How to Choose a Surgeon

Finding the right surgeon is an extremely important decision, but how can a parent decide who to trust with the care of their child? Making the wrong choice can increase the chance of a complication or make it more likely your child might need a second operation.

To start with, take the time to do your homework; just because your child has been diagnosed with a craniofacial problem doesn’t mean that surgery must be done right away. It is important to learn as much as you can about the diagnosis you have been given and what the various treatment options are, before agreeing to any surgery. The best way to do this is to get another opinion. This section is written for parents who seek the best for their child. Following this section are some sample questions to help you to prepare before meeting your surgeon.

Parents are usually referred to a local surgeon, who they have been told has an “excellent reputation.” Even though this surgeon is supposed to be “a top doc” and might work at a major medical center, what are the chances this doctor is only average? Surprisingly, statistics (specifically, the Bell Curve) tells us that the correct answer is there is about a 95% chance your local surgeon is just average. Imagine everyone at school takes the same test, a few will flat out fail, most will get some score in the middle, and only one or two will receive the highest scores. Doctors are no different than teachers, auto mechanics, carpenters, etc.; they run the gamut from not so good to excellent. Interestingly, surveys show that most people consider themselves to be an above average driver. This is called the Dunning-Kruger effect, or “illusory superiority.” Of course, not everybody can be above average; yes, a few actually are better than average drivers, but most are just average – they just don’t know it. The same is true for doctors, the majority of these “top docs” are just average surgeons. So how important is it to look beyond your local area, to seek someone other than who your insurance company tells you to go see just because that surgeon agreed to be in their network? It can be very important. Think of it this way, it’s frustrating to have to take your car back to the mechanic because it wasn’t fixed properly, but no one wants their child to have to go back for more surgery because the first operation was not done as well as it should have been done. Do you think your insurance company really cares? Imagine your child having to live the rest of his or her life with a result that is not as good as it could have been.

If only the top 2-3% of all surgeons can be considered truly the best in their field, this means that there is over a 97% chance that your local surgeon isn’t one of them. How can parents without any medical background figure out who is truly is the best? Probably the two most important traits to look for in any surgeon are: experience and judgment. If you want the best, find that doctor who has treated more patients with your child’s condition than anyone else. In general, the greater the experience a surgeon has gained, the less of a chance your child will suffer a complication, and the more likely your child will get a great result that avoids the need for additional operations. Assessing a surgeon’s judgment is harder. Probably the best way to do this is to see if your surgeon can clearly explain your child’s condition, why an operation is necessary, and what is the most successful technique for treating the problem. Look for someone who takes the time to answer all your questions. The more the answers seem to make sense to you, the more likely you have a found a doctor with good judgment. Below are some tips to help parents find the best care for their child. This is followed by a list of potential questions to consider asking (don’t forget to write any important questions down ahead of time):

• Going to a top hospital or medical center doesn’t ensure that all the doctors working there are good. Well-respected medical centers might provide excellent care for heart disease or general medical problems, but maybe not as good at treating pediatric craniofacial anomalies. Parents need to focus on the actual doctor who will be caring for their child, not the hospital name. Once again, get more than one opinion.
• Search the Internet for information on your doctor. Does this surgeon’s website seem to be more focused more on aesthetic surgery or craniofacial surgery?  How much time does your doctor devote to reconstructive work and how much time is spent doing cosmetic surgery? Has your doctor published articles on your child’s condition or in other related areas? You can check this by typing in your doctor’s last name, space, and first initial in the search box at: www.ncbi.nlm.nih.gov/pubmed/, or ask your doctor for a list of his or her publications. This will help you to figure out if your doctor has a focused interest in your child’s problem or is primarily interested in other areas. Parents should expect a much better result coming from a surgeon who says: “yes, this problem is my special interest,” than one who says: “yes, I know how to fix this problem.”
•  Prepare a list of questions in advance (below are some suggestions) and then make sure that you get them all answered.  If you feel rushed during your appointment and feel that you didn’t get enough time with your doctor, then seek another opinion. Doctors who rush through an office visit are more likely to rush through the planning phase of your child’s operation, rush through the surgery, and only briefly follow your child afterwards, all leading to a poorer result. It’s okay to ask yourself: “what does this doctor have to do that is more important than treating my child?”
• How well were your questions answered?  Doctors who do not directly answer questions, or only speak in generalities, may simply not have sufficient experience with your child’s problem.  On the other hand, if your questions are clearly answered and explained in a way that makes good sense to you, then it is more likely that this doctor has the necessary experience and judgment to treat your child.
• Go to Internet chat rooms, or forums, that focus on your child’s problem. Have other families had positive experiences with your doctor, or maybe your surgeon has recently told another family that their child needs a repeat operation? Are people talking more about another surgeon instead of yours; one who seems to be doing more of these operations? Keep in mind that many families believe their child’s surgery was a success just because their child survived the operation. It takes many years to determine how successful the operation was, or if it turns out that a second corrective procedure is going to be necessary.
• Finally, listen to your gut.  A “prima donna” attitude in a doctor can be a sign of insecurity (perhaps about their own ability). Any doctor who discourages second opinions, or acts insulted if you question the recommended treatment, is most likely the wrong doctor.  Does your doctor seem to truly care about your child?

