Please help with surgeon selection!

[SpecialHeart]

Hello everyone,

my surgery is scheduled for the 23rd of this month (April) and I'm sill not 100% sure with which surgeon and hospital to chose. I've posted before on valve selection and shared my story with all of you. I really appreciated all the advice I recieved from everyone in the forum about valve choice so I'm hoping you can help me with surgeon selection. None of my family members or friends have had open heart surgery since I am still very young (30yrs) so I need you all.


Surgeon #1

Very compassionate and understanding! He takes his time explaining everything carefully and answering all my questions. He spends at least 1 hr in each of our appointments.

He's never doubted my symptoms and said that each patients are different and that he trust the patient since they know their body best.

He's made himself available for me to ask any questions or concerns I have through e-mail so that I don't need to make an appointment to see him or wait. He responds to my questions the same day or within a day or two.

He's never promoted himself as the best doctor and has been very honest with me about what to expect.

He's encouraged me to do lots of research and take my time with my decision.

He even took time to show me the cardiac recovery area that I will be in after the surgery so that I can see it and see if it's where I want to be.

He's told me that I can cancel the surgery the day before the surgery if I decide he's not the one I want to be operated on.

He's reassured me over and over that I should chose the surgeon I trust and feel comfortable with and he will not be offended at all if I do not chose him.

I have really bad keloid problem so I requested a plastic surgeon to close my chest and he's made arrangements for me to consult with a plastic surgeon to see if he can close my chest.

The hospital itself is nice and clean and feels very peaceful. I've never had any procedures done at this hospital so I have no idea how the hospital services are. I also love the name of the hospital and what it means.

He's had 20 yrs of experience and operates mainly on standard cases so older patients.

I never had to wait to see him. He is always punctual with the appointments.

My concerns:
Healthgrade gave this hospital 1 star out of 5 for valve surgery and it's based on mortality. My surgeon says this statistics based on medicare group and that every year their number changes but this year was a challenging year for them. He shared with me the rating for all patient group for valve surgery compared with the state average and this hospital is above the state average.

I will be the youngest patient he's ever operated on and since I am so small tissue valve would be very tricky to do and I want to make sure I chose a very skilled surgeon.

According to the Congenital specialist, my heart is unique and doesn't compare to text book heart but this surgeon doesn't believe its so unique that I need congenital specialist. He thinks it a standard case.

Surgeon #2
He's the best in the area and the only congenital surgeon in the state. According to him he's the best in all of Northwest.

He operates on complex cardiac cases.

He's not as accessible or considerate or attentive or empathetic as surgeon number 1.

He's very vocal about being the best and he's very proud of his accomplishment and I understand that.

He's had 40 yrs of experience.

My concerns:

Each time I've seen him I've had to wait more an 1.5 hrs to see him!

He's part of a teaching hospital and they've been very disappointing.

I've had more than 100 IV's in my lifetime but the worst experience was with them. I thought it was just a one person thing but the two others that had to do my IV's after weren't good either.

I had allergic reaction to iodine contrast medicine and when I did the CT nurse told me to go to the ER right away but when I called and left messages with my medical assistant and nurse to see if they wanted me to go to their hospital they didn't respond. I decided to go to their ER since I have a "unique" heart according to them. When I got to the ER they made me sit in a tiny room with a small bed and nothing else for a long time then the nurse came and gave me meds and sent me home.

The following week I had 3 other testing with them and the last one was heart cath. It was scheduled for 6:30 AM so when I went in they got me ready for the procedure and had my IV and everything. The cardiologist came to see me and told me that they won't be able to do the procedure because they didn't prepare me for my allergies and the procedure we were supposed to do that day. He asked to reschedule. I was very frustrated that they didn't tell me all week and I informed everyone about the allergy. The next time we went to check in and they told me I wasn't scheduled for the procedure. There was some error and I had to wait for them to clear up. Finally after all of this, I got checked it and they prepped me for the procedure but they placed the IV in the wrong hand. When I went to the procedure room they said that it should have been on the other hand but there was nothing they could do then so they went on with the procedure. The IV was on the same hand as my blood pressure cuff so it made it extremely painful! It took me 3 or 4 days for the pain in my arm to go away.

The nurse at my recovery room was training another nurse and she was very rough. He showed her how to draw blood through the cath line twice and let her do it by herself without supervision. She did it incorrectly 3 times all without supervision and this pushed me back another 2 hrs to start the 4 hr recovery. I went in for cardiac cath at 6:30AM and didn't get discharged until 7PM.

I'm a very happy person and I normally don't complain so much but I couldn't believe how many errors they made for a simple procedure. I've been a patient since I was a child so I'm used to errors but this was more than the usual.

