HealingWell
Search Close Search
☰

Finally Found a Surgeon... or did I?

Support Forums
>
Prostate Cancer
✚ New Topic locked
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/21/2010 7:12 PM (GMT -5)
So after asking everybody I know and querying forums, I finally got two referrals to a doc who does robotic surgery in my area. One was from someone on this forum, who very generously traded a few emails with me and was very forthcoming and helpful. The doc is a department head who's done over 800 robotic prostatectomies, and comes highly recommended by credible sounding people.

Then I find out he's being sued for allegedly letting students do ghost surgery for him, and (also allegedly) wasn't even in the room when a patient's prostatectomy was botched. That patient now claims to be permanently incontinent, although that probably happens one or two percent of the time with the best of surgeons.

Then I find out that somebody else has an internet vendetta against him for allegedly botching her son's kidney transplant through sheer (alleged) negligence and indifference. She's got her own website dedicated to trashing this doc's reputation.

I don't even know how to think about this. The man practices at a teaching hospital, an internationally recognized center of excellence, so having young docs do some portions of the surgery just go with the territory, I guess. A complete surgery with little or no oversight is pretty far beyond the pale though, if true. The kidney transplant lady just kinda sounds like a raving lunatic, and centers of excellence do attract the most difficult cases, so I guess some percentage of surgeries are going to go badly.

So I'm left with the question: Do I go talk to this guy or run like hell? I guess I can start my search all over again, but yeesh! And I thought all I had to worry about was cancer... eyes
Posted 9/21/2010 7:22 PM (GMT -5)
i wouldn't let him touch me. learning centers -- stanford in this area -- are places i would avoid.

ed

Posted 9/21/2010 7:23 PM (GMT -5)
If you decide to stick with this surgeon, I'd have him tell you before witnesses that he will do the surgery, and see what he says. I did that before my surgery and my surgeon admitted he required other people in the room to move equipment and arrange lighting etc., but he reassured me he personally would be doing 100% of the operation. That was good enough for me. Good luck with your decision.

Btw, if it was me, I'd try to find another if it was possible.
Posted 9/21/2010 7:23 PM (GMT -5)
Jazzman,

I didn't mention the legal stuff because it is a very common practice. Actually there are three doctors operating the Davinci process, but only one at the console. Apparently, according to the lawsuit, someone else was at the console during some part of the operation.

I still believe that he is a great surgeon. I would recommend talking to him. You can specify on your surgical release that only he can do the surgery, or you can cut bait.. It is a teaching hospital, and they do have to teach the up and coming surgeons how to do it. I think neagtive outcomes are very rare, but obviously, they do happen.
Posted 9/21/2010 7:26 PM (GMT -5)
if you have any other reasonable choice(s), why take the chance? sounds like enough red flags to be cautious in this person as your choice. even if you got satisfactory answers to these alleged charges, do you feel confident to take the chance with your body and cancer at risk?
Posted 9/21/2010 7:31 PM (GMT -5)
Goodlife,

I appreciate the referral and I also appreciate your being so forthcoming and helpful. You're right; it is a teaching hospital. If you're going to have surgery there I think you have to accept the fact that young docs will be involved.

Everything about this is explainable -- and unnerving. I know your recommendation was a sincere attempt to be helpful, based on your experience. So was the other fellow's recommendation.

I may see him yet, but I'll have to think this one through. Thanks again for the information. More information is always good.

Jonathan
Posted 9/21/2010 8:39 PM (GMT -5)
Jazzman:

RUN LIKE HELL.

Why have these doubts?

My surgeon up front told me who would be doing what exactly.

You have to have confidence in the surgeon and you have some definite, serious warning signs.

Mel

Posted 9/21/2010 8:48 PM (GMT -5)
Not sure turning and running is useful, but I would certainly do a no-holds barred point blank conversation (I would call it a "come to Jesus meeting", but may have to edit that out).

He would have to convince me all over again, after a penalty and loss of down.

And understand your alternatives before you have that sit-down.

Posted 9/21/2010 8:59 PM (GMT -5)
So far the tally is:

4 Run like hells!

1 Have a sit-down, but read him the riot act!

1 Give the guy a chance!

Hmmmm...
Posted 9/21/2010 9:00 PM (GMT -5)
Uh, make that 5 Run like hells!

This is a tough crowd...
Posted 9/21/2010 9:04 PM (GMT -5)
Of course its your choice and your call, and you did ask for opinions, and opinions we have plenty, lol.

Seriously, don't know what your choices are in your area, and I am sure depends on your insurance limits/finances, etc.

