50 Secrets Surgeons Won’t Tell You
Surgeons have our lives in their hands, but most of us know more about the people who cut our hair than the doctors who cut our bodies. Here, insider tips to become a smarter, healthier patient.
To know which doctor is good, ask hospital employees
“Their word trumps an Ivy League degree, prestigious titles, and charm.” —Marty Makary, MD, author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. Here is how to find the best doctors, according to other doctors.
Ask about their complication rate
“If they don’t have one, they’re hiding something or haven’t operated enough to have one. No one is immune to complications.” —Arnold Advincula, MD, division chief, gynecologic surgery & urogynecology, Columbia University Medical Center
Practically all surgeons have an inherent financial conflict of interest
“That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively.” —James Rickert, MD, an orthopedic surgeon in Bedford, Indiana. This is what your doctor is really thinking but won’t say to your face.
If an airline told you that their pilot is the best but he’s not FAA-certified, would you get on the plane?
iStock/Jacob Ammentorp Lund
“For the same reason, always check if your surgeon is board-certified in his specialty. Many are not.” [Visit absurgery.org.] —Tomas A. Salerno, MD, chief of cardiothoracic surgery at the University of Miami Miller School of Medicine
Don’t assume your primary care doctor’s recommendation is best
“Referrals may be politically motivated or be given because the doctors work within the same multi-specialty group.” —Howard Luks, MD, chief of sports medicine and arthroscopy at Westchester Medical Center and University Orthopaedics
Ask if you can talk to former patients
“It’s like getting references for a babysitter.” —Marc Gillinov, MD, author of Heart 411: The Only Guide to Heart Health You’ll Ever Need
Some surgeons won’t mention procedures they don’t know how to do
“I’ll see patients who were told they needed an open hysterectomy, even though it could be handled laparoscopically. That’s one reason it’s good to get a second opinion.” —Arnold Advincula, MD
Always ask ‘Who is going to take care of me after surgery?’
“You want to hear ‘I will see you on a regular basis until you have recovered fully.’ Often it can be residents or physician’s assistants. Sometimes it’s not anybody, especially after you’ve been discharged from the hospital.” —Ezriel “Ed” Kornel, MD, clinical assistant professor of neurological surgery at Cornell University. Use these insider tips to improve your hospital stay.
It’s better to have an elective surgery early in the week
“Lots of doctors go away for the weekend and won’t be around to make sure you’re OK. If you go in on a Friday, and then on Saturday or Sunday something icky is coming out of your incision, you’re going to get someone who’s covering for your surgeon.” —General surgeon who blogs under the name Skeptical Scalpel
Some doctors hire practice management consultants to help capture more revenue
“The consultants may want the practice to sell equipment like knee braces or walkers at a markup. They may want the doctors to buy or build a surgery center to capture facility fees. They usually want orthopedic surgeons to get an in-office MRI. Every time a doctor does this, he becomes more financially conflicted. As soon as you put in an MRI machine, you order more MRIs so you won’t lose money on it.” —James Rickert, MD
Go to your preoperative appointment with a family member
“That reminds your doctor you’re not a gallbladder or a bypass or a valve—you’re a person who’s part of a family.” —Marc Gillinov, MD. Check out this advice to decide whether you should hire a patient advocate.
It’s amazing how diligent people can be about searching for the right surgeon but have no idea who their anesthesiologist will be
“That’s just as important. Ask ‘Who’s going to be putting me to sleep?’ or ask me who I think the best anesthesiologist is. In some hospitals, you can request that person.” —General surgeon who blogs under the name Skeptical Scalpel
Years ago, a patient sent his slides to three different pathologists and got three different answers
“I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab—not just one or two slides but the whole lot—and get a second interpretation.” —Bert Vorstman, MD, a prostate cancer specialist in Coral Springs, Florida
So often the risks on legal consent forms aren’t the things we actually worry about
“Or, there may be one complication we’re really concerned about. If you truly want to understand the dangers, ask your surgeon, ‘What is the risk that gives you the most pause?’” —Kevin B. Jones, MD, author of What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine
In medicine, you can get a DUI, go to jail for a couple of hours, and walk out at 7 a.m. the next morning and do a surgery
“You can be accused of sexual misconduct and drug and alcohol abuse in one state and pop over to the next one and get a license. Some state medical boards don’t even thoroughly research your background; they argue that the less-than-$10 fee to access national data is too expensive.” —Marty Makary, MD. These are the six signs your doctor is a keeper—and five signs they’re not.
Surgeons are control freaks
“When things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.” —Paul Ruggieri, MD, author of Confessions of a Surgeon: The Good, the Bad, and the Complicated … Life Behind the O.R. Doors
Mistakes are probably more common than you would think
“But most of them don’t actually hurt people. I work with residents, and I don’t let them do anything that I can’t fix if they screw it up. If there’s an error that I fix that I’m sure won’t affect the patient at all, I’m not going to say anything about it. That would accomplish nothing except to stress out the patient.” —An orthopedic surgeon
Some problems just don’t fix well with surgery, like many cases of back pain
“My advice? Grin and bear it. Some surgeons vehemently disagree. They say, ‘Oh, you have a degenerative disk, and that must be the culprit. Let’s fix it.’ But many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people.” —Kevin B. Jones, MD
Always ask about nonsurgical options and whether there’s anything wrong with waiting a little while
“Surgeons are busy, and they like to operate. A professor from my residency would say, ‘There is nothing more dangerous than a surgeon with an open operating room and a mortgage to pay.’” —Kevin B. Jones, MD
Talk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery
“Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there’s less chance of those reactions.” —Kathy Magliato, MD, cardiothoracic surgeon at Saint John’s Health Center in Santa Monica, California
Residents have to learn how to operate, and it’s required that an attending physician be ‘present’
But ‘present’ doesn’t mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour.” —Ezriel “Ed” Kornel, MD
It’s always interesting to hear what people say when you’re giving them anesthesia
“I once had a guy who was a horse trainer who started going on about how this one horse was a sure thing to win. One of the nurses collected money from everyone in the operating room and bet on the horse. It came in second place. The smart people bet the horse to place, but some had bet the horse to win, so half the staff was happy, and the other was upset. He woke up and had no idea what kind of ruckus he’d caused.”—Michael Salzhauer, MD, a plastic surgeon in Miami, Florida
I did an intestinal operation on someone who had been stabbed
“As I was running my hand along the bowel, I came upon something and said, ‘What the heck is this?’ It felt like a condom. Then all of a sudden, it wiggled! I dropped it, shocked. The guy had worms.” —Sid Schwab, MD, a retired general surgeon in Everett, Washington
During my six weeks as a surgical intern in the ER, I inadvertently stuck myself twice with contaminated needles…
… briefly nodded off in the middle of suturing a leg laceration, accidentally punctured a guy’s femoral artery while trying to draw some blood, and broke up a fight between the family members of a guy who’d come in with a stab wound to the abdomen. I was slugged in the head by a delirious patient in an alcoholic rage, spat upon, coughed on, vomited on, farted on, bled on, and mistaken for an orderly.” —Paul Ruggieri, MD
When I get polite in the operating room, when I start saying ‘please’ and ‘thank you’ and talking in a monotone, that’s when nurses know things aren’t going well
“It’s this mechanism to maintain calm. When we become unglued, everyone becomes unfocused, and that’s when patients die. How you handle stress is absolutely critical.” —Kathy Magliato, MD. Here are 60 secrets emergency room staff won’t tell you.