Choosing a neurosurgeon

[Bzalthek]

After several MRIs it looks like my father is going to have surgery on his back soon and he is going to need to choose a neurosurgeon.  While he is doing his own independent research and I am assisting him as well, I thought it might be a good idea to pick the brains of people here.  I am looking for suggestions for web-sites or other publicly available sources so we can get a good idea of who is out there and what their track record is. 

This is pretty important to me and I appreciate any advice on the matter.  Like I said above, other research and avenues are being taken, but I figure it's better safe than sorry.

Thanks.

[Sky]

Finding a good doctor is hell. I've got a couple good specialists through asking friends/family/coworkers, but those same people all hate their general practitioners. Except my mother, who loves hers. Except in the entire time she's been going there, she's never seen the doctor, just the nurse.

[ghost]

Here's my thoughts, having been in the medical field a long time and having dealt with neurosurgeons quite a bit.

1.  Choosing a neurosurgeon is not quite the same as choosing a family physician.  Typically, in the US, they are some of the very best in their medical school classes and spend an exorbitant amount of time in school and training.

2.  Gestalt is important-  if you don't like the guy take that into account.

3.  Bedside manner isn't everything.  There are plenty of folks that are excellent surgeons and have terrible bedside manner.  

4.  Ask your personal physician what their opinion is of the surgeon.  They may have someone they like better that is further away or on different insurance plans.  That is important to know.

5.  If it is a potentially life threatening surgery get several opinions and see what you think.  You will be evaluating the doctor on gestalt, bedside manner and also comparing their treatment plans.  If their plans match up then you have a consensus.  If they don't you will want to know why, what the risks and benefits of each plan are and then make the best decision you can.  


Addendum:  Back surgery is a very, very controversial topic and I would definitely recommend several opinions.  I might even get the opinion of an orthopedic surgeon that does back surgery.  Always keep in mind that surgeons have a tool to use:  surgery.  The old saying is that if you have a hammer, everything looks like a nail.  There may be non-surgical options.  The success rate of back surgeries is not super for certain procedures.

[Trippy]

Addendum:  Back surgery is a very, very controversial topic and I would definitely recommend several opinions.  I might even get the opinion of an orthopedic surgeon that does back surgery.  Always keep in mind that surgeons have a tool to use:  surgery.  The old saying is that if you have a hammer, everything looks like a nail.  There may be non-surgical options.  The success rate of back surgeries is not super for certain procedures.

Indeed, there was just an article about this in the mainstream news recently:

http://news.yahoo.com/s/ap/20100608/ap_on_he_me/us_med_overtreated_back_pain

[Bzalthek]

He's going in Friday for a final MRI and checking with his primary physician about options.  He's keeping everything open to make sure all bases are covered.  I haven't seen his most recent record, but 5 years ago the prognosis was "severe acquired spinal canal stenosis" and that "the spinal canal is almost completely blocked."  Of course, he's 71 and just 3 days ago we were out cementing rocks into place for a wall around the pond.

I appreciate the advice and the tips.  This will be very helpful as he makes his decisions.  Thank you.

[Soln]

Nebu might know

[Sky]

Of course, he's 71 and just 3 days ago we were out cementing rocks into place for a wall around the pond.

http://www.medicalmarijuana.net/

[ghost]

Of course, he's 71 and just 3 days ago we were out cementing rocks into place for a wall around the pond.

http://www.medicalmarijuana.net/

Not a bad gig, for a lot of reasons.   

[CmdrSlack]

What Ghost said.

Well, the first time.

I would ask my uncle, who is a doc in Cali, but if you're not in that state or cannot afford to travel there, I have no idea whether anyone he knows would be useful.

Let me know if you want me to ask anyway. Location is probably a good thing to know as well, just in case he knows people out of state. So I guess PM me if you want me to ask.

[Nebu]

Nebu might know

My advice is simple. 

1. Choose the surgeon with the best technical reputation.  They are mechanics.  Their bedside manner is irrelevant.   I feel this way about all surgery subspecialties. 

2. Get the work done at one of the top hospitals for that specialty.  I'll be happy to provide a list, though the top 5 are readily recognizable.  (Johns Hopkins, UCSF, Mass General, Mayo, etc)

3. If two is impossible, choose the closest teaching hospital.  Surgeons there are exposed to the most specialty surgeries and will have the best tool set. 

If you would like some resources, I'll do everything that I can to help.  Sadly, I can't think of a single colleague of mine in this field.  I know many in neuroscience and neurology, but no neurosurgeons. 

