Is my (ex-)surgeon an idiot, or is it just me?

[dwfreck]

Everyone,

This is a long one (I tend toward wordiness), so grab a cuppa something...

Immediately following my angiogram on 11/18/03, my cardiologist gave me the name of a surgeon, as he had said he would. We didn't meet the surgeon that day because he wasn't available, but we did meet with a representative from the hospital who worked closesly with the surgeon. The representative explained the basic valve replacement options and my likely suitability for each, then gave us a brief sales pitch for the hospital's cardio unit. I REALLY like and respect my cardiologist, we've had excellent experiences at the hospital (child birth, endoscopy, catheterization), and the hospital rep did a good job, so my wife and I had high expectations for our first visit with the surgeon.

Today my wife and I had our first (and likely last) meeting with the surgeon. We spent nearly forty-five minutes talking to the doctor and came away feeling like we hadn't learned anything we didn't already know (other than needing to be aware of vitamin K intake when taking Coumadin).

We discussed my case history, symptoms, and current health status, and the sorgeon concurred with my cardiologist's opinion that it was time to replace my aortic valve, but that we had a few months to work out the details. For some reason, he didn't have the results of my angiogram.

He asked me if I had picked a valve yet. I said, "no," and we discussed the options that were available: mechanical valves of various designs, tissue valves of various origins, and the Ross procedure. We discussed the basic tradeoffs among the options: Coumadin vs. not, lifetime durability vs. 10-15-year durability, one AVR surgery vs. two or more AVR surgeries, relatively simple operations vs. a really complicated operation. There was nothing new here; I've read and heard the basics and discussed them with my wife.

I felt like I had to drag information about homografts out of him. He barely acknowleged their existence, said we would need to measure the size of my aortic annulus via MRI (which I already knew), and then expressed skepticism that a homograft would be available. I understand that the dynamics of donor organs can lead to scarcity of the correct homograft, but his response left me with the impression that he thought the homograft would be a big inconvenience (mostly for him).

I also felt like I had to drag information about the Ross procedure out of him; his first response was that he didn't perform the Ross procedure, but one of his partners did, and that it was a relatively rare procedure in the Cincinnati area. When I pressed him for details, he said my pulmonic valve was probably bicuspid the same as my aortic was. I told him that I would like to find out whether it was or not, and he suggested a CT scan. I told him my cardiologist had suggested an MRI. The surgeon said he would need to ask the radiologist if an MRI would detect a bicuspid pulmonic valve.

I asked for more details about the tradeoff between Coumadin-for-life with a mechanical valve and a second AVR surgery with a tissue valve, and the surgeon responded that he thought the risks of serious medical problems or death were about the same over the course of a lifetime. This was the first time I had ever heard anyone express that particular opinion, and wasn't the answer I was looking for. I pressed him for details about quality-of-life concerns with Coumadin, and he was noncommital, other than saying I would have to watch my diet to regulate my vitamin K intake. This was all new information, but wasn't the answer I wanted.

I specifically asked which valve or procedure he would recommend to me considering my age (39), expected longevity (70-80?), medical history (moderately healthy, except for AV problems), desired post-operative lifestyle (I'd like to ski, but don't want to bleed out on the slopes), and career (I'm a computer programmer). He told me that he uses tissue valves in his other patients, but did not elaborate on why, and suggested I make my own choice. Once again, this was new information, but wasn't the answer I wanted.

He did a brief examination (checked pulse, listened for my murmur in various places), then concluded our visit, with a vague promise to schedule an MRI to measure my annulus and/or image my pulmonic valve.

Add to this the fact that when I arrived at the office, ahead of my scheduled appointment time, I discovered that I wasn't "in the computer," meaning that my (imcomplete) records had shown up, but I wasn't on the schedule and the fact that the receptionist couldn't process a credit card transaction for my $10 insurance copayment, and I was thoroughly, completely, and in all other ways, unimpressed and underwhelmed by my visit. My wife feels exactly the same way.

So, there you have it.

Now, give me a sanity check: Is my (ex-)surgeon an idiot, or is it just me?

I walked into the office with a confirmation letter from the surgical practice and a set of first-visit paperwork; shouldn't I have been on the computerized schedule?

