How to Select your Surgeon
Contemplating excision surgery is a big step, but an even bigger one is hiring the surgeon you’ll use. You know that the typical OB/GYN isn’t the best candidate, and you’ve scoped out the list of member-recommended surgeons on Nancy’s Nook, but how do you choose among them? Here are some tips that may help you hire the surgeon who is best for you.
Some things are really important when you are hiring an excision surgeon.
Training. Look for a surgeon who is MIGS or FMIGS (Minimally Invasive Gynecologic Surgery, and Fellowship etc.) certified. The fellowship is a two-year program after residency is completed for those who want to specialize in endoscopic gyn surgery. Surgeons with this designation have spent a great deal more time in the OR than a general OB/GYN (at minimum, 35 cases of Stage III-IV endometriosis (but 110 hysterectomies, go figure)). Your surgeon should be Board-certified.
Experience: Ask how many surgeries he or she has done. How many laparoscopies? How often do they convert to open laparotomy? What kinds of complications have they encountered, and what was the outcome? Even top-notch surgeons can run into something unexpected during surgery. What matters is what happens next. Ask about their use of imaging for planning purposes. Some surgeons will request an MRI, some an ultrasound, and some will do their own ultrasounds. Imaging can help with surgical planning.
Team: Ask about the team your surgeon uses. Who will work on the bowel if needed? Or the bladder and the ureters? What is there is diaphragmatic involvement? Will Fellows be in attendance? Who will do the actual surgery? Can everything be done during a single procedure? These are all important questions to ask.
Obstetrics: The most experienced excision surgeons no longer practice obstetrics. Catching babies is wonderful work, but doctors who do that can’t dedicate enough time in the OR to excel in the excision of endometriosis.
Excision: Ask your surgeon their thoughts on excision vs. ablation. When and where do they excise? Do they ever ablate (also called fulgerate or cauterize or vaporize)? Excision is the preferred method, although some surgeons may ablate some small areas.
Suppression: Ask if they routinely prescribe suppressive medications before and after surgery. If they do, ask for how long, and why. Some member-recommended surgeons do prescribe these drugs, but you should know beforehand that they do. If they do, they should be able to explain to you why.
Fees: You are absolutely allowed to ask about costs. Do they accept insurance? Are they in-network? Will they file, or if not, will they help you file? Can they estimate what you will pay? Do they require some or all of the amount up-front? What is their policy on paying over time? Do they cap their fees? Is there a charge for records review, a consultation, a pre-op and post-op visit? Asking lots of questions can prevent unhappy surprises later.
The Fit: Are you comfortable in conversation with this surgeon? Are your questions answered to your satisfaction? Some doctors may seem more aloof and others more touchy-feely. You get to decide what works best for you.
What doesn’t matter
Gender: The gender of your surgeon does not impact care quality. While you may have a preferred gender for your healthcare providers, gender has no bearing on their surgical ability.
Preferred tools: Your surgeon might use a laser. Or maybe the robot. Or another cutting instrument. It makes no difference, as no one method has been shown to be better than another. What matters isn’t the tool, it’s the skill of the hand that holds it.
Bowel prep: Some surgeons will have you do a bowel prep before surgery, to empty your intestines. They feel that this helps prevent infection, should the integrity of the bowel wall be breached. Others don’t have you do a bowel prep, believing that solid stool is more easily dealt with than liquid. It all comes down to surgeon preference, and doesn’t seem to make any difference in outcome.
What might matter
Reputation: Reputation can be important but you need to be careful. Some surgeons gets lots of media coverage but aren’t experts in the OR. Others have absolutely wonderful bedside manners but aren’t experts in the OR. Others are experts technically, but don’t connect well with patients. You need to figure out what matters most to you and hire accordingly. Sometimes fame is absolutely earned, and sometimes, not so much. Ask lots of questions.
The office: A well-run front office can make everything go smoothly. A poorly-run front office can make you want to scream. You can decide how important it is to you to have your calls returned and your questions answered promptly. Anyone can have a bad day, but if they’re all bad days you’ll have to weigh that against the surgeon’s expertise. You get to decide how much it matters to you.
Location: Are you willing and able to travel to seek care? You might have to incur travel, lodging and dining costs. If you live in a large city, will you be comfortable in a more rural location? If you’re from a small town, will a large city be overwhelming? If you’re trying to decide among experts, factoring in the location might help you lean one way or another.
Timing: Some surgeons have waiting lists of many months. Some can get you in much sooner. You may have to decide how long you can wait. Also, sometimes surgical schedules get jammed. The last several weeks of every year are very busy as patients have met annual deductibles and try to schedule surgery before the new year. Early summer is a busy time as teachers try to schedule surgery and then have the summer to recuperate before school starts again. You’ll need to consider these factors when you select your surgeon.
What Matters Most
The number one thing patients report over and over about the surgeons that made them most satisfied is that they listen. Your surgeon should pay attention to you and listen when you speak. They should not challenge your knowledge or experience. They should not object to being recorded, nor to having someone with you during consultations. You should feel that you and your healthcare provider of choice are part of a team effort to get you living your best life. Ask alllll the questions. Listen, really listen, to the answers, then give yourself time to think. Your heart will guide you to the choice that is right for you. When you make it, don’t second-guess yourself. If you’ve done your homework, you’ll make the right decision. Then look forward, with great hope and anticipation, to your new life.