How to find a safe surgeon?

Posted

I’m an RN (mostly psych experience) living in an area where I’ve never worked. Long story short, I’m recovering from my THIRD surgery within a year for an anal fissure (flap, redo the flap, remove the flap) and have finally realized my surgeon is a hack. I did get a second opinion prior to the second surgery but was assured that the best job possible was done. (I later found out the two surgeons were buddies) I have seen red flags: different excuses as to why the surgery didn’t work including blaming me and then blaming my body type, ignoring my lidocaine allergy and insisting I use a cream with lidocaine in it, this surgeon won’t stick around and talk to you after surgery, even though the second surgery I specially requested to speak to him after. There is just a gross lack of communication and unwillingness to help in all areas including preop and postop care. (Also at one point he even lied to me and told me he would trim the flap off in his office if it needed to come off.) 

I was assured by my primary MD (who is great but also new here) that this surgeon was one of the best in town. So the question is how do I find a surgeon to fix this mess in a town where I’m unfamiliar with the medical community and haven’t heard the OR gossip? I have actually considered flying back to my previous state to get help from a surgeon that I personally know is awesome but not sure my insurance would pay for that. I would appreciate any advice. 

Anonymous865

Anonymous865

483 Posts

I've been watching this hoping that someone would provide some good advice, since I too need to find a good surgeon.

I've learned you can't trust the recommendations of your physicians anymore.  It seems that most physicians no longer have a private practice.  They are employees of hospital owned practices.  As such their contract specifies who they can refer to.

No physician will ever criticize another physician even if they think he is a hack.  The best you might get is a comment like, "It's always a good idea to get a second opinion."

Like you I'd consider flying back to your previous state to see a surgeon that you personally know is awesome.

I considered going out of state too, and looked into the insurance situation.  What I found out is that the surgeon and hospital will probably be "out-of-network", so you will be responsible for more of the cost and possibly all of the cost. 

Most insurance plans are only applicable to your state.  The state insurance commissioner has to approve all the plans for that state.  Even if you have a national insurance company like Cigna, United, Blue Cross, etc. the plans will probably vary by state.

When I was considering going out of state, I had Blue Cross.  Only physicians and hospitals within my state were in-network.  I logged into their website and read the detailed literature on my plan.  I found that I could petition to go out of state and be treated as in-network on one of the Blue Cross plans authorized in the other state.  The Blue Cross in the other state and the Blue Cross in my state had to work it out between them.  The physician/hospital would bill the Blue Cross in the other state. The Blue Cross in the other state would pay the claim.  The Blue Cross in my state would reimburse them.  The plan in the other state might have a higher co-pay or deductible, but it could be done.  I didn't pursue it, so I don't know how difficult it would be to get it approved.

If you want to see the surgeon that you know in the other state, call your insurance or get on their website and look at the detailed plan literature.  Find out if you can go out of state.

After 3 unsuccessful surgeries, you would think the insurance company would be very interested in making sure you have an excellent surgeon for the next surgery.

I hope your next surgery goes smoothly and is successful.

Susie2310

Susie2310

2,083 Posts

In my personal life, what I would do to start is to check the physician's licensure and any actions/discipline etc. taken against their license at one's state Board of Medicine.  I would want to see that the physician's license was in good standing and that there was no history of problems/actions taken against their license/no public documents that indicate any problems.

My experience has been that observing the personal experience of other people who have had surgery by a particular surgeon is very helpful.  

 

Edited by Susie2310

canoehead, BSN, RN

Specializes in ER. Has 30 years experience. 6,837 Posts

Talk to the surgical nurses. They know who has good outcomes.

Guest 1152923

Guest 1152923

301 Posts

     Career OR RN here.  Over the years, I've worked with many mediocre surgeons, a few exceptional ones, and a few, mostly incompetent surgeons.  From my perspective, I don't see a whole lot of oversight from the medical community (other surgeons) or any regulatory agencies..."you're 74 years' old, your hands tremble like a leaf and your surgical outcomes are terrible, but you do have an active MD license and hospital privileges so you're good to go!"  As others have suggested, I would network and get the straight scoop from perioperative nurses or nurses that have cared for many of their patients.  Lastly, I have worked in the ORs of large, teaching hospitals and though I'll likely get flamed, I personally wouldn't have any surgery that actively involved physician residents or medical students...Ay yi yi, I have some doozy stories, but I'll digress.