If you or a loved one needs surgery, you’re very likely terrified. You also may be shopping around to find a surgeon. Of course, you’ll want the best. (I’ve never heard someone say, “I’d like the most average surgeon I can find.”) There are lots of factors to take into account. But here are two questions you might not otherwise have thought to ask:
1. When you sit in the surgeon’s office, you’ll want to know all about the surgeon. But it’s easy to forget to ask about his team. So, one good question is, “Do you always work with the same team (assistant, nurses, etc.)?”
The surgeon’s technical skill is paramount in ensuring a successful outcome. But surgery is a team sport. In the operating room, the surgeon is the captain of the team. An essential part of being a great captain is surrounding yourself with top-notch talent and keeping them at your side through thick and thin.
Research confirms that achieving favorable results in critical situations depends heavily upon the smooth functioning of an experienced team. In Harvard Business Review, Diane Coutu investigated the crews that fly commercial airplanes. The talent and mental state of the pilot was important factor in passenger safety. But a familiar team was even more important. Coutu reported (based on a National Aeronautics and Space Administration study) that fatigued pilots and crews who had a history of working together made about half as many errors as rested pilots and crews who had not previously flown together.
The National Transportation Safety Board also highlighted the importance of a familiar team. The vast majority of the accidents in its database occurred before people had the chance to learn through experience how best to operate as a team. These errors were reported on a crew’s first day of flying together, amounting to more than three-quarters of the total. Half of those incidents occurred on a crew’s first flight.
2. Many people remember to ask about a surgeon’s experience volume. (“How many years have you been doing this?” or “How many times have you performed this exact type of procedure?”) That’s a good question. But a better question would be about frequency, “How many times per month do you perform this exact type of procedure?”
The surgeon may have done a huge number of pertinent cases. But she may have not done any of them in the last several years. During that time, techniques may have changed. Or else, she just may have gotten rusty.
Honing, or even maintaining, a surgical skill requires regular practice. This was demonstrated in a large scientific study of vascular and neurosurgeons who perform carotid endarterectomies (CEA). CEA surgery is designed to prevent strokes by cleaning the interior of an artery that travels through the neck, towards the brain). The doctors were categorized in terms of annual procedure volume as low-volume surgeons (fewer than ten operations), medium-volume surgeons (between ten and twenty-nine), and high-volume surgeons (thirty or more). The researchers reported that patients undergoing CEA by low-volume surgeons were more than twice as likely to die as those patients who were cared for by a high-volume surgeon. They also found the postoperative stroke rate was twice as high for patients of the low-volume surgeons compared to the high-volume surgeons.
Marc Arginteanu is a neurosurgeon.
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