Quick poll - which surgeon would you choose?

[phdlife]

My dsis has to have major, major back surgery - her spine is deeply fucked up but she is only 36. This surgery has to be good because it has to last her a long time. She is also in the middle of a nasty breakup with an ex who turns more vindictive by the day - this is relevant as it is competition for her time, energy and money, all of which are in poor supply atm.

Anyway she has two choices of surgeon.

Doc A has known her for a couple of years, is warm, friendly, funny, understands her pain, is one of the top in the business, he takes good care of her and she trusts him. He's met the twat ex and is himself going through a nasty divorce so sympathetic on that score.

However, Doc A sent her to Doc B, who is regarded as the "rock star" of this type of surgery. Dsis felt this guy was great, but also cocky, breezy and matter-of-fact, and doesn't know her (or her pain thresholds/history etc) at all. Plus, one of the ex's closest cronies is one of this Doc's long-term patients.

So, wwyd: Doc A or Doc B?

A, if he's also v. good in the field - psychological support important in recuperation, I think.

Why did doc A send her to doc B?

A, if she doesn't trust her doc completely it will affect her recovery afterwards.

B. Fuck the aura, soft skills count for balls when you're on table. Go to the guy with the technical ability, who is also the chap your cuddly friend has referred to. So even Doc A himself thinks your sis will be better served by the other guy.

If A sent her to B, then it's obvious that he doesn't feel comfortable to do the surgery himself.

I'm afraid that many (but not all by any means) of the really, really good surgeons are cocky. That he has a long term patient who is a friend of her ex should be irrelevant - if it's not, then he would be subject to disciplinary action by his governing medical authority.

I'd def go with B

Lol at "psychological support important in recuperation" and "if she doesn't trust her doc completely it will affect her recovery afterwards".

For a start, you're not going to see this or any other surgeon more than once post-op unless something goes horribly wrong.

And secondly, if your mental state has that much bearing on your post-op results then the surgery should probably have been aimed a little higher than the spine.

Swedes her back is such a mess, she saw seven different surgeons before she found these two agreeing on what should be done. Mostly.

Doc B being the rock star, does a new op that they don't really know the long-term prognosis. Doc A agrees that if it works, that would be best, but is more inclined to the older approach. Less mobility (as I understand it) but at least they understand the procedure/risks/outcomes really well. I think he could do the rock star procedure, but he's a quieter, more cautious man and afai can tell, maybe not all that comfy with it?

So in fact Doc A and Doc B don't agree on the way forward? If Doc proposes operation A and Doc B proposes new operation B?

so doc B is the one willing to chance a patients future health in order to gain prestige, doc A is more concerned with making sure she has the highest chance of a postive outcome, even if the end results might be marginally less good but still vastly improved on her current state?

still doc A imo.

bruxeur... a patients mental state and it's effects on recuperation are well researched and it's common knowledge that how a patient feels about a procedure and her mindframe during recovery can hugely affect the recovery time and how complete a recovery is acjieved

Jeez, bruxeur - pain relief and recuperation have both biological and psychological elements - it's not some freakish new age comment to say that. Why so harsh?

If it were me, I would be looking at the potential up sides and down sides to both techniques and completely dismiss the personalities of the two surgeons.

If technique A gives a potentially better outcome than technique B, are the potential risks associated with technique B very much greater than those for technique A.

We need an actuary.

I would opt for the surgeon who seemed to be technically best, and it sounds like Doc A thinks that that person, for your sister, is Doc B.

I dont see how the surgeon treating one of the ex's friends is relevent.

Hang on people, I reckon if we wait a bit the rest of the stealth reveal might come to light...

PinkTulips - you are absolutely right, the best procedures simply spring into being without going through a stage in which they are considered new. You are also correct to say that anyone interested in developing new techniques and procedures is only interested in prestige, and takes chances with their patients health. Good precis.

Habibu - you're talking about the short term. The OP has very explicitly said that this needs to last. If the right person does the right operation, the long-term outcome will be superior to the bodged operation attempted by the wonderfully empathic communicator with butterfingers and a resting tremor you could whip cream with.

Well, I think they'd both prefer new op B if its long-term outcomes were completely understood. The main risk I guess is that she could well end up needing the reconstruction reconstructed.

OP, please clarify - A has referred to B for an opinion, or because he doesn't want to operate himself? And is this NHS or the choice of menu/substandard nursing care option?

How many patients has DrB done this new technique with ? What followup time does it have ? Results at 6m/12m in terms of pain etc. Any publications ?

IME (I don't do orthopaedics, only oncology), all new techniques go through a phase when they are considered new and risky, and are only performed by a few people who are willing to give things a try.

Theres always an early adopter phase, general acceptance, and cautious phase at the end - the length of these depends on the amount of followup required to prove the technique in terms of outcome for the condition and morbidity/mortality

And I know some Drs who are interested in pushing things forward, and do, but have no interest at all in prestige, just better results for their patients

"the bodged operation attempted by the wonderfully empathic communicator with butterfingers and a resting tremor you could whip cream with." Yes, sorry, that's clearly what "is one of the top in the business" meant. My apologies.

Accepted with thanks!

Doc B. Mainly cos she was sent there by Doc A.

Doc A would probably around for after care any way.

Best of luck

thanks CMOT - those are good clarifying questions, will put them to dsis, see if she knows.