[Morat20]

What exactly is the surgery going to entail? My father's had spinal surgery -- he had bone spurs pressing on various bits they shouldn't have, but if you're using a neurosurgeon I'm guessing it's something a hell of a lot more finicky than just replacing a vertebrae.

'course, by the time he had the surgery some of the nerve damage was permanent.

Nebu: At what level of surgery do you want a 'mechanic'? I'm thinking just a standard specialist until you get into the risky stuff. I mean, if it's just the equivilant of carpal tunnel or plantar fasciatus, it's simple in-office. If you're mucking with the brain, spinal cord, or major organs....

[Samwise]

My GP referred me to a neurologist today because I've got bilateral foot drop and he's not sure why.    Hopefully they won't have to cut me to fix it.  And if they do, hopefully it works.  The whole concept of my internal wiring being messed up gives me the heebie jeebies.

[Nebu]

Nebu: At what level of surgery do you want a 'mechanic'? I'm thinking just a standard specialist until you get into the risky stuff. I mean, if it's just the equivalent of carpal tunnel or plantar fasciatus, it's simple in-office. If you're mucking with the brain, spinal cord, or major organs....

I've learned that any time you need something invasive done, it's always in your best interest to get the best.  No offense to surgeons, but their job is to get in, fix the problem , and get out.  The people with the best training and most exposure will do this best.  I cringe every time I hear the term "exploratory procedure" for this reason.  The mere act of going in has the potential to cause additional problems. 

The statement above is why politicians and other wealthy/influential people will claim that the US has the best health care in the world.  If you can afford to fly to the top physicians in their specialty, you're likely to encounter physicians of an incredible talent level.  Sadly, most of us don't have the resources to exercise this privilege. 

[Morat20]

One of the things that made me feel, strangely, both relieved and worried was my podiatrist admitting she only did "4 or 5" EPF's a year. She sees some 20-odd new cases of heel pain a week, but only 4 or 5 a year resist treatment and require surgery. I happened to hit the jackpot. I can't figure out if that means I really need the surgery, since she has tried virtually everything else first -- and whether I should find a surgeon that does a hell of a lot more of them.

Then again, her more common surgeries involve playing "hunt the bone fragments" and reconstructive foot surgeries of all types, so I'd imagine a tiny slice on a ligament is like, I dunno, what they do for warmups in the morning before their day actually starts.

But your spine? I'd want the best, or at least top 10%. There's really important shit there.

[ghost]

1. Choose the surgeon with the best technical reputation.  They are mechanics.  Their bedside manner is irrelevant.   I feel this way about all surgery subspecialties. 

I disagree with this to a point.  If someone is going to split open my skull or back I want to know that they are a decent human being.  Too many surgeons cross that line of ethicalness too often for my tastes.  Technical reputation should take top billing, sure, but if you don't feel comfortable with how someone treats you that is extremely important.

[Murgos]

You talk to the surgeon two or three times unless something goes seriously, seriously wrong.  Getting the one with the genius hands means you don't have to worry about his bed-side manner.

[Paelos]

I do realize that you are exploring the other options, but I agree with Nebu that you want the top technical expert here regardless of people skills. The guy is not trying to sell you a car, he's fixing your brain.

It reminds me of the old Jeff Foxworthy joke about Southern accents:

There are just some times you don't want to hear a Southern accent. Like when your brain surgeon says, "Now what we gunna do is, we gunna get inside thar, root around with this here stick, and see if we can't find that dad-burn clot."

[ghost]

Yeah, you're right.  I would totally disregard any personal feelings for the surgeon.  I'm sure it plays no role. 

As an ex-surgeon, I would warn you-  don't proceed with someone you don't feel comfortable with.  That is all.

[Paelos]

Yeah, you're right.  I would totally disregard any personal feelings for the surgeon.  I'm sure it plays no role.  

As an ex-surgeon, I would warn you-  don't proceed with someone you don't feel comfortable with.  That is all.

I'm not sure why you believe liking the dude has to do with anything? I'm just not understanding your point rather than arguing against your experience. What are the pitfalls of the personality issues? That's assuming the credentials are good and he's top-rated in his field?

[Nebu]

I disagree with this to a point.  If someone is going to split open my skull or back I want to know that they are a decent human being.  Too many surgeons cross that line of ethicalness too often for my tastes.  Technical reputation should take top billing, sure, but if you don't feel comfortable with how someone treats you that is extremely important.

This is a very valid point.  I know several that will decline procedures for fear or tarnishing their reputation and others that will do a procedure based on profitability when something simpler would be as effective. 

I should have tempered my response.  Thanks for this addition. 