 

Sample questions to consider

 

1. What is generally considered to be the best time (or age) to perform the surgery that has been recommended? How long can the operation be safely delayed, and what problems are likely to happen if we were to delay too long?

This question will help you to understand the urgency of your child’s condition and how much time you have to research your options. It is important to realize that when children are still growing, waiting a little longer to operate can help to avoid the need for second operation later in life. If your surgeon is recommending immediate surgery, try to understand the cause for urgency and consider a quick second opinion. Is it just that the doctor has an opening next week so “let’s do it then,” or does your child truly have a life-threatening condition that requires immediate attention? Just because an operation is scheduled for your child, it usually doesn’t mean that it must be done exactly at that time.

2. Besides the operation that you propose, are other doctors doing different operations for my child’s condition? If so, what are they, and why do you not recommend these techniques?

This question may help you to get a sense of your doctor’s judgment. If the explanation doesn’t make sense to you, or if your surgeon dismisses the other operations by just saying “they aren’t as good,” this could be a sign that you need to get more information from someone else. A surgeon with good judgement should be able to explain to you in a simple way why one technique might be preferred over another.

3. Do you get to personally choose the anesthesiologist who will care for my child, or do you work with a group of anesthesiologists that assigns you an anesthesiologist?

This question gives parents a sense of how much control their doctor has in putting together the most experienced team to care for their child. The difference between an anesthesiologist who is very knowledgeable about craniofacial surgery and one with less experience can be very significant, especially if a problem arises during the operation. You don’t want to hear, “they usually give me Dr. – to work with.” Ideally, your surgeon personally selects the anesthesiologist; this way, the doctor who puts your child to sleep is not left to chance.

4. Will students, interns, residents and fellows be looking after my child?  Can you define their roles in my child’s care?

 Parents certainly don’t want their surgeon insulated from their child, with doctors-in-training making important medical decisions. Surgeons working at teaching hospitals have a responsibility to teach junior doctors. This includes letting them do some of the operation. If residents and fellows are going to be involved, then consider planning surgery in the spring, as far from July 1st as possible (that is when all new interns, residents, and fellows start the year).  It is okay to tell your surgeon that you expect him or her to be present for the entire procedure and to be the one who is actually doing the operation. You don’t want your surgeon letting junior surgeons practice on any important parts of your child’s surgery (which is really most of it!).

5. Besides you, who are the other top one or two surgeons for treating my child’s condition?

If you ask this question to enough different surgeons, you will probably start hearing the same names. If you want the best for your child, seek their opinions and see if their treatment recommendations are similar to what you’ve been told. If you want your child to get the best result, go to the best.

 

Some Final Thoughts

 

Take the time to do your homework and don’t feel rushed. There are almost no true craniofacial emergencies, making it okay to delay an operation for at least a couple of weeks to allow you to “get your bearings.” If you are the type of parent who feels like there is nothing more important in the world than your own child, then go get the best care you can find. Craniofacial problems are unusual enough that most surgeons don’t have the opportunity to treat these conditions all that often. There is a huge difference between going to a good doctor and a great doctor. Don’t let insurance companies tell you that you must stay close to home, or “in-network;” it can take a lot of work but persistent parents who are willing to put in the extra effort are almost always successful at getting their child the very best. All it takes is determination. Finally, never be shy about telling your doctor that in addition to seeking the very best for your child you are also seeking care that will be affordable to you and your family.

While the most valuable second opinions require knowing your child’s complete medical history, performing an examination, and reviewing of any imaging that may have been done, Dr. Fearon (cranio700@thecraniofacialcenter.com), or Dr. Coombs (drcoombs@thecraniofacialcenter.com), are willing to answer any general questions you may have by e-mail. If you have general questions that require a more in-depth explanations, you can contact our office to set up a telehealth visit. It is recommended that you include your child’s last name, if it is different from your own, in all email correspondences.

 

Why choose us?

 

Founded back in 1987, The Craniofacial Center in Dallas is one of the original craniofacial centers first established in the United States. But this alone, is not the only reason to choose our Center. Published studies suggest our Center has treated more pediatric congenital craniofacial conditions than any other center in the country. This experience has privileged us with an unmatched knowledge of the best way to take care for rare craniofacial birth differences.

Everyone wants the best for their child. Everyone wants a surgeon who is available to answer their important questions. Everyone wants someone they can actually talk to.

No one wants their child to undergo an operation that ends up not completely fixing the problem. All too often, children end up having to undergo an additional surgery that might have been prevented had the original procedure been done by a more experienced surgeon. Studies looking at all different types of operations confirm, the more times a surgeon has performed a specific operation, the better the results and the lower the complication rates.

Just because a doctor is closer to home, or because your insurance company is pushing you to be treated by someone on their list, doesn’t mean your child will be okay. Consider getting a second opinion from the most experienced team treating craniofacial differences. It is better to have taken the time to get more information beforehand, than to later regret that you hadn’t made that additional effort for your child. Information enlightens, and knowledge is powerful.

Why choose us? Our goal is to take the very best care of your child. We strive to find the smallest operation that provides the highest level of safety and the best long-term success rate. By virtue of our deep experience caring for children with craniofacial difference, our patients can expect to enjoy shorter operative times, shorter hospital length of stays, and the lowest published complication rates.