How to Choose the Best Doc?

[Chainsaw_Willie]

How do I find the best doctor to patch me up?

the guy who did my right knee 18 years ago is retired now or I'd go back to him, he was great. That was before the internet made everything both easy and difficult...

I didn't like the doc I went to for my shoulder - he kept quoting statistics saying that guys my age rarely re-dislocate. Is that because guys my age are typically desk jockeys who's most extreme sport is golf? After 10 dislocations in two years I'm ready to discount that statistic and find a doc who will deal with the fact I'm not ready to give up on climbing mountains and hurtling down them on planks.

I need my left ACL and my left shoulder done. My sister recommended a doc down in Lakewood (probably an hour from here with traffic) as he'd done good work on a friend of hers and has a rep for fixing stuff other docs botched. Looking up his name on the 'net, he certainly seems qualified - fellowship trained and board certified. I wanted to get in somewhere closer to home though so did a little more digging and came up with UW sports medicine clinic. They're ranked high in patient satisfaction and I figure if they can fix college football players and other athletes, maybe they can help me. The doc I'm being referred to there is a young guy, been practicing for 7 years and the only info I can find on him says he got his degree back east in NY, practiced in PA for awhile, was assistant team physician to the Nets for a couple years and now is out here at the UW. No board certification that I can find.

I saw a doc at UW sports medicine about my knee today and after talking with him about my shoulder as well, he referred me to this other doc who he said could handle both problems. I'm guessing that's one vote of confidence - a knee doc handing me off to another doc to handle both my knee and shoulder...?

I'm getting other skiers recommending docs they've had good luck with. It's all becoming rather overwhelming. I want to get started with this whole process so don't want to research everything to death, but don't want to make a bad choice of doctor either.

So, what's the best way to find the best doc? What research tools, if any, work best? Is it all just word-of-mouth? Should I bite the bullet and do the long drive to see the doc that seems highly qualified but is an hours drive away? How do I know there isn't someone just as qualified right here in Seattle or Bellevue?

I'm committing 2013 to rebuilding - two major surgeries and a lot of PT are in my future and I'm giving up a chance to ski in SA this summer and also trek in the Yukon. I only want to do this once. Any help appreciated!

[JayPowHound]

Word of mouth has always been my go-to for this kind of thing.. maybe angies list?

[PNWbrit]

Ask Mofro.

[pesto]

Word of mouth and also worth researching team docs for local professional/university football, basketball,a and soccer teams.

[LightRanger]

Word of mouth and also worth researching team docs for local professional/university football, basketball,a and soccer teams.

This. I had some work done by a local guy who posts on TGR who I only found out about through another Mag.

In the past (before I moved back to the Bay Area from Orange County) intense googling gave me a mixed bag. Loved the sports med ortho I was seeing who I found based on his bio (Dartmouth, Steadman-Hawkins, team doc for Jets and Islanders). But then when I managed to get referred out of network to the head of the department at UC Irvine (really specialized problem), the guy was a total prick, whom I would never let operate on me.

Sports med orthos are who you want (I'm sure you know this). In my experience, the others often don't understand your goals and motivations post-op, and that is almost as important as technical skill, IMO.

(For reference, I saw six orthos and three podiatrists for a gnarly tib-fib fracture and complications. Level of technical competency was high with all of them, AFAIK. The ability to think outside the box and figure out what was wrong with me and how to fix it so I could ski/run/etc. again varied widely.)

[Mofro261]

H

I saw a doc at UW sports medicine about my knee today and after talking with him about my shoulder as well, he referred me to this other doc who he said could handle both problems. I'm guessing that's one vote of confidence - a knee doc handing me off to another doc to handle both my knee and shoulder...?

I'm getting other skiers recommending docs they've had good luck with. It's all becoming rather overwhelming. I want to get started with this whole process so don't want to research everything to death, but don't want to make a bad choice of doctor either.

So, what's the best way to find the best doc? What research tools, if any, work best? Is it all just word-of-mouth? Should I bite the bullet and do the long drive to see the doc that seems highly qualified but is an hours drive away? How do I know there isn't someone just as qualified right here in Seattle or Bellevue?

I'm committing 2013 to rebuilding - two major surgeries and a lot of PT are in my future and I'm giving up a chance to ski in SA this summer and also trek in the Yukon. I only want to do this once. Any help appreciated!

