You are here
One of the most challenging tasks as a patient is to find a good doctor. This task becomes even more important if you are considering a serious medical intervention such as a spine surgery. Unfortunately, there is no one source to go to find reliable information about a doctor. There are early attempts by websites that offer grades for physicians, but even they are lacking as they often rely on patient’s opinions which may not address their abilities beyond bedside manner. I will try to explain the strengths and weaknesses of different methods to determine if you are choosing a good spine surgeon.
The first consideration is their training. A spine surgeon practicing in the United States has trained as either an orthopaedic surgeon or as a neurosurgeon. For surgeons trained in the last twenty years there is little difference between the two paths. In general more orthopaedic surgeons are comfortable and trained to care for spinal deformities, such as scoliosis and neurosurgeons are more likely to care for tumors of the spinal cord and nerves. The question then becomes the quality of their training. It is easy to recognize institutions such as Harvard or Johns Hopkins as quality medical centers. The physicians who train at these centers are bright but when it comes to a given specialty, some of the top training programs may be elsewhere, such as Thomas Jefferson, Washington University or UCSF. Do not discount your surgeon if they do not have an academic pedigree that you recognize. Instead look to see if they have had their residency and fellowship in the United States. Make sure that they were at universities that are large enough where they were likely exposed to a variety of conditions and techniques in their training. Check that they are board eligible or board certified in either orthopaedic or neurosurgery. Each specialty has a board which ensures that their members have met the highest standard of training and have passed multiple exams. There is also a process of maintaining board certification that requires ongoing education and assessment of a physicians practice. Board certification alone does not guarantee a physician’s skills in the operating room, but it does ensure that they have had the appropriate training at the appropriate schools to practice in their field of medicine.
Look for a surgeon that has focused their practice on spine surgery. The field of spine surgery has advanced substantially in the last twenty years. Not long ago it was common for orthopaedic and neurosurgeons to “dabble’ in spine surgery. I believe that the field of spine surgery has become complex enough that it is important to find a physician that is dedicated to spine surgery. A surgeon may perform brain or orthopaedic fracture surgery as part of our responsibilities to take emergency room call, but their non-emergent practice should be predominantly focused on spine care. If you have a problem that is rare, ask your surgeon if they are comfortable taking care of your condition. If a surgeon is involved in teaching other surgeons they have likely been picked because they have made an effort to stay current with new techniques and are good at performing procedures. An interest in research is another indication that a surgeon is making an effort to stay and to contribute to their profession.
Opinions from others regarding a surgeon may be helpful, but there are limitations. A very helpful recommendation would come from one spine surgeon recommending another that they know well. It may be difficult to find such an informed opinion. Another helpful source of information is a local primary care physician that has a history of sharing patients with a surgeon. They are likely to know how patients do under a given surgeons care. Patients can be enthusiastic sources of information, but their opinion may be heavily influenced by bedside manner. This group is most susceptible of having a false sense about a surgeon’s credentials or capabilities. A patient may be happy with their interactions with a surgeon, but they may not recognize if they have had substandard care.
There are certain factors that I consider as warning signs which may signal you to seek a second opinion before proceeding with a particular surgeon. The first is the use of scare tactics. If a surgeon is recommending urgent aggressive surgery for what seems to be minor symptoms, it may be an indication that a surgeon’s motivations or diagnosis are out of place. There are some spinal conditions that require urgent attention such as a fracture, infections and severe compression of the spinal cord or nerves, but they usually present themselves as an obvious problem. If you get the sense that your surgeon is trying to sell you on an intervention that does not make sense, it may be time to seek another opinion. Another warning sign is if a surgeon offers a procedure that is miraculous. Such claims made through advertising may be the modern day equivalent of “snake oil” salesmanship. If a procedure is too good to be true, then it likely is.
A final consideration is your interaction with your surgeon. Do not be too quick to dismiss the importance of bedside manner. The best outcomes for you will come from a talented surgeon that cares for you understands you as an individual. Be concerned if you have the sense that your surgeon is too busy, or too emotionally distant to listen to you and your needs. You should feel comfortable with your surgeon. You should have the sense that they are committed to you and your best interests. A surgeon should also take the time to explain the important aspects of your care. If your physician lacks a good bedside manner, take time to try to figure out why you are not comfortable with the interaction. Trust your instincts, if you are not happy with your surgeon before surgery, it is probably time to find someone else to help with your spine care.
Vail Summit Orthopedics, Surgeons in Vail and Summit County, Colorado