5252

"The Heart of the Matter"

brought to you by NEMA - The National Emergency Medicine Assoc.

Week: 525.2 Guest: Dr. Carolyn Clancy, Director, Center for Primary Care Research, ACHPR Topic: Choosing a Surgeon - One Part Host: Steve Girard Producer: Ed Graham

NEMA: You're going into the hospital...perhaps to stay a while. Do you get anxiety attacks, because you don't know how to get the doctor, or surgeon who's right for you...or do take a few steps to make yourself feel more comfortable and in control. We're with Dr. Carolyn Clancy, a general internist and the Director of the Center for Primary Care Research for the Federal Agency for Health Care Policy.....Dr. Clancy, how do you find the right surgeon?

CLANCY: Interestingly, one would think there would be a really efficient strategic approach to doing this, but in fact, its exactly the opposite...and usually requires some legwork on the part of the patient. The easiest thing to do is if you have a good friend whom you trust who's had the same operation that you need, then you can go to the at person and get some recommendations. Other than that, most people don't go directly to a surgeon, they are usually referred there...so, to some extent, their primary care physician may be a good source of information. Barring that, you could call the American College of Surgeons, which sometimes has some information. In many large metropolitan areas, magazines sometimes put together doctor's picks of the best surgeons, but ultimately, the best surgeon for you is the one who's both competent technically, as well as one who communicates easily with you.

NEMA: How do you interview a doctor?

CLANCY: Some of the questions that are pretty general but do apply to most kinds of conditions and procedures are pretty straightforward....and yet, many people don't think of them. What operation, precisely, are you recommending? Why do I need it? Are there other alternatives...do I have to have it? What are the benefits of the procedure? What are the risks? What happens if I don't have it? And, some people will want a second opinion. Getting a second opinion is, in principle is a wonderful idea. In practice, I have to say, I find it sometimes a bit intimidating....as a physician who was also a patient a few years ago, I actually requested a second opinion, and it was not the easiest thing I've ever done. I think the message that was conveyed to a physician that I knew and who had operated on me once before was, "you don't trust my judgment". And what I had to say was no...I know that there's some doubt and this is a difficult situation and I actually would like another consultant to weigh in now, rather than later. But it's not easy...but I think very worthwhile. I felt much, much better for having done it. The other questions that people might want to ask ...What has been your experience in doing the operation? Where will it be done? What kind of anesthesia will be used and so forth ? How long will I be in the hospital? And how long will I be, y'know, not up to my usual level of activities?

NEMA: Is board certification a good way to qualify potential surgeons?

CLANCY: If you didn't know two people or they appear to be equal in all other qualifications, probably board certification would be an extra plus. The truth is that the linkage between board certification and actual performance is not that clear. And board certification was not really established to document performance....it means that you've passed a test and are considered to have good credentials by the members of a particular college...usually in this case the American College of Surgeons or some other college of experts, but it really is not a guaranteed marker of performance...and you have to remember that most hospitals have done a fairly thorough check of the physicians' credentials before they let that person admit there.

NEMA: If you face an important procedure at your hospital...make sure you feel Good about your surgeon...and ask any question you like...so you feel comfortable and confident. I'm Steve Girard.