The prospect of facing neck or back surgery is daunting – the anxiety over whether the surgery will work and the pain involved is part of almost every conversation I have with my patients. The concerns over costs and insurance reimbursements are also just as stressful for the patients and their families. Neck and back surgery are major events in a person’s life and can feel overwhelming. The good news is that outcomes are better than they ever have been with new minimally invasive surgical techniques making the whole process much easier on patients. Chances are, if you pick the right surgeon, you are going to have a better quality of life after your surgery than the painful days that compromised your quality before.
Picking the right surgeon is everything. It should never be a passive process, and there are certain criteria that you should look for to find out if you are in the right hands. There are certain questions to ask that will give you the essential information for making the right decision. The best information always comes from those “on the inside” – in this case a surgeon like myself who has practiced a long time and knows what to look for. Here are my secrets and principles that you should consider when picking the right surgeon:
1) Decide beforehand that you will speak to more than one surgeon. It will be an act of due diligence on your part, and it’s important you see more than one style and approach so you have contrast. When you go to make a consultation appointment simply say, “I was told I need neck/back surgery and I am looking for a surgeon.” That should avoid any presumptions in the office visit and the surgeon will know you are undecided.
2) When asking about your likelihood for success, look up statistics for positive outcomes for your type of surgery beforehand so you know what numbers are in the ballpark – WebMD, Mayo Clinic and Healthline are great sites as are Spine-Health.com and SpineUniverse.com. You want to have an understanding of how many people benefit from the operation you are getting. For example, if you are scheduling a discectomy find out how many people have less pain after six months, then see what your surgeon says about your particular case and the operation in general. If there are wild deviations in the numbers, ask for clarity.
3) Ask for complete clarity on billing – this may be better handled with the office manager or practice administrator. Ask if there will be costs beyond what your insurance will pay and how much you will asked to pay out of pocket. Ask if there will be a SEPARATE BILL from the hospital and what costs may come from elsewhere other than your surgeon. Ask for an estimate of what the whole experience will run you. The issue of billing should be thoroughly discussed with no ambiguity. Your surgeon needs to say explicitly exactly how much you’ll much be asked to pay out of pocket, as insurance plans will often only pay a partial amount. If it feels like you are buying a Buick rather than discussing surgical billing, that’s a bad sign…
4) Ask about pain management post-operatively – this is a critical area. You need to know what your options are, as well as what the surgeon’s philosophy is on pain management. Post-operative pain is no joke and most surgeons can manage a patient fairly well in the crucial 72 hours when the pain is worst. But there will be additional pain in the weeks as you heal and you don’t want to overdo it with the medications. You do, however, want the option should you have breakthrough pain for an unforeseen reason. Have a very frank discussion on what the thresholds are and what the pain management plan is – this is not something you want to sort through when you are in throes of post-operative stress.
5) Do a background check on your surgeon – that’s not as sinister as it sounds. Today there are many tools that can give you an idea of how your surgeon is viewed by other patients and the professional community. A site like Yelp can be useful, but reviews can be very deceiving – sometimes unreasonable disgruntled patients may write a review about a frivolous grievance or just have a desire to be nasty. If there are only one or two Yelp reviews (or low volume on an analogous site) it’s likely not very valid. If a surgeon has a bad reputation, it will appear multiple places. Do a simple google search and see if there are any newspaper articles about whether the surgeon is good or bad. If your surgeon is quoted as an expert in several articles, that’s a good thing. Other sites like Healthgrades, Vitals, and RateMDs are good. Lastly, ask everyone you know – word of mouth is a powerful and trustworthy method and like the Kevin Bacon game, everyone knows someone who knows someone who works in healthcare and can get an answer.
6) Ask your surgeon how many operations they have performed like yours. The more the better. Ask how many times your surgeon has had incidental infections – if the answer is never that likely isn’t true, there should be an honest discussion about the risk of surgery including infection and the plan to deal with it.
In picking a surgeon, you want someone that comes across as an advocate and a partner. Sometimes the bedside manner can suffer but be replaced by superb technical skill – in this case the office staff and nursing staff surrounding your surgeon should fill in the gaps where emotional support is required. The bottom line is after you’ve checked all your boxes, you want to feel good about the surgeon you’ve consulted with. Your gut is always the best diagnostic.