Choosing a Surgeon
What to Ask the Surgeon
Before selecting a surgeon to perform your weight loss surgery, make certain you know the answers to each of these questions:
- Number of cases performed: this is a difficult number to put to good use, as it only weeds out the inexperienced surgeon and doesn't protect you from the surgeon who has performed a large number of cases in substandard fashion. That being said, the general feeling amongst surgeons is that the minimum number for gastric bypass is about 125. The gastic banding is a new operation, relative to the gastric bypass, so many very skilled bariatric surgeons are now performing banding surgery. Banding surgery is technically much less complex than gastric bypass, so it is possible that a very good Bariatric Surgeon can start to do banding with very good outcomes from the start.However, I strongly caution patients against getting a band placed by a surgeon who isn't a very experienced Bariatric Surgeon.
- How was the surgeon trained to do Bariatric Surgery? Did he/she get a quickie course at a conference or spend an extended period of time with an established surgeon? Fellowships (advanced training which involves working with an established surgeon, generally lasting a year) are available now. A surgeon who completed a fellowship may or may not have learned from a reputable surgeon, so look into the instructor's credentials as well. Also, if your surgeon is fresh out of a fellowship, remember to ask how many cases he/she performed as primary surgeon, not just how many they may have assisted on.
- Certainly, ask about the specific surgeon's mortality rate. Don't accept a mere quote of the national averages,( Gastric Bypass: 1 in 200 Banding: 1 in 500 to 2000), but make sure they tell you what their personal death rate is. This number is widely variable between surgeons, even from within the same program. Ask this question and be a smart consumer!
- Ask for their overall complication rate. The overall complication rate should be less than 5%.
- For gastric bypass, ask how large they make the stomach pouch, and if they measure it every time, with a consistent measuring tool. Creating a stomach that is too large is probably the most common “mistake” that less experienced or less skilled surgeons make. The best size is 15ml (or 15cc). It is technically challenging to make the stomach this small, so unfortunately, some surgeons take the easy way out and make it too large, which ends up stretching out over time and patients re-gain weight down the road. There is also no consistently accurate way of determining where to cut the stomach just by looking at it. A measuring tool (like the balloon that I use) should be used every time. Making the stomach the right size is the most important part of the surgery for you personally, as it affects the amount of food you can eat, and therefore your ability to keep the weight off.
- Does the surgeon do their own follow-up? Do you get to speak to your own doctor personally or do you speak to nurses or medical assistants? Do you speak to a doctor in training (a “Fellow”) instead of your surgeon?
- How long is the follow-up? Remember, this is a life-long process and life-long follow-up is essential. In the end, it is your responsibility to ensure that you recieve the care you need, so make sure that your program won't turn you out after a short period of time.
- How willing is the surgeon to include your regular doctor in your recovery process? Communication is essential and you must be confident that your surgeon is willing to take the time to communicate with your doctor. Written materials detailing the expectations and plan for follow-up that you can take to your doctor should be provided. Remember that many primary care physicians don't know the details of how to best care for the patient who undergoes weight loss surgery. I strongly advise that you ensure that your family physician will be included in the educational and follow-up processes.
- Who takes care of you after surgery? With “Fellowships” cropping up now, you must beware of an introduction to a younger doctor, who is in training with the older surgeon. It may be that your surgeon won't be seeing you in the hospital, discharging you, or seeing you in the office after surgery. You may, without your knowledge, be shuttled into the care of the doctor in training. Training new surgeons is very important, but too often older surgeons hire younger doctors to do “Fellowships,” just so they can use them as cheap labor and to relieve the surgeon from having to spend time with patients who have already paid their bill.
- What is the average weight loss and the maintained weight loss in the practice? The national average weight loss after gastric bypass surgery is 50-75% of excess weight lost, which, just like mortality rate, varies tremendously between surgeons and programs. Some solid surgeons in an experienced program like Alvarado's have much better statistics than this, but some have worse, to bring the average number to what it is.
Questions to ask yourself
- Do I feel confident that this surgeon will be invested enough in my success to be personally involved with me and my care for years to come?
- Do I feel comfortable in potentially calling this doctor in the middle of the night if I had a problem? In other words, is this surgeon approachable and willing to answer questions, taking all the time that is necessary?
- Does the surgeon have a consistently positive reputation amongst patients?
- Does this surgeon have a consistently positive reputation amongst his or her colleagues? Sometimes a call to the Chief of Surgery at the hospital is a good way to find out if your surgeon is respected as a good doctor and colleague. Beware - if the Chief seems to hesitate, or to just say things like "His patients seem to do well" or "His outcomes are good", this may mean that he is a good technician, but his overall reputation is less than stellar. You should feel even more confident in your decision after this conversation and if you don't, then think hard about your choice.
- Call the surgeon before you have filled out paperwork for the practice. Does the surgeon answer the call? Do you get your questions answered? (Remember though, that there is too much information that you need to know to convey it in a telephone call, so don't expect to get all of your education on the telephone. You need to demonstrate to the surgeon that you are motivated enough to do the research on your own and attend a lecture if available to you, but the surgeon should be willing to return your call and discuss your specific concerns.)