There are many highly qualified Ortho's in the Sea-Metro area, and yes it can be a bit overwhelming.

First question to ask- Which doc's are covered by current insurance? While having a quality doc fix you up is paramount, having to get fixed but also donate a body part to do so won't be so fun.

Word of mouth is usually best. Start by asking any medical friends/primary GP who they would recommend, and ski friends since they'll have there own opinions, and you'll likely get multiple references as to so and so being the "best".

Ultimately though, the best doc is the one who's not only qualified but that you trust based on consultation and understands what level of activity and return to function you are tying to achieve, and is able to explain everything in detail.

[Chainsaw_Willie]

Thanks for the replies so far, if anyone has any other insight it would be appreciated.

Sounds like WoM is the route most people go.

I'm not about to go to an out of network - I simply couldn't afford it.

MRI for the knee scheduled Friday. The following Friday I have a follow-up with the doc at UW Sports Medicine. I at least want to meet him and see what he has to say. Based on WoM from another skier I've also scheduled an appt. with another doc who is the Sounders soccer team medical director AND head of sports medicine department at Virginia Mason. Seems like a highly qualified individual, we'll see how we mesh.

Gotta agree that you have to be on the same page as the doc and that the doc needs to understand and be on-board with your goals, which is why I'm not going back to the first guy I saw about my shoulder. I never got the impression he really understood the importance of having a shoulder you can rely on for self-arrest with an ice axe and to not dislocate in an otherwise minor fall in the BC.

[old goat]

How to find a good doc?--I don't know and I'm a doc. As far as surgeons go best way I know of is to ask an OR nurse. (But the most technically proficient surgeons are not necessarily the best--good patient/case selection and postop care are more or less important as technical skill--depending on the specialty and kind of case). Obviously stuff like board certification, medical board complaints are important but are going to exclude very few. (I'm sure anyone practicing at UW will be boarded.) Personal compatibility--but you can only tell once you meet them. Referrals from other docs?--the saying is that professional success for a surgeon depends on affability, availability, and ability--in that order. In some specialties--heart surgery, vascular surgery--where surgeons do large numbers of similar cases and where outcome is easily measured--heart attack, stroke, death--you can ask a surgeon for their statistics. Not the literature statistics, their statistics. That won't help much with a shoulder. Things that make me nervous--dodging the question or giving a slick answer when you ask about their experience--how many of this operation have they done? And I'd worry more about dodging or defensiveness than about the actual number. Sometimes the guy who does the most is doing them for shaky reasons. Similarly, reluctance or defensiveness if you ask about a second opinion unless it's an emergency and there really is no time, and then you still have the right--it's your life. In talking to the surgeon I would want to get the sense that he was willing to spend whatever time with me was necessary--not too rushed. I would want to get the sense that he was thoughtful about whether or not you needed surgery and not just ready to operate on anyone who walked through the door. You want the sense that he is listening to YOUR case (the guy you saw was right--older guys don't usually dislocate again, but you are dislocating again so in your individual case the statistic is meaningless.) But none of that guarantees success. It is very hard to define what makes a good doctor and how to identify one.
My cousin had a rare stomach tumor in his fifties. Went from place to place trying to find the best person to care for him--University of Chicago, Mayo Clinic, University of Michigan--and while he was diddling around trying to make up his mind he started to bleed out from his stomach. The ambulance took him to the nearest community hospital in Chicago where he wound up in the hands of an excellent cancer surgeon who saved his life and cured him. Just good luck. Hope yours is as good.

[bigdude2468]

