Tuesday, September 6, 2016

Choosing Your Child's Surgeon


Choosing a surgeon for your young child with a birth difference of the upper extremity can be challenging, stressful, and confusing.  There is no simple equation to simplify this process but there are a few factors which might help.

Bedside manner.   When a family chooses a surgeon for their child with a birth difference of the upper extremity, a long- term relationship with doctor and his/her team of nurses, assistants, and therapists often develops.   It is crucial that you get along well with the surgeon and his/ her team.  There is no need to put up with a surgeon with a poor bedside manner or a surgeon with whom you have a difficult time communicating.  It is imperative, therefore, that you meet as many times as necessary with the doctor and his/ her team to have your questions answered.  I see many families that have ‘interviewed’ different doctors across the country to find the best fit for their family and their child. This is expensive and time consuming, but it can be very helpful.

Surgeon Background.  I believe that children with congenital hand differences are best served in the care of pediatric hand surgeons.  This means hand surgeons with specific training and expertise in the care of kids and hand surgeons who spend a majority of their time caring for kids.  There are certainly other surgeons that can do a great job in caring for your child, such as hand surgeons that primarily treat adults or pediatric orthopedic surgeons who treat the whole child.  However, it is more difficult as a parent to understand the expertise of doctors in these other groups.  If you are considering such a surgeon, it will be more important that you question the specific experience of these doctors for your child’s specific problem.

A pediatric hand surgeon may be trained in orthopedic surgery or plastic surgery.  As long as they treat kids regularly and have a background and training in caring for kids, they are likely qualified to care for your child.  

I believe surgeon certification can be a helpful piece of information as I believe in the value of a board certified orthopedic or plastic surgeon.   In addition, society membership shows a commitment to continuing education and the physician community.  The two key societies for upper extremity birth differences are the American Society for Surgery of the Hand and the Pediatric Orthopedic Society of North America.  I believe membership in one or both societies is a helpful sign for families.

Surgeon Experience.  This is likely one of the most important factors to consider, but also one that may be the most difficult to assess.  As a parent, you are interested in the surgeon’s overall experience (i.e., volume of cases performed over a lifetime) but you are most interested in their experience with the specific surgery your child requires over the preceding 5 years.  You should ask that specific question.  In my opinion, if a surgeon doesn’t answer or gives a vague answer, this is a red flag suggesting limited experience.  For most uncommon birth difference procedures, if the answer is ‘a few’ or ‘1-2 each year’, it is inadequate to obtain and maintain expertise.   When possible, your child deserves a surgeon who specializes in the problem that he/ she has.  You should avoid a surgeon who only occasionally does the procedure.

Some surgeons are active in the academic world through teaching and writing about uncommon conditions such as upper extremity birth differences.  I believe it is important that all surgeons critically analyze the results of their patients from all surgeries.  I also believe that surgeons who publish their results as scientific papers are more likely to carefully look at patient outcomes and share those results in the medical literature.  Therefore, one other criteria for a parent to consider is publications by a surgeon on a particular topic.  A parent can search for such publications at Pubmed.  This will both provide information on the surgeon and also provide information on the medical problem.

 Other Parents’ Experience.  Families with a child similar to yours may be very helpful in choosing a surgeon.  Such families may have already been through the process of sifting through the limited information out there on different surgeons and certainly will have good information on the surgeon they have chosen for their child.  Most families in this situation are willing and even eager to share their experiences.  However, finding the right family can be tricky- you want a family that you can talk to and relate with.  You want a family whose child has a similar limb difference as your own child.  And ideally, you want a family in your geographical area.  It can be tough to identify such families but Internet resources including Facebook parent groups, parent blogs, online messaging boards, etc. can be helpful.  My blog offers some links which might be helpful.Doctor Rating Sites (Healthgrades, Vitals.com, etc.) provide some information on doctors and surgeons.  While these sites fill a void, the information is far from comprehensive.  These sites provide basic information on surgeons (medical school, training, insurance accepted, etc.) but perhaps most importantly, the sites allow patients to rate the doctor.  However, the ratings are most reflective of bedside manner, not technical skill or outcomes.  There are inevitably a few poor ratings for almost every surgeon with enough reviews.  In my opinion, as long as the majority of ratings and reviews are positive for a particular surgeon, a few poor scores should not rule him/ her out.  Likewise, all positive scores may suggest a pleasing bedside manner but such scores indicate little regarding knowledge, skill, and experience.

Hospital Rating Sites also provide useful information.  The criteria for hospital ratings are more objective than the doctor ratings as they are based on specific criteria such as readmissions, etc.  Hospitals are beginning to pay more attention to these criteria and many are working towards improvement- this is good for patients.  However, it is important to remember that there can be great surgeons at hospitals with lagging scores and poor surgeons at great hospitals. 

Doctor Rating Sites (Healthgrades, Vitals, etc.) provide some good information on doctors and surgeons.  While these sites fill a void, the information is far from comprehensive.  These sites provide basic information on surgeons (medical school, training, insurance accepted, etc.) but perhaps most importantly, the sites allow patients to rate the doctor.  However, the ratings are most reflective of bedside manner, not technical skill or outcomes.  There are inevitably a few poor ratings for almost every surgeon with enough reviews.  In my opinion, as long as the majority of ratings and reviews are positive for a particular surgeon, a few poor scores should not rule him/ her out.  Likewise, all positive scores may suggest a pleasing bedside manner but such scores indicate little regarding knowledge, skill, and experience.

      Choosing a surgeon for your child is a challenge.  I hope that this information can make the process a little bit easier.  Good luck!


Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu


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