Searching For The Right Surgeon

A Message From Winnifred Cutler, Ph.D., July 2010

“For my most recent book, Hormones and Your Health, I spent extensive time researching how to solve pelvic problems like fibroids and incontinence without the huge trauma and acceleration of aging that hysterectomy is now proven to cause.  I came to the conclusion that a woman needs to ‘Take Ownership” of her health and see herself as a healthcare consumer, that it is simply realistic to recognize that a doctor’s primary agenda is to sustain his own finances by selling you on the training tool, expertise or equipment he so expensively achieved.  Conflicting medical or surgery recommendations usually reflect the enormous investment (time AND money) any one surgeon must make to become expert in any one technique.  Put another way, if you go to a Ford dealer, don’t expect to hear good things about Chevrolets.

This year a family medical diagnosis presented an opportunity to practice what my book preaches about finding the right surgeon. The situation was colon cancer. The patient was a man. The cancer needed to be removed as soon as possible. We took "ownership".

In our case, we consulted with several surgeons and researched several hospitals – and chose the hospital with the lowest infection rates and the doctor whose consultation was prompt, attentive, and whose skills matched the procedure (laparoscopic instead of invasive surgery) we had discovered had the best options for recovery. It took a little time, and some energy but it was well worth it.  The first surgeon offered us the traditional surgical procedure that would have taken 8 weeks to heal.  We knew the less invasive laparascopic route could produce healing within 2 weeks.  That is a lot less pain and stress!  The first surgeon emphasized that the laparoscopic procedure carried risks that we knew were only valid if done by an inexperienced surgeon. The second surgeon we interviewed had performed 40 to 50 such laparoscopic surgeries in each of the last several years. He was responsive, articulate and enthusiastic. And he scheduled our surgery that actually occurred 7 days later, and we were discharged from the hospital after three days.

Below are relevant excerpts from my book to help your search.  While they specifically address pelvic and fibroid issues, I believe the advice applies to approaching any surgery. And remember the Internet can be invaluable for your search. I hope you are encouraged, and hope my experience can make yours a little easier to manage. “

YOU ARE IN CHARGE OF YOUR HEALTH. No one else should do it for you. No one else can feel what you feel when your energy is soaring, your sense of joy is boundless, your bones and muscles are vibrant…

Don’t accept less than what is best for you. As a functioning, intelligent adult, you have many decisions to make that will affect both the quality and quantity of your remaining years.

YOUR CHOICE OF PHYSICIAN:  You need and deserve a relationship with a compassionate physician who respects your intelligence, your dignity, and your time. If a doctor keeps you sitting in the waiting room for an hour past your appointment, without explanation or apology, this is disrespectful. Find a doctor who respects you.

DIVERGENT AGENDAS AND INTERESTS:  Your physician must rely on pharmaceutical sales representatives and Big Pharma–sponsored continuing medical education courses to stay up-to-date on essential information about drugs and medical devices. The reps and the speakers do present truthful, FDA-approved data, but they have no incentive to discuss their competitor’s products.         ***

Fearing malpractice attorneys, your doctor may practice “defensive medicine” by ordering redundant, expensive tests for you. Or sometimes doctors may stick to defensively postured practice guidelines that serve their, rather than your, best interests, in order to minimize their liability. You need to take charge of your own health and well-being; consult with the best medical people you can find and decide which recommendations to accept 754. And you need to identify the economic interests behind the recommendations offered to you.

YOUR POWER AS A HEALTH CONSUMER: As a patient, did you know that competition for your business is real? Consider the inherent conflicts when you get medical advice. Your doctor can help you only within his skill set. Will he or she refer you to another physician who can offer you a less-invasive treatment? No law says that a doctor must do this.698

If you must have a hysterectomy, keep this in mind: less cutting is better. The general trend in the last ten years has revealed that the least amount of surgery possible produces the least amount of damage. And if any other procedure short of a total hysterectomy can be done that will solve your problems, this should always be the first choice. The examples that follow point the way to this general conclusion.

Ask your doctor about the possibility of your having a subtotal hysterectomy. The procedure of removing the body of the uterus but not the cervix or the back part of the vagina has become more widespread. In fact, the rate tripled over the seven-year period from 1990 to 1997, but subtotal hysterectomies still represent only 2 percent of all hysterectomies that are performed.

***
Be prepared to use facts to counter perceptions. Your doctor would not willingly mislead you, but remember that your doctor’s perceptions may motivate him or her to recommend a particular procedure….

Women should be ready to make choices that their doctors may subtly oppose, because the physicians are using “viewpoints,” rather than evidence-based reasoning, to make their recommendations.

***
The most challenging procedures are often better for you. German researchers concluded that compared with an abdominal hysterectomy, a laparoscopic or laparoscopic-assisted vaginal hysterectomy provides many advantages but takes more skill.19 Patients recover more quickly and have shorter hospital stays and a faster return to work. Surgeons need more practice, having performed at least thirty procedures, to be competent in their training experience.

What this means to you: No surgery is simple, and you want to find someone who is skilled in the chosen procedure. A laparoscopic procedure in skilled hands seems better for the patient who is undergoing a hysterectomy.570

So why aren’t women being offered these procedures? One author, putting it delicately, explained that the different routes are used because of doctors’ conflicting goals and skills.130

*** Conclusion: Take Command -- If you having a problem with fibroids, I hope you will seriously study the information presented here. Your informed, dignified command of the facts can profoundly affect the solutions you seek and find. Don’t be in a rush to get the process over with. Every surgery provides fodder for future medical problems. Surgery is dangerous.

Hospital infection rates expose women to danger, independent of their reasons for seeking treatment in a hospital. ***
Opportunistic staph infections that you acquire during a hysterectomy, a myomectomy, or an endometrial ablation (which are common surgeries for bleeding or fibroids) can incapacitate you for months or years and may require extensive and expensive recovery. These are mainly caused by inconsistent (or no) hand washing. The issue is not trivial for a woman who is considering whether to accept her physician’s suggestion that she undergo a “little” surgery.


OTHER TOPICS ADDRESSING YOUR SURGERY DECISIONS (Read more in Hormones And Your Health):

• What is Prolapse? Surgical and Non-Surgical Approaches
• Surgical and Non-Surgical Treatments for Uterine Incontinence
• Unexpected Vaginal Bleeding
• Uterine Artery Embolization
• Myomectomy
• Comparing the Vaginal to the Abdominal Hysterectomy
• Total Laparascopic (No Abdominal Cut) Hysterectomy

---Winnifred B. Cutler, Ph.D.

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