Plus in this age of endless litagation, I would want to make sure how much of these "charges" against the doctor are even accurate
and true.

David in SC
Posted 9/21/2010 9:05 PM (GMT -5)
I don't think I voted for 'run like hell'. If he is the best in your area and you have faith and confidence in him and his work, then I vote you look him in the eye, before witnesses, and ask him if he will be the surgeon doing the surgery and who else will be in the room and what is their responsiblity. If you don't get the right answer, then run like hell. If you have other alternative surgeons with equal skill and experience, then the decision to switch is easy. You have to have the best surgeon, that is a priority.
Posted 9/21/2010 9:11 PM (GMT -5)
Yeah, David.

I can take the flying opinions; I'm tougher than I look, and I did ask. I'm being a little flip about it all, but it is a choice.

I'm in Cleveland, so there's the Cleveland Clinic. Insurance shouldn't be a problem. I already spoke to a urologist there who seems excellent on all fronts, except that he favors doing open surgery. He may end up being my guy. As for making sure of the truth of these charges, I don't know if you can ever really do that. As with any surgeon, it all comes down to a leap of faith at some point.

I'm seeing a general oncologist tomorrow, and maybe he'll offer an opinion about these docs, but faith is a fragile thing. We'll see.
Posted 9/21/2010 9:17 PM (GMT -5)
Thanks for the clarification, Red Nighthawk.

The tough thing is making any kind of definitive determination about just who is "the best surgeon." Assurances are good, but the guy whose suing him claims to have had it in writing that he alone would handle the surgery.

In the end, I think we talk to these docs and try to get a feeling for who is really good. Referrals are good too, but everybody's experience is unique. At some point you jump off the cliff and try not to look back. More often than not, it works out. I'll cling to that thought.
Posted 9/21/2010 9:46 PM (GMT -5)
"the best" is always going to be subjective even on a good day. we have brothers here, that went to the best of the best, and still had/have issues. and we have plenty that have been to local surgeons or uro/surgeons that no one would ever hear of normaly, that have had excellent results.

i had open surgery by choice. in my case, even had i chosen robotic, it would have needed to been converted to open, so you never know sometimes. with open surgery nowadays, excessive bleeding is rare, magnification to the surgeon is similar in scope to robotic, hopsital time - i think too much is made of that - some robo guys are out in a day, but we have had open guys home in two days, if the insurance is paying, i think thats a minor point, i was in for 4 days and needed all of it. and then, and this always brings out the debate guns, is with a good, experienced open surgeon, that old fashion tactile feel has its merits. not opposed to robotics at all, but i just wasn't willing to go that route.
either method, with the right surgeon, should get you the best results.

yes, in the end, you have to make the choice on what you think is best. and then, not look back. the important part to remember, there is no re-do button with any primary treatment. so the advice is choose slowly, choose wisely, then go for it.

good luck as you continue to research and ponder your decision. to be fair, have you considered all non-surgical options? i orginally wanted seeding, but there were circumstances in my numbers where i was advised not to. in the end, my surgery failed its main objective, and i have already been through the salvage radiation route. so you never really know where its all going to go.
Posted 9/21/2010 9:55 PM (GMT -5)
Purgatory,

Thanks for some really insightful comments. Good points all.

Yes, I am considering non-surgical alternatives. I've been leaning toward robotic surgery, but with a G6 and a 4.11 PSA, I'm probably a good candidate for seeds. I'm seeing a general oncologist tomorrow to try to get a more balanced and less biased view of my alternatives. I may be making an appointment with a radiation guy after that.

In the end it is all subjective, and a little bit of a crap shoot. I'll roll those dice when the time comes, but right now I'm still gathering information. Thanks for sharing yours.

Jonathan
Posted 9/21/2010 9:58 PM (GMT -5)
I just had my robotic done 8-23-10 and is recovering well. My thought is not to do surgery at a teaching hospital unless the chief assures you that he personally will be operating at the console. Even then, they still do have to "teach" or they cannot train new surgeons. Someone told me teaching hospital Da Vinic had two consoles, one for the surgeon and the other for the trainee?

I looked into major teaching and research hospitals, major cancer centers and ended up picking a young surgeon in my city who dedicated his career doing robotic surgery and was formerly trained at the City of Hope and had done over 1000 RRP. He told me outright that he would be performing the surgery himself and that he kept statistics on his record and outcome and was able to cite his statistics without hesitation.

The outcome in terms of side effects (incontinence and ED) was excellent. Of course long term result is still TBD but all negative margins, etc. so far.
Posted 9/21/2010 10:05 PM (GMT -5)
Newporter,

Great story; I hope mine turns out as well.