[ghost]

I'm not sure why you believe liking the dude has to do with anything? I'm just not understanding your point rather than arguing against your experience. What are the pitfalls of the personality issues? That's assuming the credentials are good and he's top-rated in his field?

I'm not saying that they have to "like" the dude.  That has absolutely nothing to do with it. 

They have to be comfortable with the clinician, meaning they have to be comfortable with the plan, the ability of the surgeon, and (as Nebu pointed out) whether the surgery is going to be even necessary. 

"Bedside manner" is more than just patting someone's hand after the surgery.  It encompasses everything about your interaction with the patient as a clinician.  It includes giving appropriate informed consent (something that many well-regarded technical surgeons do not do) and giving the patient the appropriate options.  A patient should always have options and should understand what they are getting into.  So saying that bedside manner should be completely thrown out the window is just not true at all.  I do agree that it should take second place to technical ability, because if they can't do the procedure well none of the above matters. 

Again, this goes back to the comment about surgeons being able to do one thing-  surgery.  I don't care how well regarded or skilled an individual is, if you are not comfortable with what they are telling you then you need a second opinion.

[Morat20]

Besides manner -- your surgeon should be able to effectively explain to you what he/she is going to do, and why, and what the risks are in a way that ensures you are informed and comfortable with your understanding of the procedure. And he or she should be able to communicate effectively post-surgery to assses your recovery.

I don't care if she's a genius with her hands, if she can't explain to me what she's doing and why -- well, her genius should convince the hospital to hire a genius-to-patient interpreter who can.

Other than that, I don't think any other beside manner matters.

[ghost]

The definition of bedside manner is:  The doctor's attitude and conduct when in front of the patient. 

It matters in all regards for every clinician.  That doesn't mean you have to want to go have a pint with him/her.

[Nebu]

I care more that my technician has ethics than I do that they have social skills.  I'm fine with tactless.  I'm not fine with unethical. 

[Paelos]

I care more that my technician has ethics than I do that they have social skills.  I'm fine with tactless.  I'm not fine with unethical. 

This was moreso a better way of what I was thinking. I don't care if my surgeon is a dick, as long as he's not an amoral douchebag.

Also, that's why we have House on TV.

[Rasix]

I liked my pediatric orthapedic surgeon.  Started with him at 15, but didn't have my spinal surgery until 20 (due to growth concerns).  He did a hell of a job beating his estimates: one less large incision, one rod instead of two, and a little over 3 hours of surgery instead of 5 plus.  I imagine that cut a great deal out of my potential recovery time.  He was very confident going in.

My dad played golf with him a year or two afterwards.  Said the guy is one of the crudest, cocky people he's ever met. Cavalier attitude that completely flies in the face of my cautious, conservative dad.   "Man, I'm not sure I would let him cut into you after that game." 

 

[ghost]

To the OP-   You can find a good surgeon that isn't a douchebag asshole and has technical talent.  I personally recommend you do so, having worked with and around many douchebag asshole surgeons over the years.  I personally don't know any douchebag assholes with a strong sense of ethics and morality, but I suppose there are some out there. 

Summary:  be very, very careful about letting someone cut on your body........

[Bzalthek]

I find that to be good advice.  My family are all a bunch of assholes, but we do have tact and know when to let the brown eye fly.  I'm fine with asshole docs and I'm sure my father is too, we just make sure they know we have the potential to be much bigger assholes than they ever dreamed existed =p  But that's all extreme cases anyway, we're not going with anyone we don't feel comfortable with and we're not exactly going to be shy about it.  Still have the last MRI tomorrow (well today) and we'll see what's up from there.

Oh, we're in Tennessee to answer a previous question.

I appreciate the input.  It's helped us considerably and I thank you all.  I'll post again when I find out what's up.

[Paelos]

Oh, we're in Tennessee to answer a previous question.

Definitely look out of state. 

Sorry, that's the UGA fan in me.

[Nebu]

Definitely look out of state. 

Sorry, that's the UGA fan in me.

Vanderbilt university hospital is a fine medical center. If I recall correctly, they have a world class pediatrics unit.  If you're closer to Memphis, I'd look into Wash U. 

[Bzalthek]

I should have been more specific.  We're in Crossville, TN which is about halfway between Knoxville and Nashville on I 40.  There's actually a decent doctor pool for the area as a lot of people come here from up north to retire.  My father retired here, though, mainly because there's something like 7 golf courses within an hours drive =p

[Slayerik]

I work for a high end University Neurosurgery department, if you find a surgeon let me know and I'll ask about him.

[Furiously]

Jack Shepard!