Exactly who is doing your radical prostatectomy for you?

The article points out that many patients are having surgeries done by doctors with too little experience. It also questions some of the highest-volume surgeons - are they really doing all those procedures themselves?

I like the recommended question:

"Are you going to be doing all of the really important parts of my procedure yourself? (You need to be particularly careful about this at major training institutions where residents may be doing some parts of the surgery, or even the whole operation, while “your” surgeon is overseeing it. Every young urologist has to start somewhere!)"

Exactly who is doing your radical prostatectomy for you?

- Allen

BTW, I just looked up Smith's CV, and under training it says he completed- in addition to a surgery and Urology Residency- a Urologic Oncology fellowship. So, maybe he passes the grade for this: "It is probably also a good idea if he or she has qualified as a urologic oncologist as opposed to just a general urologist (although there obviously exceptions to all such generalizations)."?

This is tricky, to be sure. Because, as was said, the "trainees" have to start somewhere. I met at least 3 residents and a surgical fellow during my hospital stay. Who "did the job"? Don't know, and especially since I have had a good outcome, it doesn't really matter to me.

compiler said...

As former poster Casey used to say, the only thing you can do is try and get the odds in your favor.

That's a darn good perspective...do what you can to stack the odds in your favor for the best possible overall outcome.


It is highly common for the very best surgeons to do the important part while the trainees do the opening, closing and other nominal tasks. Not a problem.

By my own action I had this documented in my informed consent. My surgeon attested to the fact that he would be doing all the critical parts of my surgery. I was very pleased and welcomed his residents to open and harvest nodes and do the closing. But the dissection of the actual prostate and the anastomosis was his assignment. We did the same arraignment with my brother when he had his prostate surgery. All patients should remember that they are in charge. I also signed an intent to use a third party arbitrator in the event that I had a seriously bad outcome rather than to pursue a lawsuit. Lawsuit takes way to much time and emotion. Thankfully both my brother and I had great outcomes and it was a mute point.
Hero

Even if you think you know who is doing your surgery you have to be careful.

We had my surgery set with Dr. Pinto at NIH for 12/8/15. During the various consultations it was clear that he was handling the robotics and doing the surgery himself. We made it clear that we wanted him and not someone else since it is a teaching hospital. Well, they eventually changed our date to 12/15 since Dr. Pinto was not going to be available the 8th. Fine, 'Fine, Dr. Pinto is doing the surgery, right?' Yes,yes,yes. The week before they call to see if we would change the date to 12/14 and we said fine as long as Dr. Pinto is doing the surgery. Yes,yes,yes. Well, fortunately we are all about double and triple checking important things because we decided a day later to call someone else in his surgical group to ask if he is in fact doing the surgery on the 14th. They said he would not even be there on the 14th and some other Dr. was scheduled to do the surgery. She explained that they had spoken to the person in charge of my trial and instructed them to call us and ask if we would be willing to switch the date and that another Dr. would be performing the surgery on that date and would we be okay with that. Well that person told someone else to call us and the Dr. switch got lost in the translation. Fortunately they were able to change us back to 12/15 with Dr. Pinto but it just shows how easily someone else could have done the surgery without our knowledge. I think the anesthesiologist gave me extra so we would stop asking Dr. Pinto the morning of surgery 'You are definitely doing the surgery yourself today, right?' Crazy....

Dr. Atul Gawande's Complications is an revealing account of surgical training, decision-making and errors. While he makes the case that every surgeon must start somewhere he also shares the stories of surgeons who, when the patient is a relative, require that no resident be so much as in the room.

- Wilderness

Back in January 2007 my surgeon told me he was the only guy doing all the cutting , sewing and whatever. He said that he had slightly less than 200 Davinci procedures, and would never do more than three a day and only three days a week. After reading of the 1000 patient prostatectomy factories, his plan gave me a lot of confidence.

He is good and spent time with me and my family. He has gone on to be recognized as one of the finest surgeons around. On the other hand, if I knew more back then some form of radiation would have been my first choice. I eventually needed that anyhow.

I did have quick recovery with few urinary problems. My ED problems are a bummer, but We have found some solutions.

The topic of this thread always gets me back to the thought that someday the surgeons with the present day experience that you want will retire and somehow those you now cast off as inexperienced will be the ones called upon.