How to find a good doc?--I don't know and I'm a doc. As far as surgeons go best way I know of is to ask an OR nurse. (But the most technically proficient surgeons are not necessarily the best--good patient/case selection and postop care are more or less important as technical skill--depending on the specialty and kind of case). Obviously stuff like board certification, medical board complaints are important but are going to exclude very few. (I'm sure anyone practicing at UW will be boarded.) Personal compatibility--but you can only tell once you meet them. Referrals from other docs?--the saying is that professional success for a surgeon depends on affability, availability, and ability--in that order. In some specialties--heart surgery, vascular surgery--where surgeons do large numbers of similar cases and where outcome is easily measured--heart attack, stroke, death--you can ask a surgeon for their statistics. Not the literature statistics, their statistics. That won't help much with a shoulder. Things that make me nervous--dodging the question or giving a slick answer when you ask about their experience--how many of this operation have they done? And I'd worry more about dodging or defensiveness than about the actual number. Sometimes the guy who does the most is doing them for shaky reasons. Similarly, reluctance or defensiveness if you ask about a second opinion unless it's an emergency and there really is no time, and then you still have the right--it's your life. In talking to the surgeon I would want to get the sense that he was willing to spend whatever time with me was necessary--not too rushed. I would want to get the sense that he was thoughtful about whether or not you needed surgery and not just ready to operate on anyone who walked through the door. You want the sense that he is listening to YOUR case (the guy you saw was right--older guys don't usually dislocate again, but you are dislocating again so in your individual case the statistic is meaningless.) But none of that guarantees success. It is very hard to define what makes a good doctor and how to identify one.
My cousin had a rare stomach tumor in his fifties. Went from place to place trying to find the best person to care for him--University of Chicago, Mayo Clinic, University of Michigan--and while he was diddling around trying to make up his mind he started to bleed out from his stomach. The ambulance took him to the nearest community hospital in Chicago where he wound up in the hands of an excellent cancer surgeon who saved his life and cured him. Just good luck. Hope yours is as good.

What this guy says!!.. Personal story, everyone has one. I was a serious runner, no family history, great diet, never smoked, etc etc. About 20 years ago was diagnosed with moderate mitral valve prolaspe, a leaky heart valve. No symptoms, no issues, do a stress test every year, then every other year. Techs never liked to see me, as I would go for 18 - 20 minutes as opposed to the fat smoker that would make them stop after a minute. All good until 2005 when the Mayo Clinic publishes a study that says it is best to repair moderate to sever mitral regurgitation as opposed to watchful waiting. Even with an ultra sound hard to know for sure how bad the leakage is. They did a TEE ultra sound still not conclusive. Then they do a catheraziation and find two arteries 80% blocked and three at 50%, no good explanation where it came from based on my history. F...ing lucky as all too often the first symptom is a heart attack or sudden death. NOW WHAT?. I started to do some research and found a surgical nurse who recommended a specific cardiac surgeon. My sons girlfriends sister-in-law works in the cath lab at another hospital and gives the same surgeons name. What are the odds in a major metro area the same name comes up twice. Have my tests sent to him, get an appointment, discuss and go for it. 7 1/2 hrs of surgery and I have OPCAB for the five blockages and then the valve repaired on bypass. Have the surgery on a Thursday, out on Sunday and back at work for half a day on Monday. Had zero pain from the sternum, went so well I ended up doing a print and radio spot for the hospital.

Find someone that does a lot of whatever you need done. My guy had done 3000 heart surgeries including running a transplant program at a teaching hospital. Also, my surgery was at a specialty hospital for heart surgery, heart procedures / heart patients only. If possible stay the hell away from a traditional hospital filled with people that have all sorts of diseases, infections, cancer patients with compromised immune systems etc etc. Post surgical infections are a huge issue and staying away from sick people is a BIG deal.

[old goat]

Heart surgery is a bit of a special case--pure technique matters more than with other kinds of surgery. Most surgeons make the decision as to whether or not to operate, which is often more important than the technical skill of the operation, depending. Heart surgeons pretty much do what the cardiologist tells them to, and results have a lot to do with technical precision and speed. (although less than they used to). And there's less intraoperative decision making than with other kinds of surgery--the operations are pretty rote, although not easy. So I might accept a bad personality, lousy communication skills, etc, for someone with excellent results (which they should be able to document) with a heart surgeon.
As far as infection rates--hospitals are supposed to report clean infection rates (infections after operations that are completely sterile, as opposed to say an operation on a dirty organ like the bowel) and you can find out that information. Problem is--the statistics are self-reported and depend on the diligence of the person collecting the data--particularly whether infections after leaving the hospital are identified. I worked at an integrated health care system (Kaiser) where the infection control nurse had access to outpatient records and records from other Kaiser hospitals to see if a pt was readmitted. In an ordinary community hospital infection surveillance stops at discharge unless the patient is readmitted to the same hospital (Michael Debakey was famous for having patients with complications admitted to a different hospital where he didn't have to know about them and could claim a low complication rate. Not the most admirable ethics but modern cardiovascular surgery might not be what it is today if the pioneers were honest about the complications rate in the early days.)