My cardiologist and the surgeon's representative both said the surgeon would get my angiogram results; shouldn't my angiogram results have been there (angio done on 11/18)?

The surgeon is part of a large practice, appears to be in his mid-forties, and was recommended by my cardiologist; shouldn't he have been able to discuss, in greater detail and based on his surgical experience and knowlege of current trends and technology, all of the relevant options, their advantages and disadvantages, the appropriate diagnostic procedures to determine my eligibility for a given option or procedure, and its suitability for my personal situation?

I'd like to have the "Which valve/procedure should I pick?" discussion some other time, so please limit your responses to my and the surgeon's relative sanity, intelligence, and doctor-patient relationship skills.

By the way, I'm calling my cardiologist tomorrow to tell him what happened and ask for another surgical referral.

 

[Nancy]

Hi Dale-

Welcome to the site.

It doesn't sound like your surgeon is an "idiot". It sounds like he's a man of few words, and may have some preferred types of valves that he likes to work with, and perhaps what you brought up weren't ones that he was comfortable with. Not every surgeon does every procedure. He did mention that one of his partners did do one of the ones you were interested in.

Homografts are difficult valves to work with, hard to come by and sizes may be limited, and the Ross procedure isn't done by everyone.

If you're not comfortable with him, by all means set up an appointment with someone else. It should be a good "marriage" on both sides. But I should tell you that some of the most gifted surgeons at some of the largest centers have spent about 20 minutes with their patients prior to surgery, and some have not even met them until the patient was in the operating room. I seem to remember some posts to that effect.

The surgeon's personality is less important than his hand's on skills.

Best wishes finding a good "fit" for your needs.

 

[fisher6476]

HI Dale,
I concur that neither the surgeon, nor you are probably idiots. Although "bedside manner" is important, what is more important is for you to determine what you want to acheive, and then to find the right person to help you acheive your goals. When my cardiologist had a clear picture of my condition he said I am going to get you the best "mechanic" there is for these proceedures.
I had not heard of the surgeon he was referring me to but after a few inquiries I heard things like "Dr Brown is a litlle man with a big ego. He is pretty blunt when he talks with people. Oh yeah, he also is one of the best heart surgeons in the country". Ok, I think a guy like that might work for me. On my first visit to meet with him my wife decided to stay in the waiting room for the first few minutes. I was escorted to one of the exam rooms and in walks Dr Brown who introduces himself and immediately asks me if I am alone. I tell him my wife is in the waiting room and he say "well go get her ! If something happens on the table I won't need you, I will need to talk to her!" So much for being blunt.
Although Dr Brown had my file he still had to call over to the cardiologist office and have some pics of my anuerism faxed over.
Anyway this guy was straight forward, told me what he thought, including valve type recomendations, and proceedures he did like and did not like. He did not bring uo homographs and neither did I. My long winded point is I chose this guy for his skills as a technician, and for his experience in doing these proceedures.
With a little luck myself or my wife Susan will let you know Friday Afternoon that I made a good choice. By the way, do you think when the wheel me into cicu that my incinsions might be "scarlet" and my skin tone might be "grey"?
PS: This surgeons office is in a very nice medical building and as I walk down the corridor there are beautiful placards with the various Drs names on their office doors and finally I come to a door that has a tattered piece of printer paper with th words " Dr. Brown" taped to the door. Go Figure!

 

[JimL]

The surgeon I had a couple years ago is widely recognized as having one of the worst bedside manners, but being one of the best heart surgeons in this area. Maybe all heart surgeons are the same?
I didn't really have the opportunity to talk with the surgeon much ahead of time, but my after surgery visit with him was very disappointing. I had all kinds of questions, but he didn't want to take the time to answer them. But he did a fine job on the surgery.

 

[hensylee]

Does anyone know of sites where you can go to check out your doctor. Isn't there one?

My local internist isn't talkative either. He's from Phillipines, educated here many years ago, practiced in this country since the 60s, has a strong accent and I have trouble understanding, but he does try tho he's not in-depth. However, if I really want to know something specific, I must take my list - and he answers when I ask. Wouldn't trade him for anyone because he has saved lives of loved ones so there's personal knowledge of him. I just hope he lives longer than I do because he's irreplaceable. I think many doctors believe we don't know what they are saying anyhow. But there are lots of us that do and we need to know.

