Choosing a Cardiothoracic Surgeon

Overview

By Robbin G. Cohen, MD, MMM

Article

Though you may not realize it at first, your cardiothoracic surgeon may have been chosen for you. This is because you may have been referred to him/her by your cardiologist, pulmonary specialist, primary care doctor, or your insurance payer. There are advantages to this custom, as it’s likely that your doctors have had good results and maintain a good working relationship with the surgeon they have chosen for you. Furthermore, seeing a surgeon within your payer network may minimize the administrative headaches and delays sometimes associated with getting payer approval for appointments and your surgical procedure. Having said that, it is important that you are both comfortable with and have confidence in your surgeon’s ability to get the best results possible, and that he/she is the best match for you. Remember, you and your family have the final word when it comes to selecting a surgeon. 

The patient/surgeon partnership requires a mutual commitment. I often tell patients that we hope for and even expect a good surgical result. However, if a surgical complication occurs, it’s important for you and your family to have been informed that it could happen and that you still have confidence that you chose the correct surgical approach with the correct surgeon. Prior to your operation, you should have a reasonable understanding of your surgical problem, your therapeutic choices, the operation that your surgeon recommends, the expected hospital course and recovery period, and the risk of common complications. Don't hesitate to ask questions and look for explanations in language that you understand. It’s also appropriate to ask about your surgeon’s experience with the operation that has been recommended for you. This is especially true if the operative approach is relatively new (such as a minimally invasive procedure) or involves new technology (such as a surgical robot). 

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There are lots of ways to find out more about your surgeon and his/her credentials.  Your surgeon’s local reputation is very important, and the power of “word of mouth” can’t be underestimated. It is common for patients to tell me that I have operated on another family member or friend or that they asked one of the nurses in my hospital about me. Many surgeons and surgical groups have websites containing information about their training and areas of specialization. This is especially true if your surgeon is affiliated with a medical school. 

Internet searches regarding your potential surgeon can sometimes be misleading, depending on the source. Information contained on websites that “grade” physicians can be inaccurate when it comes to your surgeon’s training, specialization, or even their address and phone number. Furthermore, be wary of online patient reviews that are overly critical or even overly complimentary. These reviews are frequently from a small minority of patients seen by that surgeon and may not be an accurate representation of his/her practice.

The Society of Thoracic Surgeons (STS) has a surgical rating system that includes star ratings for participants who perform a number of surgical procedures, including coronary artery bypass grafting by itself (isolated CABG), aortic valve replacement by itself (isolated AVR), and combined CABG and AVR. The ratings result from very sophisticated calculations using the STS National Database, one of the most comprehensive and respected surgical databases in the world. STS uses what’s known as the 95% confidence interval to assign star ratings. This is very different from star ratings used by popular websites, such as Yelp or TripAdvisor, which average the star ratings given by customers in order to assign restaurants or other businesses an overall star rating. In the STS rating system, two stars means that a participant has had EXPECTED results, with a 95% certainty. One star falls below expected and three stars demonstrate above expected results for a given category.  In other words, if your surgeon or hospital has two stars in the STS reporting system, there is a very high likelihood that they are doing excellent work. It should also be noted that STS ratings can change from year to year. 

Perhaps the most important component in choosing a cardiothoracic surgeon is how you feel when you leave his/her office after meeting for the first time. Hopefully you felt that he/she had time for you, listened attentively, answered your questions, is an expert in his/her field, and showed interest and concern regarding your surgical care. Though certainly not mandatory, a second opinion might help to make you more comfortable about your surgeon choice. Though not all surgeons are for all patients, the right type and amount of inquiry usually results in an excellent patient/surgeon match. 

 

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.