Last time when I had my first open heart surgery, patient care played a huge role in my recover so I want to chose a hospital that's attentive to patients needs.


Surgeon number 1 is exceptional in many ways but surgeon number 2 is the best in town (Seattle, WA)

By the way, I'm going to be having a AVR and MVR.

I need to decide by Monday which surgeon to go with. Thank you for your help in advance!

 

[Heart Of The Sunrise]

Go with your gut. Tough choice. I was lucky that my surgeon and hospital were rated extremely high. He also was very humble and easy to talk to.
If it were me...based on what you say...I would go with #1.

 

[SpecialHeart]

Hi Heart of Sunrise,
thank you for your advice. You are very lucky indeed! My gut is not to clear unfortunately. What do you think I should look for when choosing a surgeon?

 

[Duffey]

I'd go with the second surgeon. It sounds as though you have a more complex replacement facing you, both AVR and MVR, and I'd want the best surgeon I could get. If you make your unhappiness known with the care you've received at this surgeon's hospital, they should have a procedure in place for patient complaint initiation, it's possible you will receive better care at the time of surgery.
Good luck and best wishes.
Mary

 

[MrsBray]

I guess it comes down to what makes you feel the best. Grab a quarter, write down which surgeon is heads and which is tails, then flip the coin. In the few seconds that the coin is in the air, you will KNOW what your choice is!
During my final surgical consult, Doc's phone rang and he left the exam room. Upon his return, he told me he had to take the call because he had just operated that morning on his colleague's mother-in-law. That gave me peace-of-mind. So maybe you could ask a doctor (primary care or cardiologist or pulmonologist) who they would choose to operate on their mother-in-law (providing the actually like their MIL? haha)

 

[nia]

Hi SpecialHeart,

It’s up to you ultimately, but if I were you, I would go with No.2.

I had my first valve-replacement (mitral only) at 21 yrs old, with bovine tissue, and re-replaced that one with St. Jude mechanical 10 years later, at 31 yrs old (cause of re-op: severe mitral stenosis leading to pulmonary hypertension; I am a female).

The only criteria I looked for in my second surgery’s surgeon/hospital were the number of valve-replacement surgeries and especially re-ops performed, and the survival rate. Went with the hospital with the best in these categories in the country. I agree completely that post-op care plays a huge role in your recovery, but I would feel more comfortable if my surgeon/surgical team had more than enough experience of successfully operating on similar cases as mine.

Wishing you a smooth operation and swift recovery,
nia

 

[epstns]

I'm with Duffey on this one. If your case is anything out of the ordinary, then I would choose a surgeon for technical competency over bedside manner every time. In fact, that is just what I did. I met with two surgeons. One had plenty of experience and practiced at a highly-rated hospital. Surgeon #1 is very approachable, very personable and just a very nice, compassionate person. The other was world-renowned (I think), had been a department head at Cleveland Clinic, and was/is now a department head at one of the top hospitals in the region. Surgeon #2 told us "I'm not the #1 guy in the country for this procedure, but I AM #2." He is nowhere near as warm and compassionate, but for what I felt could be a more difficult case, he was THE MAN. I probably would have made it through surgery with either surgeon, but with all the complications I had after surgery, I was definitely in a better place with #2.

 

[tom in MO]

From reading your post it seems you like the first surgeon better but you have no experience with the hospital. Your experience with hospital number 2 was negative but the surgeon is more expereinced. Hard choice.

If your condition is unusual, I would go with the most experienced team, that sounds like hospital 2. To counteract your negative experience, you need to be vigilant. Tell them up front you are not practice material and do not want any hands on training being done on you. Make sure your surgeon knows this as well. If possible, put it in writing when you sign the release(s). That being said, for my first operation, it was the internest who showed the most care, came by more often and explained things quite well. She was eager.

 

[epstns]

Hey, Tom - Be careful abut excluding the trainees. . .

IF it was a trainee/resident who opened and closed my incision (and I would bet it was), they did a fantastic job of cutting and closing. If it wasn't for the bump of my pacemaker, at 3 years out you would not know that I had a sternotomy and heart surgery. My scar is almost invisible (and I'm not a hairy-chested guy, so the area is visible). They made the cut on a slight angle with the top off to one side, so that when I wear open-collared shirts, the scar wouldn't show. By the end of the second year, my scars are almost invisible.

Now, if the trainee is a cardiac surgery fellow, all bets are off. When I chose a surgeon, I made it clear that I expected his to be the only hands on my heart, and he had no problem with that.

 

[SpecialHeart]

Hello everyone,

Thank you all for your kind responses and well wises! I appreciate it so much!

The hospital gave me an extension until this week Friday to decide which surgeon to chose. I have an appointment to see surgeon #2 again to ask a few more questions. I will also be seeing a cardiologist and plastic surgeon for surgeon #1 this week so I'm hoping it would help me decide.