 

[tommy]

I agree that not all great doctors have great bedside manner. I prefer blunt to evasive. Being evasive may mean lack of expertise in a particular area or lack of familiarity with a particular valve or process.

I am concerned that he didn't know if your other valve was bicuspid and seemed hesitant about how to determine that.

For peace of mind, I would get a second opinion and get recommendations from others - family doctor, etc. You apparently have the time to "shop".

Several times you mentioned that you got answers that you didn't want to hear. I hope that you mean that he didn't answer the question adequately. What you "want" to hear may be the wrong answer. While "shopping" for a surgeon, have a real open mind, cause you may get answers that you need to hear, even though scary and unpleasant. Sorry If I'm hammering this point. Maybe I'm being too blunt.

Keep asking questions. You may never be totally satisfied, but I suspect that you can be much more content about the process and the surgeon than you are now.

Good luck. Keep us posted.

 

[RickKiem]

Dale, My surgeon and I talked for maybe five minutes during my first appointment. He came in, said hello, asked how my sister was feeling, and told me that he felt we needed to do my surgery, that we could not be sure what to do about the valve until they went in and that he felt strongly that if we replaced it that I should go with a mechanical because of my age and family history. That was it. He said he would see me on Tuesday and left. However, one of his associates spent quite a bit of time answering questions for me and explaining what would happen the day of my surgery.

I was lucky enough to have prior knowledge and experience both with the surgeon(Dr. Hazim Safi) and one of his associates(Dr. Estrera) as they had performed two different MVR surgeries on my Sister (her 2nd and 3rd MVR's) both of which were extreme high risk and life saving surgeries. I had spoken with both Doctors many times during my sisters care and remembered all of the praise and respect that the Hospital staff had for Dr. Safi and his team. Several years ago when I first learned of my aneurysm and bad aortic valve my Mother told me that when it was time for surgery she hoped that Dr. Safi would be my surgeon. Because of this I was comfortable and half expectong to get most of my information from Dr. safi's associates. I knew that Dr. Safi was a man of few words but was respected for his skill as a surgeon.

I guess the point of all this is that do not let bed side manner ruin your relationship with the surgeon. Do be sure to do some research to help you determine if this surgeon is knowledgeable and technically good with the procedure that you will be undergoing. Some Cardiac Surgeons are great at Bypass but you would not want them to do a VR or Aneurysm repair. Make sure that you get the best available surgeon who specializes in the type of work that you need. I wish you all the best and hope that this issue resolves itself soon. Good Luck!

Rick

 

[MelissaM]

Hi Dale,

Sounds like you are getting some good advice here. I concur with the others. Surgeons have their specialties and preferences and usually aren't used to educated patients who have specific questions and preferences. It sounds like your surgeon is most comfortable dealing with tissue and mechanical valves, and you might want to seek out someone else if you are wanting a Ross procedure or a homograft. Surgeons are human and medical offices range from really well run to horribly run. Find someone with whom you are comfortable with and go with him or her, but by your account, it sounds like you got the typical consult experience (I got three consults pre-surgery and they all went pretty much like yours! )

Melissa

 

[dwfreck]

Thank you all for the feedback. I really appreciate you sharing your experiences with your surgeons. It sounds like my recent experience isn't that unusual.

After a difficult evening's sleep, I feel a lot more calm about the encounter. I've realized that I knew intellectually that I'd probably have some doctor-patient relationship adjustments, but I wasn't at all prepared for them emotionally.

I've also come to the conclusion that I can't directly blame the surgeon for the absence of my appointment on the computer, the absence of my agiogram report in my file, or the absence of a credit card machine in the office.

I also realize that I probably had unrealistic expectations about the visit: I was expecting to talk to THE EXPERT on all matters related to valve replacement, and that we would pick a valve and set a date. I know how complicated cardiology is; I've been "studying" it myself all my life and I don't know diddly. I also know that we're not in a hurry and we've got time to discuss, debate, and mull over the whole thing.

