My Two Cents (longer than I planned)

[url]http://news.yahoo.com/s/nm/20090917/sc_nm/us_surgery_robotics_1

This is well worth a read. Speaking as a surgeon (not a urologist) who had a RALP 10 weeks ago for PC, had it done in a foreign country, was a former member of a hospital's credentialing committee, and a physician who went through the training and credentailing for use of lasers in neurosurgery, I believe some things should be said.

First, we are all best advised to learn as much as possible about our surgeon, the procedure, and the doctor's expertise before undergoing ANY surgery. This can be done by asking the doctor questions, asking other doctors questions, and even better, seeking out former patients to quiz. Most people love to talk about their operations. Give some a chance.

Second, going to another country to save money on an operation is, at best, unwise! I had my surgery done outside the USA because I knew more about the Swiss doctors and hospitals than I did the ones elsewhere. I do not think that I saved a penny.

Thirdly, be aware that hospitals do not plank down several million dollars for any new equipment unless they can see that it is used wisely and safely. Lots of reasons for that; reputation, patient volume, need to amortize costs, and last but not least liability. Credentialing for special privileges required specialized schooling in labs set up to teach and demonstrations of competence on an ongoing basis. Practice models are a must in training. When I was credentialed for laser surgery, I had a certificate signed by a known professor with his own reputation to protect.

In addition, be wary of any advice concerning any technique that comes from a doctor who does not do that technique. There is likely a hidden agenda somewhere. That said, also be aware that ANY surgery done has inherent risks, advantages, and disadvantages. My surgery took about twice as long as the local average, and as a result, I have had some secondary complications really related to the time spent and the diligence of my doctor. None of this leaves me with any resentment because, I had done my homework and the thickness of my omental fat pad and pelvic floor covering could not be foreseen. My surgeon sat with me and my wife to give us a detailed account of this afterward. I wanted a good job done, and I believe that I got one. I "demanded" RALP from my doctors, but I was on several occasions given the opportunity to opt out for other techniques by doctors who could do them all.

Last, every doctor that I ever met puts his pants on one leg at a time. We all have our faults and short comings. Just try to make sure that the doctor in question for you understands his own limits. Operating rooms are not places for surprises, and "oops" is a nasty word to hear.

Doctor, good post.

I fully agree your sentiments about having operations outside of the US. In your situation, you were knowledgable to know what you were doing and what you were getting into. Most of us, non-medical , regular every day guys wouldn't have that advantage. Then of course, there are severe liability issues to consider once your leave the US with a medical situation.

I agree to where you talk about your own complications, not every thing can be seen or known ahead of time with a complex operation. My own open RP turned complex once I was "opened", because they discovered that I had a very deep and narrow prostate bed. Fortunately, most of my cancer, if not all, was on the left side. The surgeon basically couldn't reach all he wanted to reach on my right side, which could have been a bigger problem had the can been on the right side.

Thanks again, its good seeing the insights from a doctor going through what we go through. Hope you continue to heal well.

David in South Carolina

Simply meant, if something terrible went wrong, or if an operation were outright blotched, what liability and legal issues would a US citizen be dealing with if they had medical treatment or an operation outside of US law.

Liability issues would be sticky in some countries. Your grandchildren might win if at all. In Switzerland, medical liability issues are a lot simpler than in the USA. Basically, a criminal act has to be proven. Then there is no big pot at the end of the rainbow for the lawyers. The doctor?? He likely will go to jail!

brainsurgeon, great post, and good to see you posting. I've not been here often enough to keep track of how you're doing, so it was also good to get an update.

I'll be looking forward to a report on the PSA --- being zero!

Sheldon AKA Sleepless

Love the post, Doc,
I really liked your perspective. Sounds like what I try to tell folks.

Tony