The 2004 adventure, archived
Where’s the data?
Date: 6/24/04 at 7:22AM
The Questions:
*Pump time is the length of time the patient is on a heart pump while the heart is stopped. The longer the pump time, the more likely there will be complications such as stroke.
Back up and regroup
Date: 6/26/04 at 9:36AM
PCP* (looking at the cardiologist’s reports): Oh, yeah, this needs to be fixed.
We then had a nice long discussion about surgeons and what I had done so far.
PCP: If you’re going to ask things like that, they’re going to have to see your face, and you’re going to have to ask in a way that they don’t perceive as questioning their competence.
What you have is pretty rare. You’re probably not going to find a surgeon outside of a tertiary care facility who does more than a few of these a year.
*PCP: Primary Care Physician
Advice from my sister: Don’t you know someone who works in one of the hospital OR’s or ICU units? Ask them who they would use, or who they’d avoid.
Me: Well, I know an anesthetist who works at a different hospital.
Sister: Ask him. They share information.
Me (during a discussion with my dad): I found a cardiac surgeon who was at the same hospital you were in 40 years ago…
Dad (recognizing the name): Yes! I remember him! I bet if I called him he could give me some good names!
What do people do when they don’t know anyone in the medical field?
What the resources say:
Date: 6/27/04 at 12:35PM
From Questions for Patients with Heart Valve Disease to Ask their Physicians:
4. What are the risks of the operation?
- If you are the surgeon, how many of these operations have you performed?
- What are your results?
From Health Care Coach, Choosing a Surgeon: Tips for Making the Best Decision:
The following questions will help you decide if this surgeon is right for you.
“What is your experience in performing this procedure? (How long have you been performing this procedure?)”
“How many have you performed in the past year?”
“Can you give me names of surgeons who perform this procedure more frequently?”
“What percentage of your patients have had significant complications related to this procedure? What are these complications?” (The surgeon should disclose this information!)
From JCAHO (Joint Commission on Accreditation of Healthcare Organizations, Helping You Choose The Hospital For You:
Do you know the hospital’s success record in carrying out the specific medical procedure you need? What is the specific training of the physician who will perform the procedure? Ask how often the particular procedure is done.
From Patient Safety First, Choosing a Doctor to do Your Surgery:
What to Ask
The best way to find out about the doctor�s experience is to ask questions.
- How many operations like mine have you done in the last two years?
- How many problems and or deaths happened?
- What is your success rate?
From “How to choose a cardiac surgeon,” by Julia Swain, M.D., in State of the Heart: the practical guide to your heart and heart surgery, by Larry Stephenson with Jeffrey Rondengen, edited by Jon VanZile, Write Stuff Enterprises, 1999:
What you should know about cardiac surgery databases
The Society of Thoracic Surgeons, the main professional organization for cardiac surgeons, has spent years developing a database for risk adjustment. Although individual surgeon data and hospital data are not available, the national average data can be accessed by the public on the internet at www.sts.org. Most of the cardiac surgeons in the country use this database to track their results and to compare themselves with other surgeons.
Other databases exist for regions (such as Northern New England and Cleveland) and for the Veterans Affairs hospitals. New York and Pennsylvania have databases that are available to the public and rate both individual surgeons and hospitals. Surgeons themselves should be enrolled in a database to be able to assess their results. Although many of these databases only rate the quality of results for coronary bypass operations, other operations usually parallel these results.
Still another database at www.healthgrades.com contains Medicare statistics for all heart surgery programs in the United States.
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Referring physicians should know the track records of the surgeons to whom they refer and be able to explain these relatively complicated scales to their patients. Likewise, every surgeon should know their results and share them with their referring doctors and prospective patients.
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The top ten things you need to ask before Cardiac Surgery
1. How many of these operations has the surgeon personally performed in the past three years? (A prevailing opinion is that a surgeon should perform at least seventy-five open heart surgery operations per year, although more experienced surgeons can obtain excellent results even though they may do fewer operations per year).
2. What percentage of the surgeon’s patents over the last three years have died in the hospital after coronary bypass operations?
3. Does the surgeon use a nationally recognized database to compare his/her results to those of other surgeons? How do the results compare?
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7. How many open heart operations are done per year at this hospital? How long has the hospital had an open heart surgery program.
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Pidgeonholed
Date: 7/2/04 at 11:25AM
Feedback from those who treat this condition (mitral valve regurgitation):
These patients tend to be middle-aged, highly educated, and ask a lot of questions.
