Greater Boston Urology Blog

How to Select a Surgeon: Tips to Keep in Mind

You just found out you need surgery, and your mind is spinning with a million questions, including how to select a surgeon. Dr. Angel Marie Johnson is the Director of Women's Health at GBU and a high-volume surgeon in her urogynecology subspecialty. Below, she shares her insights and the questions patients should ask when selecting a surgeon.

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider regarding your healthcare needs.

Make sure any surgeon you're considering is in-network.

Nothing is worse than meeting a surgeon, developing rapport, and creating a plan, only to discover that your health insurance won't cover your surgery.

Dr. Johnson says, "Current wait times are almost prohibitive, where you're waiting six months to see that surgeon, three months to have surgery, only to be canceled, and now you're nine months in, and you're starting over."

To avoid this fate, Dr. Johnson recommends calling the number on the back of your insurance card and confirming the surgeon is indeed in-network—and doing so before you have your initial consult. No one likes dealing with insurance, but it's much easier to make the call before selecting a surgeon than after the fact.

Make sure you're comfortable with the surgeon.

During your consultation with the surgeon, pay attention to how you feel. Does the surgeon put you at ease? Do they answer your questions thoroughly and clearly? Do you trust that the surgeon has your best interests at heart? Do you feel safe, seen, and heard?

Dr. Johnson says, "You deserve to have a provider that you feel connected to, that you have trust in, and that you can reach out to answer whatever questions you have. Lines of communication must be open."

Ask where you'll be having the surgery.

If your doctor recommends a specific location for the surgery, whether a hospital or surgical center, it's essential to follow their recommendation. If the surgeon works regularly out of a specific location, this indicates a certain level of comfort for everyone involved, like the medical staff within the facility.

Dr. Johnson explains further: "The preferred hospital and its staff will be familiar with how the surgeon works and how the doctor wants you taken care of pre- and post-operatively, which means you're going to have the best result at that location. You can't always trust Google reviews. A hospital can have a bad or great rating for a myriad of reasons that may not impact your care."

Ensure you fully understand all pre-surgical and post-surgical care, including any activity restrictions before surgery.

Get a copy of a "What to Expect" document before your procedure. If that's unavailable, ask the surgeon what to expect when you have your consultation (and be sure to take notes). Try to get a copy of post-op instructions in advance. Know the gist of what's going to happen during your surgery. For example, are you having any organs taken out? Will you still have your uterus or your ovaries (etc.) following the procedure?

That might sound silly, but Dr. Johnson says many patients remain unaware of what the surgeon is doing.

Dr. Johnson says, "The medical terminology can be intimidating. This is why you must make sure your surgeon breaks it down into basic words that are understandable for you. Because your other doctors will also need to understand what happened during your surgery as it can impact other areas of your health."

Ask how often the doctor performs the surgery.

Volume is important, meaning how often the surgeon performs a specific procedure compared to other surgeons who perform the same procedure. A low-volume surgeon tends to have more complications than a higher-volume surgeon.

Patients should ask the doctor about their experience performing a particular procedure and listen to their answers carefully. Dig deeper if the provider says they've been doing a particular procedure for years. Instead, ask how many they've done in the last six to twelve months since that will give you a better sense of whether the surgeon regularly performs the procedure.

Keep in mind certain procedures are rarer than others, so a seemingly low number in the last 12 months doesn't always indicate an issue if the procedure itself is rare. If you're unsure whether a procedure or diagnosis is common or rare, ask!

Dr. Johnson explains, "When you ask any question, you can gauge the answer and even gauge the words that aren't said. For example, if a patient asks how often I perform hysterectomies, I'll explain that I do one or two per week because this is my area of expertise. Whereas the average gynecologist who isn't a subspecialist does about 10 to 15 hysterectomies a year. So, it's important to understand that volume matters."

Patients can get a good sense of the doctor's expertise during the consultation, listening, and reading between the lines, and performing due diligence, like checking the doctor's online reputation. If you were referred to the surgeon by a friend or family member, that's another good sign because your friend or family member likely had a positive outcome.

Dr. Johnson adds, "Even with rarer surgical procedures, you'll want to ask the surgeon how many they typically perform. For example, I treat a condition called urethra diverticulum, where I remove the diverticulum surgically. It's a rare procedure, but still, on the whole, I do more of them than many other surgeons. I probably only do eight to 10 a year, but that's because it's a rare condition. And eight to 10 a year of this procedure is still considered a lot. So if someone asks me, 'Do you treat this all the time?' My answer is 'I do approximately one every six weeks because the condition is rare. I tend to treat more urethra diverticulums than anyone in the region.' Then, they can understand that they're in the right hands."

Don't push if a surgeon tells you they're not the right person to perform the procedure.

All surgeons have areas of expertise—and their priority is ensuring you're in the most capable hands. If a surgeon declines to operate, they have a very good reason for doing so.

Dr. Johnson explains, "Trust your surgeon when they say, 'I'm not the best person, but I'll send you to the right person for that.' I practice urogyn, but I don't do every procedure in urogynecology, so I will refer patients to another urogyn for certain things I don't do anymore. I want to make sure patients are in front of the physician who regularly performs the procedure because the patient will have a better result. So if your surgeon says, 'I'm not the best person for this,' know they're not trying to blow you off. Also, understand that sometimes surgical location matters. If the condition requires extensive nursing support, home nursing, wound care, etc., then often larger hospital systems can better coordinate these services than an independent private practice. This may also lead me to refer a patient to another provider within the same subspecialty as me."

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