[TBS]

Word of mouth from other skiers and climbers is probably the best I think. Your looking at docs that work for sports teams is good too, since they have experience with patients who punish their bodies.

FWIW, Some orthos specialize in just knees and shoulders - like the guy who did repaired my meniscus (just some trimming) and my rotator cuff/labrum/acromium (major rebuild).

Like others have said, you should walk away from the pre-op consult feeling like the Doc understands your objectives and is confident s/he can make you right again. In my case, this ortho is both a skier and cyclist, so I could communicate. He'd also blown up his R-Cuff skiing. Asked about long-term problems and he told me I should be as good as OEM if I followed the rehab - which turned out to be true. Asked him how many similar ops he's done, he told me "2-3 a week, never have had a problem" for the knee and "probably one a week for the last 15 years" for a major shoulder repair. When I asked him how many shoulder repairs didn't turn out well, he said "Just one - sadly that person works just down the hall and I'm reminded of that failure every day".

How complex are your repairs?

Personally, I wouldn't base my decision on where the surgeon is located. With my knee and shoulder, I saw the surgeon four times over nine months...pre-op consult, just before I went under the anethestic, midway through rehab and once when he cleared me for skiing and MTB riding. Proximity to a good PT is more important, since you will spend a lot of time with them.

Good luck mang

[Shredhead]

As far as surgeons go best way I know of is to ask an OR nurse.

That's what I did. But some highly proficient surgeons can also be assholes to the nurses. While that wouldn't necessarily exclude them for me, it does for them.
My dad was a surgeon and his nurses loved him, because he treated them with the respect.

[old goat]

I'm a little leery of team docs. They work for the team, not the player and don't always have the best interest of the player at heart. RGIII? Of course I'm sure there are plenty of good ones.

[bigdude2468]

I'm a little leery of team docs. They work for the team, not the player and don't always have the best interest of the player at heart. RGIII? Of course I'm sure there are plenty of good ones.

My understanding is that sometimes the "official Dr's of the Arizona Diamondbacks" actually pay for that designation and provide team services free or at low cost

[old goat]

http://deadspin.com/5980550/nfl-play...t-team-doctors
disclaimer--I have no idea if this site is reliable but it's an interesting article
of course NFL team docs are no more ethically compromised than university researchers and speakers who are paid by drug or equipment companies, or private docs who get expensive meals and travel from companies. and even if your doc takes nothing from anybody the last medical conference/course he or she attended was sponsored by manufacturers and the speakers were mostly if not all on company payrolls. Don't get sick. Don't get hurt.

[skinnyskier]

In Seattle I think VM buys the "team doc" sponsorships. Which is not to say a given VM orthopod can't help you.

[Velodog2]

You could just ask me which one I would choose. And then pick someone different. I've used all of the above methods and been unsatisfied to some extent with all of my choices so far. However I still go with the 'sports dr' thing tho, as they are more likely to understand my goals, and also look at where they have spent time. Steadman-Hawkins maintains a list of fellows and will provide you a name of someone in your area. Someone who has interned at the NY Hospital for Special Surgery might be ok too. Find one with both credentials and they might be worth talking with I'd guess.

[Shredhead]

Steadman-Hawkins maintains a list of fellows and will provide you a name of someone in your area.

I sent my film to the famous hip specialist at Steadman. I got a call back from a clerk with a simple "we can't help you, here's a number if you need any more information".
I called the number multiple times and left messages, none were ever returned.

[Chainsaw_Willie]

I've decided to go with the two docs at Virginia mason. The knee doc came highly recommended from another skier and even if he bought the sounders team doc thing he probably earned his position as head of the sports med dept at vm. The shoulder doc is his partner. I couldn't choose based on personality- felt all the docs understood my goals and they were all personable and took adequate time to explain things and encouraged me to talk to other docs and get other opinions. Ultimately the decision was made based on the UW doc really pushing for an allograft which just doesn't sound all that great based on the reading I've done about it and also on my preference to go with experience over youthful enthusiasm. I'll be scheduling the knee surgery later today.

[Velodog2]

Sounds legit to me (be afraid ...). I made my ACL doc choice in part based on the same thing - that the autograft was stronger faster than the dead guy graft and that's what a professional athlete would probably use to get back in the game faster. Turned out to b a good choice as I had some trauma to that knee a week after surgery that the allograft may not have withstood. Good luck!