[Precision]

My mother is having a 6 bypass heart surgery in October and I would like to find out how I can look up the guy who is supposed to be leading this surgery to make sure he's the right guy for the job? Is there a federal registry of some kind or another place to get essential info?

[Echo M3]

Originally Posted by Precision

My mother is having a 6 bypass heart surgery in October and I would like to find out how I can look up the guy who is supposed to be leading this surgery to make sure he's the right guy for the job? Is there a federal registry of some kind or another place to get essential info?

There are a few websites with physician reviews that you can find quickly by using Google. Like any open review site, they have their inherent biases, so keep that in mind.

You can also use these sites to look up where they trained and when, how experienced they are, who they are affiliated with, and (sometimes) their malpractice litigation history.

If you know any other physicians, asking them to inquire about the surgeon is not a bad way to go, either. Hearsay has its limits, but it can give you a gauge of whether your findings match up or not.

Finally, I'll say that medical training is rather rigorous and the oversight process is extensive in the US, so the odds of getting stuck with a completely incompetent surgeon are much lower in this country, particularly in a specialty as competitive as cardiothoracic surgery.

Best of luck and health to you and your mother

[yakev724]

Good luck and hope your mother gets through without any complications.

Stony Brook has some of the best cardiothoracic surgeons in the country.

[Augenbrauezug]

Does his last name end with; man, stein or berg?

[BMW//M]

Originally Posted by Augenbrauezug

Does his last name end with; man, stein or berg?

Lol, I know one who's last name is Weiss. Those too.

[Gesler]

Reviews on google or where they trained from may not mean much. The volume of surgeries done by the surgeon and the center may be a better index - the higher the better.

[M3Bahn]

Most states have an online database where you can check for license standing and look for other red flags.

[just4kickz]

just go to a hospital thats ranked nationally... most of the surgeons doing work are going to be the best...

[Precision]

Originally Posted by just4kickz

just go to a hospital thats ranked nationally... most of the surgeons doing work are going to be the best...

She is on social security because shes permanently disabled at age 49. Her cardiologist is a very good one and she THINKS that he wouldn't recommend or let just any mediocre guy work on her. He graduated from Hershey Medical @ Penn State (surgeon)

[bumere90]

Contact the hospital in which he works or the department of health maybe?

[Gregxi]

What hospital does he practice at?

I recently had a surgery performed at Georgetown University Hospital, I had researched the best I could about the neurosurgeon online but I asked some doctors that I knew who would they recommend and they all said my neuro without a doubt.
Your Mother is going to someone that is highly trained in that field there is a very low chance that he is a hack.

[ItsHectic]

Keep in mind doctors arnt allowed to speak bad about other doctors.

I have also come across not so great doctors for surgery through referral of another doctor.

In my experience nurses are more open about what a doctor is like, they get a lot of gossip where as doctors have to keep their mouths shut.

As you are concerned try get the surgery done in the morning, its safer.

I read somewhere you should just straight up ask the surgeon what their complication rate is for that particular surgery and they should openly tell you and you can compare, I dont know if this is true or not though.

[El_Duderino]

Originally Posted by JustMe

Keep in mind doctors arnt allowed to speak bad about other doctors.

As a surgeon, let me state that the above is not true. It is true, however, that many doctors will be selective in their criticism in all but the most extreme cases. This is more an aspect of professionalism.

I have also come across not so great doctors for surgery through referral of another doctor.

In my experience nurses are more open about what a doctor is like, they get a lot of gossip where as doctors have to keep their mouths shut.

I agree that, in some cases, doctor to doctor referrals can be biased. Generally speaking, in a large university academic center this is less of a problem as doctors are salaried employees and less likely to refer you to their "friend" so that he/she may turn a profit.

Listening to the nursing staff with regards to a doctors overall attitude may be important, but relying on nurses to provide any insight into a doctors technical performance is just foolish. For example, I work alongside many doctors who are rather aggressive in the operating room and may receive very negative feedback from the nurses -- but these same doctors have incredibly low complication rates, manage highly complex cases and go out of their way to publish their outcomes in peer-reviewed journals. In essence, I would much rather have a curt, short-tempered doctor who knows how to operate--but may be disliked by the nurses--versus a warm, fuzzy, tree-hugging doctor who the nurses love but who is technically incompetent.

As you are concerned try get the surgery done in the morning, its safer.

There is no peer-reviewed data that reliably supports this claim. Generally, speaking large bypass surgeries will be scheduled for the morning in any case.

