How to assess a surgeon's expertise/quality

MLScott · July 2017

My wife is soon to undergo prophylactic double mastectomy (skin/nipple sparing) after PALB2 diag. She'll have the surgery at UCSF, which is generally very well regarded for medical care and cancer research. That said, I'm wondering how to know whether the plastic surgeon is top notch. When we met with him there were a few red flags in my mind but maybe they are nothing? Specifically:

Attitude -- he seemed pretty cocky. maybe that's not uncommon. thoughts?
He talked about how he has pioneered this or that (I think when he was talking about the use of alloderm, though I'd need to look back on notes)

So when thinking about him as a "cocky pioneer" I'm wanting to make sure he really knows his stuff and people have had good experiences with him. What I know so far:

Nothing bad shows up on the california medical board
He has pretty mixed reviews on the various review sites out there (e.g. Realself and similar) but frankly, a lot of what's written sounds kind of fake.

Is there any way to get past patients to give us the real story on his work? Is it common (or offensive) to ask a doctor for patient references? Neither of us have ever had surgery so the whole process is new to us.

MTwoman · July 2017

MLScott, first off, I'll state that this is just my opinion. I believe that many surgeons have that "cocky" trait. If you add "pioneering" to surgeon, then I think you increase the odds of that particular trait. My BS was extraordinarily empathetic and kind. I found out later that he wasn't always that way. His metamorphosis happened after his wife had bc, and he saw it from the other side. That being said, I'm not sure that being "cocky" means he isn't stellar. What I would recommend is putting a thread on the forum "surgery, before during and after" and ask if anyone has any experience with that specific doc. You may have women here who can speak to their own experiences with him and his work. Good luck!

Artista928 · July 2017

Hello fellow bay arean. I live in Fremont and had all my care at Washington Hospital since it was around the corner from me.

If you haven't checked yelp yet, check him out there. I used to work for a very busy (cocky/pioneer) surgeons office. He and his partner are the real deal. He was more humble though in front of his pts. When pts praised him to the heavens he would play it down, but us staff new. Many docs are cocky so that shouldn't be a concern unless he's not spending enough time learning about your wife and too much building himself up.

Thoughts:

Google alloderm and see if his name is anywhere.

Not a bad idea to post a thread his name on this board under Recon (since you are asking about a PS) to see if anyone around here knows him. We can also help dig to see if we come up with anything. I know a few other bay area peeps so you may get a pt review right here. I wish I could remember who had their care at UCSF here.

Ask the office if they do have pts who would be willing to talk to you. We had a list of pts who were willing to talk to new pts.

Also:

Did he spend good amount of time with you? Did he answer your questions? What's the gut feel?

gb2115 · July 2017

You could also ask another treating doctor...if your wife has a primary care doctor, or an OB. Ask their opinion. Many many many docs all know each other, and know the quality of each other's work, and who they'd go to themselves, or who they'd not go to.

I have been working in healthcare for the better part of 2 decades...surgeons are not known for award winning personalities. That said, my surgeon is an absolute sweetheart AND does good work, but my understanding is this is an unusual combination.... :-)

Artista928 · July 2017

I've never seen a doc say another doc wasn't good. When I brought up a clearly bad MO that everyone knew but me at first, all I got from my pcp and others was a look or a little smile. Docs don't bad mouth other docs as it's not professional.

MinusTwo · July 2017

Yes surgeons are cocky and it's sure annoying. I picked a woman surgeon breast surgeon and she was great. But my Plastic surgeon (head of the dept at at major teaching hospital) was a true a$$. That said, he did a marvelous job and I can barely see any scars at all 3 years later.

Sometimes docs will give hints. One time I asked a doc for a reference and he said "I'd pick someone else". But have your wife ask someone she trusts (like her GYN) who he/she would send his mother or sister to see without any prompts. A second opinion is always a good idea and docs don't resent that.

Thirdly, if you send a PM to Whippetmom, she keeps a list of plastic surgeons around the country. She's in the LA area but will be familiar with San Francisco. Go to Member Search on the left and type in her name. You will see how to send a private message.

MLScott · July 2017

Thank you all so much. I'll definitely PM Whippetmom and also suggest that my wife asks someone who they'd want for their mom or sister. That's a nice indirect way. Hopefully he'll get a vote. Will also check Yelp. Didn't know that people review docs there.

To answer some questions:

Yes, he did spend a fair amount of time with us. And he did answer our questions. It was just the cockiness that got me. And that he was really really late. But I know that happens at a hospital.

Artista928 · July 2017

I figured a lot of peeps won't know healthgrades or vitals sites to see reviews but everyone knows yelp so I did all mine on their as well.

