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FirstHealth of the Carolinas
Choosing the right surgeon By Dick Broom
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  By Dick Broom

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 physician.”

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.

FirstHealth’s surgical specialties
More than 70 board certified surgeons are affiliated with FirstHealth and operate in FirstHealth hospitals. They represent 12 surgical specialties:

  • Bariatric
  • Cardiac and Thoracic
  • General Surgery
  • Neurosurgery
  • Obstetrics and Gynecology
  • Ophthalmology
  • Oral and Maxillofacial
  • Orthopaedic
  • Otolaryngology (Ear, Nose and
    throat)
  • Plastic and Reconstructive
  • Urology
  • Vascular

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 colors.’”

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 shoes.

“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.”

What you
should
know
about
anesthesia


Steven Karan, M.D., is an anesthesiologist at FirstHealth Moore Regional Hospital.

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 surgery.

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 says.

“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 other.”

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.”