Care Triad

How to pick a surgeon

Several years ago a close friend asked me to recommend a surgeon for an elective procedure. I told her I had a colleague with a great bedside manner who also had great technical skills. He was absolutely the person I would go to if I needed general surgery. My friend went to see him but ended up using a different surgeon. When I asked her what she liked about the other guy, she said that he told her that he was “the best” surgeon to perform the procedure. She didn’t like his personality but he instilled her with confidence.

The truth is that there is no single “best” surgeon for everyone. And there are many factors that go into picking a surgeon: insurance issues, convenience, etc. And there are advantages to going to a surgeon who works well with our primary care physician (communication) and in having surgery in a place that has an electronic medical record that our primary care physician can access (coordination of care). But the most important thing is how skilled the surgeon is at performing the surgery we need. How do we figure that out? The short answer is that we don’t.

There’s been a lot of controversy about a recent  report card published by ProPublica rating 17,000 individual surgeons in the US. The ratings are based on data collected on Medicare patients between 2009 and 2013 that looks at readmission rates for 8 surgical procedures (that are usually done on people who are generally healthy): knee replacement, hip replacement, spinal fusion (3 types), gall bladder removal, full prostate removal, and partial prostate removal. The idea is that patients who have been readmitted to the hospital within 30 days after a surgical procedure, are likely to have experienced a complication from the surgery. ProPublica used a panel of experts including physicians, to help them evaluate the complications.

Many physicians have criticized the report card (ProPublica calls it a Surgeon Scorecard) including Sandeep Jauhar in a New Times opinion piece. Among the physician concerns are that:

• the data used for the ratings only includes Medicare patients
• the data isn’t directly measuring surgeon skill
• when physicians know their data is going to be publicized, they stop operating on the sickest patients in order to make their results will look better
• some doctors and hospitals have sicker patients than others
• there is better data about surgeon quality that is collected by the American College of Surgeons (although they do not make this data available to the public)

While many of these concerns are valid, the truth is that we need a way for patients to measure the technical quality of surgeons. I agree with a number of bloggers including Ashish Jha, Paul Levy and Ira Nash (yes, he’s my husband) that we need to figure out how to compare surgeons based on their clinical outcomes and we need to start with the data we have. If we wait for the ideal data, it will be a very long wait.

The ProPublica Surgeon Scorecard is far from perfect but it is a step in the right direction.