How to choose your surgeon

Most patients know what they want when choosing a surgeon but are less clear about how to get it. They want someone who listens to what they have to say and is prepared to tailor advice to their particular requirements. They would like someone who can communicate that advice clearly and who is honest about his or her level of expertise and experience. They would like someone who undertakes the operation to have a high level of skill and to be patient and careful, and they would like the operation to be done in a safe, clean, comfortable and caring environment. Finally, they would like follow up to be thorough and would like to know if anything went wrong, they would be in the right hands and well looked after.

The great trick is how to do your best to guarantee this. Well, I suspect the first thing most people do is ask for recommendations from friends or other professionals who may know of surgeons such as family doctors. Others choose by careful research on the internet and finally many will choose as a result of media profiles or advertising.  Neither of these methods of choosing a surgeon is wrong but to blindly assume all surgeons are the same and all will look after you with the same care and attention is probably a little naive.

The internet is now a fantastic resource for finding out a little more about who is out there but be aware that there is as much misinformation as good information. Try and identify what is clear marketing and what is objective information. The first thing the internet can help you to do is to ensure your surgeon has the right qualifications and is a member of what is effectively one of the “trade organisations” for plastic surgery.

One of the qualifications that surgeons will claim to have:

1  FRCS.

This means they are a Fellow of the Royal College of Surgeons. While you might assume this says a lot about the level of expertise, in itself it is a very basic qualification. It does not mean they have done any plastic surgical training at all. However, you should not allow someone without this very basic level of surgical expertise to perform a surgical operation on you.

2. FRCS Plast.

This means that the surgeon has completed his training in plastic surgery and has passed the intercollegiate exam at the end of this training. You should expect your surgeon to hold this qualification (or one of the equivalent qualifications for ENT, ophthalmic or maxillofacial surgery). Organisations such as the British Association of Prosthetic and Plastic Surgeons and British Association of Plastic Reconstructive Anaesthetic Surgeons are recognised by the Royal College of Surgeons as being responsible for educating, training and maintaining standards in plastic surgery. All members are required to adhere to a strong ethics and conduct. Their activity is audited annually.

I would recommend if you are choosing a plastic surgeon to undertake your surgical procedure, he or she is a member of one of these two organisations. If you choose an ENT, ophthalmic or maxillofacial surgeons, there are equivalent organisations that they might belong to. It is often a good idea when choosing surgeon to consider having a consultation with more than one person. It is very helpful to be able to compare one approach to another and you will probably find you click with one surgeon more than another.

It is important that as well as being highly qualified, you are able to have a good and honest relationship with your surgeon. It is very helpful if you can communicate reasonably easily. Ensure that you ask all the questions that you want and that these are answered appropriately. Make sure that you have discussed all of the surgical options that may be available and you understand the limitations of surgery, the implications of the operation that you are discussing and any complications that might possibly occur. Make sure you understand who will follow you up and what will happen if you do have any postoperative problems or difficulties, particularly out of hours.

What you should not be expected to tolerate is having a consultation with anyone but the surgeon who is due to undertake your procedure. Some clinics will offer nurse consultations. These are fine if they are preoperative screening checks. Frequently, they are to help you understand a little bit more about the procedure before you see your surgeon. They are not there as an alternative to a surgical consultation. It is very important you see the surgeon who will be undertaking your surgery well in advance of the operation. There is no point meeting your surgeon on the day of surgery. What happens if you don’t like him or what he is suggesting, it is a bit late to back out. Having had your consultation, you should have an adequate time within which to change your mind. Don’t pay non-refundable deposits until you have had a chance to consider things very carefully and you are absolutely sure you wish to proceed. Don’t accept the suggestion that a different surgeon might see you for follow up from the surgeon who undertook your procedure. This is not acceptable. It is only the surgeon who operated on you who will truly understand what was done; clearly there will be occasions when your surgeon might be on holiday and follow up may have to be undertaken by someone else. Under these circumstances, you must make sure you are seen by your own surgeon at a later date.

Try and avoid getting seduced into travelling abroad for your surgery. It may seem very attractive and the financial advantages may be difficult to ignore.  Unfortunately, many patients find that in the long term, it costs them significantly more.

What are the risks?

First, you might decide you just don’t like your surgeon, his attitude or the clinic when you arrive. If this is the case in your own country, it is very easy to turn around and go home. It is not quite so easy if you are 5,000 miles away and you have paid up front. Even if you get the opportunity to meet your surgeon in the UK, patients often find that the facilities are less impressive than they had been promised. Most patients who end up with problems admit that their gut feeling preoperatively was to turn and run but they feel trapped by circumstance into proceeding.

The difficulties really arise if you have problems postoperatively. Firstly, do you speak the language adequately? Will you be able to communicate with the nurses if you have a problem while in hospital? Will they look after you well? What happens if you can’t contact the clinic in the evening when you are staying in your hotel just down the road? Is it safe to fly back to UK after major surgery? Well, the advice is that you shouldn’t consider long haul flights for a month after major operations because of increased risk of venous thrombosis. This is largely ignored in the advice given by these clinics.

What happens if you have a complication when you are back home? Well, that really is a problem. In most cases, patients end up going to their GPs and being referred to another surgeon. This invariably costs them considerably more money. In the UK, management of complications from revisional surgery is usually free of charge. This is clearly not the case if it is a situation where you are looking after someone else’s patient. If you are going to take what I suggest is a foolhardy step of travelling abroad for your surgery, what are the insurance implications? Is the medical indemnity insurance that your surgeon carries equivalent to United Kingdom indemnity? You should certainly not consider embarking on such a venture unless you know the answers to all of these things and you are prepared to leap into the unknown.

If you choose carefully, your surgeon will look after you, even in the unlikely event of postoperative problems. If you choose badly, you will be left looking after yourself and searching around for others to help. It is worth investing some time and effort into choosing your surgeon carefully.