Surgeons and Scorecards

I may be off base here, but I seem to sense an inordinate dependency on the number of cases that surgeons do weather laproscopic, robotic, or open in nature. I believe that in some cases this can lead to false impressions.

I am reminded of my intern days when I was called upon to assist a resident doing a pelvic procedure. This guy had an inflated impression of himself and loved to show it off. On occasion, he would set the operation clock and see how fast he could do this particular procedure. We can all agree that such behaviors are stupid and have no place in surgery.

Once you have done a procedure many times, enjoy doing it, and are good at it, your work can become fun. There is a fine line between this point and becoming complacent. If this happens, it is a matter of time until the fates jump up and grab you. Hopefully, this doesn't affect patient care and does serve as a wakeup call to the doctor to eat a little "Humble Pie'. This is a fact of human nature at some point. It is important to realize that all procedures have a learning curve. This curve varies from one to another. I believe that anyone with several hundred procedures under their belt is a safe bet. At some point, complacency arrives, one gets and enjoys a reputation, and one begins to have more and more surgeons come into the OR to observe and learn. These observers are a distraction but in the interest of medical teaching, they are needed.

The number of procedures done are important unless the guy is a congenital klutz. If that is the case, he eventually self destructs. I seriously question if an additional 1000 procedures added to a 1000 existing improves performance to a measurable degree. There was once a famous Mayo Clinic surgeon who had done more of a certain type of brain tumor than anyone in the world. He merely went from one OR to another, did his thing on a patient already opened, and then left for another room while others closed. I want my man to be there from step one, to do my surgery as his first case, and to have assistants that know his actions so well that they can anticipate his moves. I have seen surgical procedurs of some complexity carried out with no conversation between the surgeon and his assistants.

So, pick your procedure after hearing the pros and cons, understand that all have unique, as well as, common complications, be the first on the list in the morning, make sure he has a team that do these procedures with him, and choose a doctor with a degree of experience (how many cases?? I don't know, but more is not always better). I submit that a given surgeon with a hundred cases done may well be as good as one with 500 cases completed. Feel free to disagree!

very good post. Interesting to know. and will questioning during our surgeon interview.

about the time or day of the surgery, everyone is different. maybe Monday, the surgeon still hasn't recover from weekend mood, or the first surgery in the morning may be the warm up one, the second may be the best. who know.

Jennfier

You make an excellent point.

Humility is one of the critical personality traits I look for in a surgeon. Your post points out why it is such an important part of successful outcomes.

I have known many physicians in my life professionally, socially and personally. What impressed me the most is that despite the infamous "God Complex" I have found that generally that the most successful surgeons are also the most humble. Even a heart surgeon I knew quite well, was renowned for his expertise, and a bit cocky in his personality ... even he approached every procedure with extreme focus and sublime humility.

I don't need a "god" or "goddess" handling the surgical tools. I already have my God in the operating room to handle my soul.

OBB

Doc...interesting post.  FYI, here is a cut and paste I did about a year ago from Hopkins "Health alerts".  This represents at least one study that has tried to quantify the value of experience...

Tudpock

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.

Very good point you added, Mavica. It's not just a numbers game or assembly line operation techniques. More of something isn't always better.