I'm not too freaked out about the idea of a resident participating in the surgery. For me, it's all about supervision and oversight. Your point is a good one though. Asking pointed questions about how much and what parts of the surgery YOUR doc will handle is really important. It's definitely on my list of questions.

Jonathan
Posted 9/21/2010 10:17 PM (GMT -5)
Jazzman:

It's also about the integrity of the surgeon.

Mel

Posted 9/21/2010 10:24 PM (GMT -5)
That too, compiler.

When they come up with a test for that, we'll be getting somewhere.
Posted 9/21/2010 11:03 PM (GMT -5)
I don't know about the specific circumstances with this surgeon, but I want to give a different view on teaching hospitals. Arguments for teaching hospitals include the fact that a university asks their best people to stay on their faculty, and that many faculty are primarily on salary, so they are motivated by things other than money. Another argument, is that residents keep the faculty on their toes, as long as the senior guy does the critical parts of the surgery. Universities are in the business of innovation, whereas some MDs in private practice learn how to do something in their training, and just repeat it over and over for the remainder of their career.

I'm not saying that this is always true, just presenting the other viewpoint. If someone says, "avoid Stanford at all costs", that's not right, they've world leaders in many fields of medicine. Lots of smart, talented people there. The point is, you need to look at the individual doctor. Just as everyone's PCa is different, and we all encounter different problems, all doctors are just people, and need to be judged accordingly.

My bias? I had surgery at a University hospital in June of 2009. Never had the slightest incontinence, and right now, everything is working quite fine. So, like I said, no blanket judgments, pick your doctor by his or her individual skills.
Posted 9/21/2010 11:42 PM (GMT -5)
Hi Jazz. I can understand your concern, but in this day and age I really wonder if anywhere there is a surgeon who has done 800 surgeries who doesn't have a number of people blaming him/her for what they see as things-gone-wrong.

The problem is there isn't a public record of the hundreds of presumably happy patients who are delighted with him.

When I was "interviewing" my surgeon I liked him right away and trusted him. Just something about him clicked with me. Then, that afternoon, I went to the hospital where he'd do the surgery to do a pre-op class. My wife, who was an OR nurse was with me and she got talking with the nurse who was doing my bp and such. Turns out this nurse was a former OR nurse as well, and soon she and my wife were talking it up about work in the OR as if I wasn't there. When the name of my sugeon was mentioned, her face lit up and she said I had "the best.' Matter-of-fact, she'd worked with him in the OR and he was who she sent her husband to two years before. The two groups of people who really know how good the surgeon is are the OR nurses, and the nurses on the ward who take care of you afterwards. The second best source of intelligence are the doctors "passing gas" at the head of the table. They know.

I'd not be too fussed about what you've found out ---- but I would ask him about it. Just tell him in your research about PCa and da Vinci you'd come across X and Y and as you had no idea as a layman how to evaluate the information you thought the best thing to do was ask him about it directly. I think you'll have no trouble telling, from his response, if these issues really are issues. You'll know. And, if you're unsure, you know --- the answer is 'no.' You want to leave totally happy with the guy.

As for the teaching hospital --- I'd go for it every time. You want all those critical eyes watching over you in the OR. As for learning, the bulk of that is done on a robotic softwear program and a great teaching hospital is only going to have a resident do the part he/she is on top of. It wouldn't bother me a bit. I'd see all that backup as a bonus. I was eviscerated at a teaching hospital and I knew if my main surgeon had a heart attack, or suddenly was hit with the flu, there were lots of skilled hands in the room to step in.

Sheldon AKA Sleepless
Posted 9/22/2010 10:36 AM (GMT -5)
I don't know where you live but before I went with this doctor I'd find another one in the area to compare him to. I think you need another option at least before deciding. Just my $.02
Posted 9/22/2010 1:09 PM (GMT -5)
Jazzman,

I hope you will definetly make an appointment with a radiologist/oncologist before you make a final decision. You are a good candidate for seeds or a seed/external combo. Not trying to talk you out of surgery....just saying that you should consider carefully all your alternatives. Best wishes,

Joe

Posted 9/22/2010 1:45 PM (GMT -5)
Tough call Jazzman.

Objectively, one would hate to see a good surgeon drummed out of business while the jury is still out. And, how does a surgeon get the over 400 RRP's (s)he needs to get to the optimal experience point?

Subjectively, I insisted on written confirmation that my selected surgeon, and only he, would be doing the surgery. He had no problem with that. If you asked, and got even the slightest hesitation on that point, then I would bolt for sure.
✚ New Topic locked
12