I read somewhere you should just straight up ask the surgeon what their complication rate is for that particular surgery and they should openly tell you and you can compare, I dont know if this is true or not though.

This is absolutely true and an excellent piece of advice. Ask the surgeon directly what their case volume is for coronary artery bypass grafting and to disclose their complication rate. Also ask them about their last 10 or 20 CABG cases.

I think the most reliable way of finding an excellent surgeon is to go to a university, academic center with a high-volume cardiac program. There are several around the country. US News ranking--although somewhat biased and not entirely accurate--can be a good indicator as to which centers to research. These centers actually publish their outcomes in journals rather than just telling you that they do a good job and assuming you will take their word for it. The very best outcomes will always be obtained from high-volume centers that do these cases, day in and day out.

I hope this helps.

El Duderino

[Precision]

Originally Posted by El_Duderino

As a surgeon, let me state that the above is not true. It is true, however, that many doctors will be selective in their criticism in all but the most extreme cases. This is more an aspect of professionalism.



I agree that, in some cases, doctor to doctor referrals can be biased. Generally speaking, in a large university academic center this is less of a problem as doctors are salaried employees and less likely to refer you to their "friend" so that he/she may turn a profit.

Listening to the nursing staff with regards to a doctors overall attitude may be important, but relying on nurses to provide any insight into a doctors technical performance is just foolish. For example, I work alongside many doctors who are rather aggressive in the operating room and may receive very negative feedback from the nurses -- but these same doctors have incredibly low complication rates, manage highly complex cases and go out of their way to publish their outcomes in peer-reviewed journals. In essence, I would much rather have a curt, short-tempered doctor who knows how to operate--but may be disliked by the nurses--versus a warm, fuzzy, tree-hugging doctor who the nurses love but who is technically incompetent.



There is no peer-reviewed data that reliably supports this claim. Generally, speaking large bypass surgeries will be scheduled for the morning in any case.



This is absolutely true and an excellent piece of advice. Ask the surgeon directly what their case volume is for coronary artery bypass grafting and to disclose their complication rate. Also ask them about their last 10 or 20 CABG cases.

I think the most reliable way of finding an excellent surgeon is to go to a university, academic center with a high-volume cardiac program. There are several around the country. US News ranking--although somewhat biased and not entirely accurate--can be a good indicator as to which centers to research. These centers actually publish their outcomes in journals rather than just telling you that they do a good job and assuming you will take their word for it. The very best outcomes will always be obtained from high-volume centers that do these cases, day in and day out.

I hope this helps.

El Duderino

The surgery will be done at Maine Medical Center in Portland, it is a teaching hospital.

[firstkill]

If its a teaching hospital, make sure to ask WHO is actually doing the surgery.

Teaching hospitals are for teaching, which means a lot of times your surgeon may not actually be doing the surgery or closing up the chest.
fk

[Precision]

Originally Posted by firstkill

If its a teaching hospital, make sure to ask WHO is actually doing the surgery.

Teaching hospitals are for teaching, which means a lot of times your surgeon may not actually be doing the surgery or closing up the chest.
fk

a 6 bypass surgery there better not be any fing one doing the surgery besides the real guy.

[SpacE82]

I work as an analyst in the quality department at a big teaching hospital here Chicago. Look at the hospital website, most hospitals have quality reports (mine does) that are publicly reported. While it may not have physician specific statistics, you can get an idea of how the hospital does in a specific area. If you look at the report and dont understand some of it, PM me, i can prob help. Let me just say that going to a teaching hospital (academic medical center) is a good choice. They are usually ranked the highest and have the highest quality physicians and staff. As far as the rankings on US News go, obviously they do have a lot to do with the quality of the hospital and that is a BIG part of it, but another big part of those rankings is popularity. It is going to take A LOT to move Johns Hopkins out of the top spot since its been there for so long. So like El_Duderino said, those rankings can be biased, but they are a good indicator of the top hospitals in the country. PM me and I can try and help you out finding information.

Hope this helps.

[El_Duderino]

Originally Posted by firstkill

If its a teaching hospital, make sure to ask WHO is actually doing the surgery.

Teaching hospitals are for teaching, which means a lot of times your surgeon may not actually be doing the surgery or closing up the chest.
fk

Originally Posted by Precision

a 6 bypass surgery there better not be any fing one doing the surgery besides the real guy.

