Something TV rarely shows—and there
is no reason why it should—is how patients
decide which surgeon they are going to let
operate on them. You might even get the
impression that patients have little or no
say in the matter.
That isn’t true, of course. In real life, the
patient nearly always gets to choose. But
if you’re the patient, how do you know
which surgeon is the best choice for the
operation you need?
Dennis Devereux, M.D., a general
surgeon at the FirstHealth Montgomery
Surgical Center in Troy, has an answer:
“Ask your primary care physician: ‘Who
would you go to if you had this problem?’
“Your medical doctor is going to know
which surgeon is experienced, has a good
way with patients, and fully explains the
benefits of the surgery and the complications
that could arise,” Dr. Devereux says.
“That’s how we (physicians) choose another
If the surgeon that your primary care
doctor would select doesn’t take your
insurance, then you might need to choose
another surgeon. In that case, your doctor
can probably help you decide among the
surgeons who do take your insurance.
William Edsel, CEO of Pinehurst
Surgical, says it’s always a good idea to ask
friends, relatives and neighbors if there is a
surgeon they would recommend.
Depending on your particular surgical
need, you might have many choices or only
a few. For example, in most places, there
are more orthopaedic surgeons to repair
broken bones and replace arthritic joints
than there are heart surgeons or brain surgeons.
More than 70 board certified surgeons
are affiliated with FirstHealth and operate
in FirstHealth hospitals. They represent 12
- Cardiac and Thoracic
- General Surgery
- Obstetrics and Gynecology
- Oral and Maxillofacial
- Otolaryngology (Ear, Nose and
- Plastic and Reconstructive
Among the various types of surgeons,
the largest number are general surgeons
who perform most of the types of procedures
that most people are likely to need.
Some of the most common of these are
appendectomies, hernia repairs and gall
bladder surgery. General surgeons also perform breast, stomach and intestinal surgery.
“Although we do many different kinds
of procedures, most general surgeons
have a few areas of special interest,” says
Leslie Salloum, M.D., a general surgeon at
FirstHealth Richmond Memorial Hospital
in Rockingham. “It’s important for
patients to know that a surgeon has had a
lot of experience and good results in a particular type of surgery.”
Breast surgery is an area of special interest for both Dr. Salloum and Dr. Devereux.
Touber Vang, M.D., a family physician
at Mid Carolina Family Medicine in Troy,
says he looks for—and recommends to
patients—a surgeon who is “particularly
competent in a specific type of surgery, has
done a lot of them and has had good success with very few complications.”
A good question for patients to ask
is whether a particular surgeon is board
certified. Certification means the surgeon
has passed rigorous oral and written
exams given by the American Board
of Surgery. The exams test surgeons’ knowledge and judgment in their area of specialization.
Edsel says the easiest way to find out
about a surgeon’s education, training and
board certification is to call his or her office
and ask. “Most offices have this information
readily available and would be happy
to send it to you,” he says.
If you don’t feel comfortable with a
particular surgeon or you aren’t absolutely confident in his or her abilities, then you should go to someone else, Edsel says.
“After all, what is more important than
having confidence that the person who will
be operating on you is going to give you
the best care?” he says. “There are no more important decisions than this.”
General surgeons are not required to
be re-certified at certain times, but the
American College of Surgeons recommends
that they take the certification
exam every 10 years.
“I have done that, because I want
to know that I’m up to date and know
everything I should,” Dr. Devereux says.
“There are innovations and new developments
all the time. I might think I’m up
to date, but I want to pass the test again
to make sure.
“I wouldn’t want to fly an airplane just
because I thought I was a good pilot.
I would want somebody to objectively
evaluate me and say: ‘You’ve done all
these things we told you to do, then we
gave you the test and you passed with flying
Physicians who specialize in family medicine,
general internal medicine, obstetrics
and gynecology, and pediatrics often see
the same patient many times over many
years, so it is important to develop a good
relationship. A surgeon might treat a
patient only once, but the fundamentals of
a strong relationship—respect and communication—are still important.
“A big consideration for me as a physician
is how well surgeons communicate
with the patients I send them,” Dr. Vang
says. “Do they explain what they’re going
to do and how they’re going to do it and
answer all their questions?”
Dr. Salloum agrees that talking with
patients and educating them is essential.