There are two things that sets my case apart from standard case.
1. Re-operation (both surgeons do re-operations on a regular bases although surgeon #2 does more complex cases).
2. I'm a small person so I have a small heart. This is a problem because they may not be able to fit tissue valves so I may end up with mechanical. Both surgeons agree with this and say that there's a strong chance that tissue won't fit. (Surgeon #1 operates on older patients and majority of his patients are bigger than me (I'm 5'3 and weigh 101 LB). Almost half of surgeon #2's patients are younger patients with congenital heart disease).

Do you think I should be concerned about these two things? I feel they are both very skilled to handle both but surgeon #2 has double the experience (Surgeon #1 20yrs, surgeon #2 40 yrs)

According to surgeon #1 my case is not challenging or too unique for him to handle. He says it should be standard and he's very confidant about the surgery. Surgeon #2 is very confident about operating on me as well. I will talk with surgeon #2 about my concerns about the hospital to see what can be done about it. This will help me feel more at ease with my decision.

 

[Bryan B]

For me personally I would go with the more experienced surgeon since you are having 2 valves replaced and it's your second surgery. When it came time for both of my surgeries I went with the best surgeon AND the best hospital, because bedside manner doesn't really matter when the surgeon is holding your heart in his hand.

I agree that as a patient teaching hospitals can be a pain, but they tend to attract some of the best surgeons, at least that has been my experience.

 

[AZ Don]

The trait that I consider most important in a surgeon is surgical skill. Everything else is secondary. The first surgeon would likely do a fine job but if things go wrong or get difficult it is the second surgeon you probably want dealing with it. Regarding the hospital, it is unfortunate you have had some bad experiences at the hospital. I had my knee surgery at a teaching hospital so I understand some of the issues that may be encountered, but as was stated earlier, you often have excellent Doctors there. Unfortunately mistakes or sloppy care can happen at any hospital. I think it is important to speak up whenever you have concerns with your care. For a recent surgery (not heart related) I allowed an intern to remove my stiches. In the middle her cel phone went off and so she turned it off. Then she was about to continue removing my stiches and I stopped her and told her to go wash her hands again.

I pay a lot of attention to the rankings. I'm sure they are far from perfect but they are the most objective measurement I know of. Seattle's hospitals are listed here: http://health.usnews.com/best-hospitals/area/seattle-wa. For my surgery I went to the best local hospital and chose a Dr. ranked in the top 10% of his field nationally. You can get Dr. rankings for a small fee here: http://www.castleconnolly.com/doctors/index.cfm?source=ccm. I would feel better about the 1st surgeon if he/she was a highly ranked cardio-thoracic surgeon.

 

[AZ Don]

I have really bad keloid problem so I requested a plastic surgeon to close my chest and he's made arrangements for me to consult with a plastic surgeon to see if he can close my chest.

FYI, post surgery my scar was a very fine line, so it was disappointing to find a couple months later that such a clean closure didn't prevent scarring. It is now raised and 1/2 as fat as a pencil. I read not too long ago about silicone gel or tape to prevent or reduce scarring. The research seems to indicate that it can be helpful and is the only home remedy that is, though Dr's can administer corticosteroids. You may want to look into these options post surgery. I'm using a silicone gel I purchased on Amazon and it seems to be helping.

 

[Agian]

Scars can sometimes get angry and itchy. Injected steroid works well.

 

[epstns]

. . . And some of us don't have trouble with our scars. If you have a tendency toward pronounced scarring, then by all means investigate the post-op treatments. The only thing I did was to request that my final exterior closure be done with surgical glue so as not to have "railroad tracks" from staples or sutures. Worked fine for me.

I apparently don't tend toward pronounced scarring, so at 3 years, mine is almost invisible.

 

[Bryan B]

. . . And some of us don't have trouble with our scars. If you have a tendency toward pronounced scarring, then by all means investigate the post-op treatments. The only thing I did was to request that my final exterior closure be done with surgical glue so as not to have "railroad tracks" from staples or sutures. Worked fine for me.

I apparently don't tend toward pronounced scarring, so at 3 years, mine is almost invisible.

I requested the same Steve and my surgeon said "I use staples" and I could tell that was the end of that conversation. The funny thing is that after everything healed up I couldn't really tell much difference between the staples and the surgical glue they used for my first surgery (although I do have some camouflage). All of the chest tube scars from 2 surgeries are more noticeable than my sternotomy scar.

 

[njean]

Is your surgery still scheduled for tomorrow? If so, I just wanted to let you know that I will be thinking and praying for you!

When it's all over and you're able to post again, we will be waiting to hear all about it!

Godspeed!