Misinformed nonsense. There is a reason that morbidity (ie complications) and mortality outcomes are lowest in university teaching hospitals. That reason is because you have a team of dedicated residents--who are all fully qualified doctors--looking after you and reporting to the "attending" staff who runs the show. It's really simple -- the more eyes on a patient, the more likely you are to pick up on a problem.

In the OR, these same residents are being taught directly by the attending staff. Generally, critical moves are being performed by the attending and his/her fellow (someone who has just completed residency training). It is a well supervised environment. Some of the more straightforward portions of the case are being performed by a resident--closing the chest, for example, which is not technically challenging.

Contrast this with a private practice/community hospital where your care is entirely in the hands of a single surgeon. Do you think that this single surgeon is really going to swing by and check on you 2-3 times per day -- which is the minimum number of times a surgical resident team will see any given patient? In the operating room, this single, experienced surgeon will be relying on a nurse or PA to assist rather than a fully qualified doctor. So, rather than have a surgical resident with 10 years+ of education/training under their belt closing their chest, you will have an individual with 2 years of PA school helping out.

This is not anecdotal. The data is out there. University teaching hospitals do so well, in part, because you have a team of residents assisting the attending in all aspects of patient care.

El Duderino

[firstkill]

Originally Posted by El_Duderino

Misinformed nonsense. There is a reason that morbidity (ie complications) and mortality outcomes are lowest in university teaching hospitals. That reason is because you have a team of dedicated residents--who are all fully qualified doctors--looking after you and reporting to the "attending" staff who runs the show. It's really simple -- the more eyes on a patient, the more likely you are to pick up on a problem.

In the OR, these same residents are being taught directly by the attending staff. Generally, critical moves are being performed by the attending and his/her fellow (someone who has just completed residency training). It is a well supervised environment. Some of the more straightforward portions of the case are being performed by a resident--closing the chest, for example, which is not technically challenging.

Contrast this with a private practice/community hospital where your care is entirely in the hands of a single surgeon. Do you think that this single surgeon is really going to swing by and check on you 2-3 times per day -- which is the minimum number of times a surgical resident team will see any given patient? In the operating room, this single, experienced surgeon will be relying on a nurse or PA to assist rather than a fully qualified doctor. So, rather than have a surgical resident with 10 years+ of education/training under their belt closing their chest, you will have an individual with 2 years of PA school helping out.

This is not anecdotal. The data is out there. University teaching hospitals do so well, in part, because you have a team of residents assisting the attending in all aspects of patient care.

El Duderino

el duderino, you would be okay to have a cardiothoracic fellow do your mothers bypass? maybe the senior resident dig out a vein for a graft? or the intern put in a central line?

post op care is great at large academic/university center which i completely agree with.

my concern for the OPs mother is just who is actually doing the technical parts vs who is observing. All in all, important questions to ask.

fk

[El_Duderino]

Originally Posted by firstkill

el duderino, you would be okay to have a cardiothoracic fellow do your mothers bypass? maybe the senior resident dig out a vein for a graft? or the intern put in a central line?

post op care is great at large academic/university center which i completely agree with.

my concern for the OPs mother is just who is actually doing the technical parts vs who is observing. All in all, important questions to ask.

fk

I would be happy for the cardiothoracic fellow, in concert with the attending surgeon, perform the bypass surgery. How in the world do you think the attending him/herself learned to do the surgery in the first place? I cannot envisage a scenario where the fellow would be left to do the surgery on their own. In my area of head and neck surgery, the fellow will often--with the attending--perform microvascular anastamoses for free tissue transplants -- one could argue this is technically far more challenging than a bypass given the caliber of vessels involved and the complex anatomy.

As far as senior residents harversting vein grafts -- yes, I'm totally ok with this. Harvesting the vein is straightforward and not technically demanding.

Having once been an intern who placed several central lines without incident -- again, I would be ok with this so long as it is a supervised procedure which, in my experience, it always is.

I understand your concern for the OP's mother -- however, please realize that the optimal outcomes in teaching facilities is not only due to resident participation in post-op care. Indeed, residents and fellows are involved in some of the most complex OR cases in virtually every large teaching hospital. I cannot think of a single incident where the fellow or resident is to blame for a poor outcome secondary to "technical" deficiencies.

Again, I ask, how do you think the attending staff learned all the "technical" aspects of the bypass surgery? By standing around and observing?

