Introduction

Reviews

Is This the Right Surgeon? The Right Hospital?

Timothy B. McCall, M.D.

Doctors vary in how technically competent they are. This should come as no surprise since hairdressers and second basemen vary in their abilities, too. For certain operations like bypass surgery a good outcome depends on, among other things, the manual dexterity of the surgeon. Other operations like traditional gall bladder surgery are easy enough that most surgeons can do them well.

Consider a study in the Journal of the American Medical Association that looked at the variation in death rates of all surgeons performing heart bypass surgery in Maine, New Hampshire and Vermont. The death rate ranged from 3.1 percent to 6.3 percent depending on the hospital. The death rates for individual surgeons varied even more. The best surgeons had a death rate of 1.9 percent. The worst surgeons had a death rate of 9.2 percent, almost five times as high.

A doctor needs to perform a procedure a minimum number of times to gain competence. Afterwards, the doctor must perform the procedure with some regularity to continue to do it well. Practice may not make perfect but it helps. Ask the doctor:

• How many of these have you done?
• How often do you do them now?
• How have your patients done?
• What complications have you seen?
• How common are they?
• If the operation is a relatively new procedure, ask what training the doctor has had in it.

Keep in mind when assessing a doctor’s track record, however, that some excellent surgeons have high complication records because they are willing to operate on patients that no other surgeons will touch.

Remember, too, that a doctor who performs a procedure often may also be recommending it often—appropriately or inappropriately. Technical competence at performing a procedure does not assure the doctor will recommend it appropriately.

Where you have a procedure will often depend on the doctor you choose to perform it. Some doctors have privileges at more than one hospital in which case you may have a choice. The hospital a doctor uses should influence which doctor you choose to carry out the procedure. The quality of the nursing staff, physical therapists and laboratories all affect your care and vary greatly from hospital to hospital.

Often the best hospitals are the ones that do the operation you need often. According to a New England Journal of Medicine study the total number of operations a hospital does per year can affect its death rates. Hospitals performing more than 200 heart bypass operations per year had a death rate of 3.4 percent compared with 5.7 percent in hospitals that performed less than 200. The death rates in hospitals performing only a few bypasses per year are often several times higher than expected. For a few simple operations, like traditional gall bladder surgery volume had no effect. According to the authors, the greater the difference in death rates for an operation between high and low volume hospitals, the greater distance you should be willing to travel to find the right hospital and surgeon.

By telephoning, it’s sometimes possible to determine how often a hospital does a particular operation. Hospitals want your business so they have an incentive to cooperate. Although hospital death rates are occasionally published, it’s usually difficult to get useful, up-to-date information.

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