“I always try to explain things in their
terms and make sure they understand
everything about their condition and the
surgery they’re going to have,” he says.
For Dr. Devereux, it’s simply a matter
of treating patients the way he would
want to be treated if he were in their
“It has nothing to do with the number
of times I see a patient,” he says. “Even
if you’re just here one time and I fix your
hernia and never see you again, I want to know whether it was easy to call and make an
appointment. Were you greeted with a friendly
hello? If you had to wait, were you told why?
“I train my staff to tell patients what’s going
on if I’m in surgery and won’t be on time for
their appointment. If it’s going to be a long
time, we offer to reschedule at their convenience,
even if that means I come in to see
them early in the morning or in the evening.
That’s just basic courtesy.”
Dr. Devereux has a suggestion box in his
waiting room, and he likes for patients to drop
in their comments.
“Medicine, including surgery, is a service
profession,” he says. “My patients aren’t here
to serve me. I’m here to serve them.”
Steven Karan, M.D., is an anesthesiologist at FirstHealth Moore
|If you have had major surgery sometime
in the last couple of years, you probably
remember who operated on you. But
can you name your anesthesiologist?
Most people can’t, which is ironic,
since the anesthesiologist is the physician
who not only makes sure you don’t feel
anything, but who keeps you safe during
Anesthesiologists evaluate patients prior
to surgery to determine the most appropriate
type of anesthesia. In the operating
room, the anesthesiologist monitors
the patient’s vital functions—heart rate,
breathing, blood pressure, body temperature
and fluid balance—while controlling
the patient’s pain and maintaining the
level of unconsciousness that is ideal for a
safe and successful operation.
Once the operation is over, the anesthesiologist
continues to monitor the patient
in the recovery room and, if needed,
administers drugs to relieve pain.
At FirstHealth Moore Regional Hospital,
anesthesiologists and certified registered
nurse anesthetists (CRNAs) work as a
team, “so we have two trained professionals
caring for each patient,” says anesthesiologist
Steven Karan, M.D.
The CRNAs administer anesthesia and
help monitor the patient’s condition during
and after surgery.
Patients need to be in a deep sleep—“out cold”—for some operations, so they
get general anesthesia. For other procedures,
they just need to be sedated.
“Sedation is like sleeping on the couch
in front of a bad movie,” Dr. Karan says.
“You’re asleep, but if somebody comes
into the room and says your name, you
might hear it and respond.
“We always tell patients that if you
look comfortable, we’re not going to
shake you to find out if you’re asleep. But
if you’re uncomfortable, don’t lie there
quietly. Just tell us, and we can fine- tune
the anesthesia to your need.”
Sometimes, depending on the type of
surgery, patients have a choice between
general and regional anesthesia. With
regional or spinal anesthesia, drugs are
injected into the spinal column to keep
pain signals from being transmitted from
the surgery site to the brain. The patient is
awake the whole time.
“To have a good regional anesthetic,
you need a patient who doesn’t mind
being awake as the injections are being
done,” Dr. Karan says. “We want all the
feedback we can get from the patient
when we’re putting the spinal blocks in to
make sure they are going in at the appropriate
places. That’s usually tolerated very
well, but some people know right from
the start that regional anesthesia isn’t for
them because they pass out when they
get a flu shot.”
General and regional anesthesias are
equally safe for most patients, Dr. Karan
“If you’re healthy, general anesthesia
is as safe as regional,” he says. “But certain
health conditions can mean that one
type of anesthesia clearly outweighs the
Prior to surgery, anesthesiologists talk
with patients about their anesthesia and
explain what they will be doing for them
during the operation. The most critical
times for managing a patient’s condition,
Dr. Karan says, are when the patient is
going to sleep and waking up.
“In the interim, we are monitoring
all the vital signs on a second-to-second
basis and closely watching the trends to
make sure they are staying stable,” he
says. “Those trends can indicate potential
danger, and we would much rather turn
things around when they are just potential,
before they become a crisis.”
Dennis Devereux, M.D., a general surgeon
in Troy, says some patients worry
more about the anesthesia than the surgery.
“But anesthesia is very safe,” he says.
“And in 30 years of doing surgery, I have
not been disappointed with one anesthesiologist
or nurse anesthetist.”