my lack of risk factors, it would not happen to me.
For my daughters tonsillectomy, the doctor was very happy to share how her stats for post surgery bleeding compared to both other doctors in her group, and the national average. But I live in a Boston suburb and every doctor is a lecturer at either Harvard or Mass General.
Another question to ask is will an intern take part in the surgery. At teaching hospitals the answer is almost always yes. You can ask if they operate at any other hospitals, and again the answer is almost always yes, they operate at a suburban, non-teaching hospital where they will be the only one operating.
I got a little bit humbled at Boston Childrens Hospital. I was doing some Googling about the risks of a CAT scan and asked if they did low-dose ones. They informed me that they in fact invented that procedure. Sure enough, the paper I was looking at was authored by a doctor on their staff.
I have 10+ years of clinical experience in academic hospitals, and have worked in Boston at Brigham and Women's. From this experience, I can tell you 2 things:
1. Being a lecturer at Harvard does not correlate with being a skillful clinician
2. Your view of the clinical system is very skewed, and will bring you more risks than benefits.
Completely agree with point 1. There are many researchers in the area who like to also practice, that lead me to ask the # of surgeries question.
My bias is towards surgery at a good regional hospital (Newton-Wellesley for example) with a surgeon who teaches downtown and does lots of surgeries.
What is my skew that that is bringing me more risk? I used to think all doctors were about the same. Now I realize that is about as true as all baseball players are the same. There are hall of famers as well as some who could be sent down to the minors. The trick is figuring out who is who, because other docs won’t say.
unfortunately if you need a rare surgery (to treat a rare condition), this doesn't work very well. it also isn't enough for surgeries with subjective outcomes (such as vaginoplasty.) with the former you look for a competent surgeon with many good outcomes on related surgeries of similar complexity, and who keeps up with or participates in research. with the latter... image boards? word of mouth? whoever your insurance covers? I get hung up on that kind of choice.
