At what point do you become just a number?

We talk about Rock Stars and better outcomes from surgeons who have more experience. Agreed. But, at what point do you become just a number?
Think of a task that takes about an hour and requires some skill to do it right. Surgery, paint a portrait, assemble a circuit... For argument's sake let's say, building a model. The first model you build will have glue marks and paint smears. The next time you will use less glue and be more careful with the paint. The 5th model looks pretty good but the seam is not perfect all the way. The 100th looks pretty darn good. Now do another hundred, and another hundred, and... At what point do you start forgetting which model is which? At what point do you start thinking about your golf date later in the week, or your girlfriend, or your stock portfolio, or your kid's birthday, or your upcoming vacation or...
Heck, I know I'd get bored doing anything 2000 times. (Although I'd like to try that with sex.)
Does the rock star with 2000 surgical notches in his belt really remember who you are? Or are they just skillful in pretending to remember?
The recommendation is that we keep coming back to the surgeon every year. Why? They are not going to be the one to do the RO or HT or anything. It seems that after the incision is healed we are cash cows that fill up the office. By the time the doc has 2000 patients elementary school mathematics tells us there is very little time left for each patient during the follow up office visits. And yet the insurance company is charged for a full visit.
Meanwhile the doc is scheduling more patients for surgery... 3000, 4000, ...

It seems to me maybe by 500 or so the skill level and follow-up service has peaked. After that you really are a number.

I'm just tossing this out there to get the discussion going. What do you think?

I forgot my excellent surgeon after failed RP and SRT. He was great but he was working with a lost cause unbeknownst to him. I had no complications which is all I could expect from him given I was gleason 9 with a high probability that PCa had left the barn. I went for a cure anyway thinking that at least RP would remove the bulk of the disease. I'm sure it did and saved me a few years. Now I'm on to a new phase in the battle.
Bob

My experience with surgeons - rock star or otherwise - is that you are just a number to them. There really is no expectation of a long term relationship and that contact beyond the post-op appointment is nill unless you develop a problem, infection, etc.

But to be honest, why would you expect a longer term relationship? Unless they screw up or you develop a complication there is no need for their services unless you have a reoccurrence.

I'm far more concerned with their being the best that I can get for my procedure and doing the best work possible than ever seeing them afterwards.

Urologists are oddball surgeons in that they spend a lot of time with their patients. High-volume prostate surgeons are more like other surgeons in that they usually see each patient three times -- once before the operation, once during and once after. Most of the time they spend with you is while you are unconscious. For the ultra-high-volume surgeons you aren't even a number. You are a time slot -- 11:30 on Tuesday the 12th, that's you.

There's nothing much wrong with that, mind you. An expert surgeon is a scarce commodity and you have to expect to share him widely. For routine care you still see your community urologist and if you need company then you get yourself a dog.

My brother is a surgeon. He did trauma for years and years. At first he really liked it. Trauma surgeons don't spend a lot of time talking to their patients. By the time you are called in the patient is usually medicated and not that talkative. Trauma surgeons are always busy and they visit their post-op patients when time allows. Again, the patients are often medicated and sleepy (often because it's the middle of the night) and the surgeon gets to look at their charts and talk quietly to the nurses and the patient may never know (s)he was there. So he liked it at first. Lots of surgery not that much talking. Then he noticed that too many of his patients were young and he spent a lot of time talking to their moms. That was painful for him. He finally decided that he couldn't tell another mother that her brain-dead son only looked alive because the machine was breathing for him. He does gall bladders and such now. He spends more time talking but he's happier.

As for your point about the learning curve, we've been having a debate about where the shoulder of the curve lays. I tend to agree with what I think I heard you saying, which is that most of the benefit of experience comes with a few hundred procedures (although surgeons do continue to improve incrementally for a long time after that) and that after a certain point the surgeon doesn't know that much about your case. But, on the other hand, there isn't really that much value in having a surgeon who has known you for years. A surgeon can look at your scan results and a few paragraphs of notes and know everything that will help him once he gets you open. If it's convenient for you to use an ultra-high-volume surgeon then being "just a number" is probably OK.

Jeff,

I am one of those patients that goes back to his surgeon once a year for a follow up and he is a 2 hour drive away. I don't see HIM anymore, just one of his NP's. I just feel "at home" when I go to his office.

They have all my records from before and after the surgery. I do it for ME, no one else. Last month I went for my yearly and they were happy with my PSA of 0.1 that my PCP had gotten from Quest Labs. I told them I was not. They suggested walking next door to the hospital and having an ultra sensitive PSA test which came back 0.06 which made me real happy! My uro was happy with 0.1 also and suggested SRT at 0.4!!! I told him that was too long to wait if it came to that.

Does my surgeon remember me, probably not. He has done over 8,500 surgeries. Do I care? No!

I have been in furniture sales for 43 years and I can't remember customers from LAST WEEK, especially the older I get.

I just feel with a high volume surgeon like him, he will have the best of the best working for him and up to the date information that my uro may not have yet.

Bill from Florida

I have seen my uro/surgeon more than 60 times since 2007, at least. Perhaps more. Have had the same oncologist now for over 4 years, and approaching being in Oncology Rehab for 4 1/2 years. Same PCP for 20 years. Guess these would be considered LT relationships.

Takes a while for a doctor to really know how their patient ticks, health wise, way more than just seeing a doctor 2-6 times.

My PC and Post-PC journey has been so problematic and troublesome, its amazing how thick my medical file has become. That's why seeing a new doctor or specialist troubles me, because it would take a new doctor quite a while just to come up to speed with what has transgressed.

If seeing a doctor for the first time, I usually give them a print out, of my basic chronology of events from 2007 to present. Sometimes, if its covering other issues, it goes back to around 1999, when I was dealing with the other cancer events.