In the morning light today, the visit looks a lot more positive than I would have admitted last night. I've met the surgeon, and he's actually quite friendly and talkative, which I've heard isn't common, but will definitely help me, because I"m the same way. I've asked a bunnch of questions, and received the best answers the surgeon can give me based on his experience. I've received an implied referral to one of the surgeon's partners if I want to pursue the Ross procedure. The surgeon has agreed to schedule an MRI and/or a CT scan to determine my elegibility for the Ross or for a homograft. The missing angio report will eventually show up, and the surgeon will then have more information about me to work with.

My cardiologist, who I deeply respect, has said several times that this surgeon "has great hands" and that, of course, is the whole point.

Thanks for listening to me gripe, and then helping me calm down.

 

[Nancy]

Hi Dale-

As you go down the road on your heart issues, please remember that most of the time the reports don't get to where they're supposed to go at the time they're supposed to get there. It's a sad fact, but most physicians know this and will request what they need on a stat basis if it's needed. The medical community is a little more relaxed on those issues than we are because they know how to get things fast. However, if it's imperative that you have to get some report or other to a destination at a certain time, walk the whole kit and kaboodle to the destination in your own hands. That way you will know they're where they're supposed to be. I've had to do that and so have many others.

Most surgeons are scheduled to the hilt in the OR. The office appts. are squeezed in. Most of them are quite rushed, and have to handle emergencies on top of the routine surgeries, plus not all surgeries go smoothly, and surgeries may extend out longer than expected. They don't have much time for handholding, but they ususally have staff members who do that sort of thing. So if you have questions, then call and ask if there is a person on staff who could go over things with you and your wife.

Best wishes and you'll do fine.

 

[Karlynn]

If you truly trust your cardiologist, then I'd ask him a bit more about the surgeon. Maybe he is an excellent surgeon, but maybe your cardiologist knows another surgeon, as good, who would fit your needs regarding bed-side manner. Just a thought. You need to feel comfortable with your choice.

My long-time cardiologist (now deceased) was a very quiet man, with few words. I'm a talker. When I first started seeing him I said 100 words to his 5. But I was able to get the information I needed and we developed a good rapport over time. I might not have gone back to him after my first visit if it weren't for the fact that he was recommended to me by other doctors who said he was the closest they've seen to God in cardiologists.

Doctors will rarely say anything bad about another doctor, but when a doctor is enthusiastic about the skills of another - bedside manner is desirable, but not completely necessary.

Karlynn

 

[bvdr]

Hi Dale,

Also figure into your evaluation of the meeting the fact that you walked into the surgeon's office with outstanding background knowledge of valve problems and solutions. Many many patients have only a vague idea of what is going on with their hearts. You might have surprised him a bit.

 

[dwfreck]

Thank you all again. I appreciate your collective experience and wisdom.

The more I reflect on our meeting with the surgeon, the more I think I was expecting to meet with God in the form of a man. That was highly irrational of me. Besides, if it really happened that way, chances are I wouldn't have time or the need to schedule the surgery.

In all, my wife and I were in the office a full hour and a half, and talked to the surgeon for close to forty-five minutes. That is an extraordinary amount of time, even for my cardiologist and family physician.

Also, the surgeon himself commented that I was relatively well educated about my condition and my options, and that some of his patients come in knowing "they told me something was wrong with my heart" or even less. Given my absence from the schedule and the missing angio report, he probably was taken by surprise.

I've gotten a second surgeon's name from my cardiologist, but I think I'll reserve that for a second opinion, and give the first surgeon a "second chance". After all, it took me three months to work up to asking my wife out on our first date...

 

[medtronic of borg]

bedside manors

bedside manors

Personnaly I want a surgion who is very confident in himself. I don't give a tinker dam about how well me and the surgion click or not. I care about having a good relationship with my cardiologist. After all you will be seeing a lot of him. I have had surgeries I didn't get to meet the man untill afterwards.

Med

 

[Nancy]

All in all Dale, I think you had a very nice meeting. My guess is that you were a little nervous like most everybody is and didn't really appreciate all that was said until you had a chance to think about it later when the pressure was off. 45 minutes is an excellent meeting, and it does sound as if he was nice to you both.