Navigating health care options can feel like both the most important and the most complex task people undergo when they are faced with a medical issue. Especially when surgery is involved, a few pieces of information may be helpful. Who better to offer these tips than an insider himself?
This is a conversation with Columbia’s Dr. James Lee. Dr. Lee is the chief of endocrine surgery at Columbia University Irving Medical Center. He serves as Co-Director of the multidisciplinary Thyroid Center, Parathyroid Center and Adrenal Center at Columbia. Dr. Lee is actively involved in the leadership of endocrine surgery at the national and international level.
Dr. Lee answered some questions about how a person who needs surgery might go about finding the right surgeon. This interview hopefully offers some insights, resources, and tips on what makes a surgeon qualified, the value of second opinions, and different communication styles.
[Note: This conversation was lightly edited for the page]
So Dr. Lee, what are the different considerations one should make when choosing and finding a surgeon?
I think far and away, the most important thing in picking a surgeon is the experience of the surgeon. And a good surrogate for that is how many of that particular type of operation the surgeon does a year.
This is actually the question that I always tell my friends and family that they should always ask the surgeon. And the reason for that is because there's something called the “volume-outcomes relationship.”
Basically, in a nutshell, it means that the more of a particular type of operation or procedure a surgeon or physician does, the better they are at it, and the better the outcomes for the patients. This means fewer complications and better chances of success.
You should never be afraid to ask the surgeon how many of “X” type of procedure they do a year. If they do a lot of them, if they're very experienced, they'll gladly, happily tell you how many they do. I think that's the most important way to figure out where to get your surgical care.
Is there a place where these numbers are published, or can we research that? Is it okay to just ask your surgeon about their numbers?
Absolutely. Ask your surgeon. Any surgeon who does a lot and considers themselves an expert will gladly tell you how many they do. I've never met a shy surgeon who does not want to brag about how many they do.
There are other surrogate ways of finding out this information. Depending on the type of disease, for example, cardiothoracic surgeons report all of their cases to a statewide database. And so you can actually look up the surgeons to see how many they do.
There are also things called “Centers of Excellence.” So for example, in weight loss surgery, bariatric surgery, there are designations called “Centers of Excellence” and surgeons have to demonstrate that they do a certain number of procedures in addition to other infrastructure type things in order to garner that designation.
But for starters, just ask. That's the best way to go about it.
How can we be sure that the surgeon is accurately reporting their numbers? Is there a way to verify that, or do we really have to take their word for it?
It's a really great question. You hope that you'll never encounter a surgeon who will lie to you about the volume that they do. Sadly, there's not really a good way of confirming with data that number, except for some of those specialties that have database reporting requirements.
But having said that, other ways of sort of piecing that together is, number one, always ask your medical team for their recommendations, because usually your medical teams will know who the experts in the area are. Definitely ask friends and family. If you have three friends who've had an operation by that surgeon, most likely they do a lot of that type of operation.
And then the other thing is, do your research. And so I always tell people, family and friends, that they should go to Google and see what the surgeon’s Google reviews are. If a surgeon has 50, four- or five-star reviews, and has very happy patients, that surgeon probably does a lot versus someone who has very few reviews.
Once again, you have to take all of those pieces of information with a grain of salt, and you have to piece it all together, and feel very comfortable with the conclusions you draw.
So while we're talking about numbers, is there a threshold or a magic number to indicate how many of a particular procedure indicates expertise?
The short answer to that is no, there's no one magic number for everything. So you have to take into account the relative rarity of the disease or the operation that's being performed. You have to factor that in.
But having said that, there is a ton of research for pretty much every procedure that we do in surgery. There's often some paper that sets a threshold, based on large databases, concluding that, for that particular procedure, a surgeon should do over X operations per year to be considered experienced.
For example, in thyroid surgery, a number of groups have studied this, and you should probably do at least 50 to 100 a year to be considered an experienced thyroid surgeon.
What I tell my family and friends is that for most things, if your surgeon's doing over a hundred of these cases a year, they're pretty experienced.
Any other practical considerations about choosing a surgeon such as location, insurance, accessibility?
Ultimately I think a lot of those other considerations are going to be very patient-dependent. Certainly insurance is a big one. How convenient the surgeon is to you also matters. But key among all of these other things, I think you have to factor in your chances of success.
You may find a surgeon who is a block away from your house, who does a couple of the particular type of procedure that you're looking for versus a surgeon who does hundreds of that operation, but who may be a little bit less conveniently located. You probably want to go to the person who does more, just to maximize your chances of success.
But again, ultimately a lot of that depends on the individual.
Great. Thanks. Now for thyroid surgery, does it matter what kind of thyroid issue is being referred to for surgery? For example, thyroid cancer versus a nodular goiter, does that matter as far as the surgical technique is concerned?
I think it probably matters less in endocrine diseases like thyroid diseases. As long as you have an experienced surgeon who does a lot of them. The difference between cancer or benign disease matters a little bit less. But certainly having a multidisciplinary team of experts taking care of you, I think is very important.
In our thyroid center, we have all of the experts who take care of thyroid disease, and we talk periodically about our patients. We try and come up with the most ideal comprehensive plan, whether it's cancer or benign disease.
Making sure that your surgeon is willing and happily talks to the rest of the medical team, in order to get a multidisciplinary consensus on how to go forward, is the critical point.
How do you feel about second opinions?
I never discourage patients from getting a second opinion. I think it's right.
Ultimately the patient has to be comfortable with the surgeon that they're choosing. And so if they want to get a second opinion, absolutely go for it. And I don't think any surgeon worth their salt would ever disagree that a patient should get a second opinion if that's what they want.
Having said that, if you've gotten opinions from your medical doctor saying, this is the surgeon for you, you've talked to friends and family, you have three friends who have had their operations with that person, and she does 200 of that operation a year and you have a great rapport with them in the office, you probably don't need a second opinion.
But again, to each their own.
Makes a lot of sense. Anything else you want to add about the topic?
I think the other thing is, surgeons have a little bit of a reputation for maybe not being the best communicators or the easiest people to talk to. And I hope unfairly so, but I think it's an important point that in terms of communicating with your surgeon, you want to make sure that your goals of care, what you want out of the treatment, are being heard and being taken into account.
So I think being able to communicate with a surgeon is very important and you have to feel comfortable that you're communicating and talking at the same level.
Probably equally important is the communication with the surgeon’s team. So their administrative staff, their nursing staff, or their extender staff. You may have less of a strong rapport with the surgeon, but if the nurse practitioner or the nurse or the administrator calls you within 10 minutes every time you leave a message on the machine, that's important.
That's a plus in terms of the communication, and of course, importantly, having the surgeon communicate with the rest of the medical team. Making sure that you're comfortable with the rest of your medical team I think is equally important.
Great. I think we all agree that every part of the team is really important all the way down from the surgeon to the person who scheduled the appointment. Thanks so much.
Absolutely. Thanks.