The key question to ask is, "As the attending surgeon, will you be present and participating in all the KEY portions of the surgery," to which any answer other than "yes" should have you looking for someone else to operate.
El Duderino

[M3Bahn]

Originally Posted by El_Duderino

Misinformed nonsense. There is a reason that morbidity (ie complications) and mortality outcomes are lowest in university teaching hospitals. That reason is because you have a team of dedicated residents--who are all fully qualified doctors--looking after you and reporting to the "attending" staff who runs the show. It's really simple -- the more eyes on a patient, the more likely you are to pick up on a problem.

In the OR, these same residents are being taught directly by the attending staff. Generally, critical moves are being performed by the attending and his/her fellow (someone who has just completed residency training). It is a well supervised environment. Some of the more straightforward portions of the case are being performed by a resident--closing the chest, for example, which is not technically challenging.

Contrast this with a private practice/community hospital where your care is entirely in the hands of a single surgeon. Do you think that this single surgeon is really going to swing by and check on you 2-3 times per day -- which is the minimum number of times a surgical resident team will see any given patient? In the operating room, this single, experienced surgeon will be relying on a nurse or PA to assist rather than a fully qualified doctor. So, rather than have a surgical resident with 10 years+ of education/training under their belt closing their chest, you will have an individual with 2 years of PA school helping out.

This is not anecdotal. The data is out there. University teaching hospitals do so well, in part, because you have a team of residents assisting the attending in all aspects of patient care.

El Duderino

Hospital teaching intensity, patient race, and surgical outcomes.


RESULTS:
Combining all surgeries, compared with nonteaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P < .001), no difference in complications, and a 15% lower odds of death after complications (failure to rescue) (P < .001). These relative benefits associated with higher resident-to-bed ratio were not experienced by black patients, for whom the odds of mortality and failure to rescue were similar at teaching and nonteaching hospitals, a pattern that is significantly different from that of white patients (P < .001).

CONCLUSIONS:
Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is because of lower mortality after complications (better failure to rescue) and generally not because of fewer complications. However, this better survival and failure to rescue at teaching-intensive hospitals is seen for white patients, not for black patients.


http://www.ncbi.nlm.nih.gov/pubmed/19221321

[El_Duderino]

Undoubtedly, racial disparities exist in US healthcare. Only in recent years have research dollars been allocated for this important area of study.

In terms of the topic at hand, please see the study below published in a peer-reviewed high-impact journal:

Circulation. 2008 Sep 30;118(14 Suppl):S1-6.
Long-term results of heart operations performed by surgeons-in-training.
Stoica SC, Kalavrouziotis D, Martin BJ, Buth KJ, Hirsch GM, Sullivan JA, Baskett RJ.
Source
Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Room 2269, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com
Abstract
BACKGROUND:
We investigated the association between trainees performing supervised operations and late outcomes of patients undergoing cardiac surgery.

METHODS AND RESULTS:
Data were prospectively collected on patients who underwent coronary artery bypass graft surgery, aortic valve replacement, or a combination of these between 1998 and 2005 at the Maritime Heart Center, Halifax, Canada. In-hospital mortality and a composite outcome of in-hospital mortality, stroke, bleeding, intra-aortic balloon pump insertion, renal failure, and sternal infection was compared between teaching (n=1054) and nonteaching cases (n=5877). Late survival and cardiovascular hospital readmissions were also examined. To adjust for baseline risk disparities, we used logistic regression for dichotomous in-hospital outcomes and Cox proportional hazards regression for survival data. Resident cases were significantly more likely to have high-risk features such as depressed ventricular function, redo operation, and urgent or emergent procedure. Resident as primary operator was not independently associated with in-hospital mortality (OR, 1.09; 95% CI, 0.75 to 1.58; P=0.66) or with the composite outcome (OR, 1.01; 95%, CI 0.82 to 1.26; P=0.90). The Kaplan-Meier event-free survival of the 2 groups was equivalent at 1, 3, and 5 years (log-rank P=0.06). By Cox regression, resident cases were not associated with late death or cardiovascular rehospitalization (hazard ratio, 1.05; 95% CI, 0.94 to 1.17; P=0.42).

CONCLUSIONS:
Cases performed by senior-level cardiac surgery residents were more likely to have greater acuity and complexity than staff surgeon-performed cases. However, clinical outcomes were similar in the short- and long-term. Allowing residents to perform cardiac surgery is not associated with adverse patient outcomes.

http://www.ncbi.nlm.nih.gov/pubmed/18824740

Hopefully, this will help put this issue to rest.

In brief: go to a high-volume teaching hospital and your outcome will be better. Resident/fellow participation has nothing to do with it.

El Duderino