appraising the surgeon's skills?
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From: rosbif on 20 Mar 2006 02:57 Still in a dither about which Tx to opt for though my 'eligibility' for surgery is pulling me that way . Of course most contributors here are from the US so I guess this will be hard to answer for me in the UK, but I wonder how proactive patients are in seeking out the most skilled? How does one go about it?
From: Leonard Evens on 20 Mar 2006 10:12 rosbif wrote: > Still in a dither about which Tx to opt for though my 'eligibility' > for surgery is pulling me that way . Of course most contributors here > are from the US so I guess this will be hard to answer for me in the > UK, but I wonder how proactive patients are in seeking out the most > skilled? How does one go about it? > > Despite the supposed freedom to choose one's own doctor, few of us in the US are entirely free to choose a surgeon. Usually our health insurance plans restrict us to certain preferred providers. Also, even if there were no such restrictions, common sense suggests that the very best surgeons can handle only a limited number of cases. The first thing is to check the surgeons qualifications by seeing where he did his training. Also, ask him how many such procedures he has done and how often he does them. Similarly for the hospital where the procedure will be performed. Also, ask about typical results for a patient like yourself with respect to recurrence rates and side effects. In the US, you can call one of the centers such as those at Johns Hopkins or Sloan Kettering and ask for a reference to a local surgeon. Walsh in his Guide to Surviving Prostate Cancer gives a list of questions to pose to a potential surgeon. Keep in mind that it is the skill of the particular surgeon that counts, not whether or not he is famous. But you can compare the results your surgeons reports with that from the best surgeons. For example, in a man under 60, the best surgeons can preserve potency in 80 percent or more of their patients. If your surgeon has a success rate of 40 percent for such men, he is clearly not proficient in that aspect of the procedure. On the other hand, even the very best surgeons have little luck preserving potency in men over 70. My case might be instructive. I just went to the urologist my primary care physician referred me to, and it turned out he has one of the better reputations in the area. At the time I considered trying to have the surgery done at Hopkins by Dr. Walsh or one of his colleagues, paying for it myself, but I decided the chances of a cure in my case would not be significantly different and the chances of avoiding impotence at age 66 not enough higher to justify the cost. My surgeon certainly seemed to have done well with me, so I have no regrets. At the time, there weren't any "star" surgeons in the area, but since then Dr. William Catalona has moved to Northwestern in Chicago, and at least one man posting here has used him. Paradoxically, were I deciding today, I probably would still not be able to use Dr. Catalona unless I wanted to pay for the procedure myself because his medical group doesn't accept my particular health plan, which is one of the largest in Illinois. And, both Dr. Catalona and I are Northwestern faculty, he in the Medical School and I in the College of Arts and Sciences.
From: RonL on 21 Mar 2006 07:33 Here's one thing I did. I went to this page: http://www.yananow.net/Experiences.html scrolled to the surgery section, and actually clicked on each entry. The first paragraph in most cases tells you where the person lives, so you can skip those not in UK. I actually found 2 or 3 this way who either had direct experience with a surgeon I was already contemplating, or who knew of him. Everyone I contacted was delighted to help. Yes, it's tedious, but you might find a precious lead this way. Just a thought. Good luck and good health, RonL >....I guess this will be hard to answer for me in the > UK, but I wonder how proactive patients are in seeking out the most > skilled? How does one go about it? >
From: rosbif on 21 Mar 2006 07:42 On Mon, 20 Mar 2006 09:12:02 -0600, Leonard Evens <len(a)math.northwestern.edu> wrote: >rosbif wrote: >> Still in a dither about which Tx to opt for though my 'eligibility' >> for surgery is pulling me that way . Of course most contributors here >> are from the US so I guess this will be hard to answer for me in the >> UK, but I wonder how proactive patients are in seeking out the most >> skilled? How does one go about it? >> >> > >Despite the supposed freedom to choose one's own doctor, few of us in >the US are entirely free to choose a surgeon. Usually our health >insurance plans restrict us to certain preferred providers. Also, even >if there were no such restrictions, common sense suggests that the very >best surgeons can handle only a limited number of cases. The first >thing is to check the surgeons qualifications by seeing where he did his >training. Also, ask him how many such procedures he has done and how >often he does them. Similarly for the hospital where the procedure will >be performed. Also, ask about typical results for a patient like >yourself with respect to recurrence rates and side effects. In the US, >you can call one of the centers such as those at Johns Hopkins or Sloan >Kettering and ask for a reference to a local surgeon. Walsh in his >Guide to Surviving Prostate Cancer gives a list of questions to pose to >a potential surgeon. > >Keep in mind that it is the skill of the particular surgeon that counts, >not whether or not he is famous. The skill of course - in fact I'm allergic to celebrity. In the UK it's celebrity chefs we have in abundance - the only surgeons achieving high public profile are usually either murderers or those about to be struck off! >But you can compare the results your >surgeons reports with that from the best surgeons. For example, in a >man under 60, the best surgeons can preserve potency in 80 percent or >more of their patients. If your surgeon has a success rate of 40 >percent for such men, he is clearly not proficient in that aspect of the >procedure. On the other hand, even the very best surgeons have little >luck preserving potency in men over 70. The consultant I saw, without actually putting a figure on it, was pretty downbeat on the prospect of saving potency. But I wonder if you're not raising my expectation too high in mentioning the 80%? I note Scardino makes mention of some surgeons cherry picking their patients to keep these figures high. Does anyone have any sense of how the figures run for those who've posted here and reported back about success/failure? > >My case might be instructive. I just went to the urologist my primary >care physician referred me to, and it turned out he has one of the >better reputations in the area. At the time I considered trying to have >the surgery done at Hopkins by Dr. Walsh or one of his colleagues, >paying for it myself, but I decided the chances of a cure in my case >would not be significantly different and the chances of avoiding >impotence at age 66 not enough higher to justify the cost. My surgeon >certainly seemed to have done well with me, so I have no regrets. > >At the time, there weren't any "star" surgeons in the area, but since >then Dr. William Catalona has moved to Northwestern in Chicago, and at >least one man posting here has used him. Paradoxically, were I deciding >today, I probably would still not be able to use Dr. Catalona unless I >wanted to pay for the procedure myself because his medical group doesn't >accept my particular health plan, which is one of the largest in >Illinois. And, both Dr. Catalona and I are Northwestern faculty, he in >the Medical School and I in the College of Arts and Sciences. It's as I feared - the US contingent here will be able to offer little that's relevant to the UK situation but thank you for taking the trouble to reply Leonard.
From: rosbif on 21 Mar 2006 07:44
On Tue, 21 Mar 2006 07:33:49 -0500, "RonL" <ronlpca(a)comcast.net> wrote: >Here's one thing I did. I went to this page: > >http://www.yananow.net/Experiences.html > >scrolled to the surgery section, and actually clicked on each entry. The >first paragraph in most cases tells you where the person lives, so you can >skip those not in UK. I actually found 2 or 3 this way who either had >direct experience with a surgeon I was already contemplating, or who knew of >him. Everyone I contacted was delighted to help. Yes, it's tedious, but >you might find a precious lead this way. Just a thought. Good luck and >good health, > >RonL Cheers RonL - I'll this follow this through > > >>....I guess this will be hard to answer for me in the >> UK, but I wonder how proactive patients are in seeking out the most >> skilled? How does one go about it? >> |