Being late is typical. Things come up and if the doc/surg is popular then it's expected. I used to provide cookies, coffee and water to help with pt complaints as the surgs I worked for were very busy taking care of biz, putting out fires, etc then they have the pts in the office. I wouldn't read much into it. If the doc showed interest, gave you the time, and you find more good reviews than bad then she should be ok.

Also note that sometimes I found when seeing what was put out there on one of our surgs was overly exaggerated. When one thing was wrong, and I mean not something big, it was written like stay away from this place. I'd ask the pt if they came in why and found out it really wasn't a big deal, was having a bad day/life. Great. Please think about your review before posting it.

Just thought I'd mention that. GL.

MinusTwo · July 2017

My MO who retired was the most wonderful doc in the world. He won doc of the year numerous times. He was always late. If my appointment was at the end of the day, it was sometimes an hour. But he gave every single patient the time to answer all their questions & put their fears to rest - as he did with me. I couldn't have asked for more.

MLScott · July 2017

Oh - that jogs my memory of one more question ... Are there any sites out there (something like healthgrades) that let you contact the person that left a review to learn more?

Artista928 · July 2017

On yelp, scroll over the person's name and there is an option to send message.

Lula73 · July 2017

it doesn't hurt to ask if they have any before and after pics of their work, what their failure rate, infection rate and complication rates are. It's amazing to me how 2 or more surgeons can have the same credentials, perform the same number of surgeries and have such drastically different results.

Artista928 · July 2017

Lula- The surgeons aren't always to blame when something goes south. Our bodies also have an effect on the outcome of a sx. Some people heal better while others are prone to infection and such. I worked for 2 10 star surgeons where people come from all over for them to have sx. Even though they have a very high success rate, some pts didn't do well not because of what they did or didn't do but because of the patients health/pre-existing conditions or just plain bad luck with their bodies.

pingpong1953 · July 2017

My sister used to work in a med-surg department in a small community hospital. One of the surgeons, who was loved by his patients and had a great bedside manner, had a terrible record for post-op complications. My sister privately referred to him as Dr. Butcher, but if anyone looking for a surgeon asked her about him, she'd tell them, "If I were having surgery, I'd go to Dr. XXX." If that person would respond and again ask about Dr. Butcher, Gail would say, "If I were having surgery, I'd really, really go to Dr. XXX." Nurses are a great source of information about doctors, even if you have to read between the lines sometimes.

MinusTwo · July 2017

If you can get to the hospital's infection control department and see the surgeon's record, that is another great tool. But you probably have to know a nurse.

besa · July 2017

FORCE (www.facingourrisk.org) has a "surgeon referral tool" or "Patient experience contact tool" (they seem to use both names.) You can search by doctors name and find woman who have used plastic surgeons and breast surgeons for mastectomy and reconstruction and are willing to talk to others about their experiences. See if the plastic surgeon you are considering is listed there.

http://www.facingourrisk.org/understanding-brca-an...

Also possibly contact the local San Francisco FORCE chapter to to see if they could give you more information about the plastic surgeon you are considering. They may have members that have used him but are not listed in the patient experience contact tool. http://www.facingourrisk.org/get-support/local-gro...

Also, as an above poster recommended, ask to speak to former patients. For breast reconstruction this is a usual request. Anyone who is good will have a large group of happy "customers" who are more than willing to talk to you. Also ask to see photos of his work (also a usual request.) My feeling is that if you can't contact former patients and see photos of his work this is a red flag. In addition you want someone who does mainly reconstructions, cosmetic enhancements are a different skill set. You also want someone who does these surgeries in high volume, if possible multiple times a week and has been doing them for years.

Another good resource... get a copy of the latest edition of Kathy Steligo's "Breast Reconstruction Guidebook." There should be a section on how to choose a good plastic surgeon and other good information.

http://www.breastrecon.com/index.html

or from Amazon.com

You can look this plastic surgeon up in pubmed. See if he is publishing anything on breast reconstruction. Publishing is not a guarantee that he will do a good job but at least a possible source of information about him.(put his name into the pubmed search engine below.)

https://www.ncbi.nlm.nih.gov/pubmed/

ShetlandPony · July 2017

Something that hasn't been mentioned is that you can check to see if the surgeon is board certified in the relevant specialty or specialties. Go to the web site of the American Board of Medical Specialties, abms.org Sometimes you end up seeing a young physician who has an MD but is still working toward board certification. You have to decide if you are comfortable with that. I prefer someone with lots of experience.

A good question to ask is "How many of this particular surgery do you do per month?"

Momine · July 2017

Surgeons tend to be prima donnas. You kind of have to be a cocky or at least confident, if you are going to stick knives in other people. i would ask him for before/after photos, as many as you can get.

CGG · July 2017

Personal references from friends or other tangentially connected people or from previous patients are helpful. Reading reviews online is not, you'll likely see negative & biased opinions. I'd steer clear of those.

How to assess a surgeon's expertise/quality

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