This is a follow-up thread to my recent post titled: Spinal MRI - Are These Images Indicative of a Possible Medical Condition?. Turns out (according to multiple radiologists and neurosurgeons) I definitely have a very large L5/S1 Disk Rupture (aka herniated disk) pressing on my Sciatic nerve. For anyone who is curious, the procedure I almost-certainly need is called a Microdiscectomy. Now I’m not really looking for any specific medical advice here related to my condition so much as I am interested in general ‘best practices’ when it comes to talking to a surgeon before deciding whether to let them to do any significant operaiton.
Here are the questions I plan to ask so far, would love to hear any suggestions you may have:
Can i record this conversation my memory sucks and the info is important?
Do I have any other options besides this procedure? what about less invasive ones that aren’t super popular yet?
What are the risks of doing this procedure? How likely am I to be killed? Paralyzed?
What will recovery be like?
How many of these procedures do you estimate you may have performed? How many of those had any significant complications?
What is the earliest date you could potentially do the surgery (I’m in excruciating pain)?
What can you tell me about the standards and quality of care provided by this hospital compared to others?
Finally, I have a couple controversial questions that may I shouldn’t ask (would love your opinion on these fellow dopers)
In researching your background I noticed you’ve only been qualified as a neurosurgeon for 10 months (and that you’re still in the process of receiving additional ‘basic’ training). I find this really scary, do you think there may, statistically speaking, a higher risk of mistake/less elegant/polish work performed by someone with your level of experience?
I also noticed that you attended a relatively obscure/unusual medical school (Medical University of the Americas on a small Caribbean island). This scares me because I naturally assume the MCAT and other assessment scores required to get into a school like this are lower than better-known schools in North America. Can we talk about this?
even sven: You have a fair point but my GP did recommend this person so I am still going to the appointment with an open mind and am more than willing to talk about my concerns and if he has good answers that alleviate my fears that’s fine. Moreover, I’m in Canada where it’s very difficult to just chose a surgeon and then see them in a reasonable period of time.
I’m in terribly pain and this is the first person who said they might be able/willing to help me, I’m going to give him a chance, I am just taking the process damn seriously.
I would also follow up and ask what the doctor means by a “good” outcome. It could be a 50% reduction in pain and improvement in mobility; of course we think a good outcome is “all better, no more pain! I can move!”
These first question above would also give me pause. How many of these surgeries has the physician done and what have the outcomes been.
A friend’s dad attended that medical school. He’s a good doctor, but a GP, not a spinal surgeon. However, I think where the surgeon received his training for his specialty is a bigger deal than the medical school he attended. A decently-rated US hospital would IMO reduce the concern over his attending a Caribbean medical school.
I thought the Caribbean thing was very common, and as much about the shortage of US medical schools than anything else. My understanding is they generally complete their residency in the US.
When I had my gall bladder taken out (not the usual almost trivial procedure, BTW) I pretty much knew what to expect going in, and did not have any serious questions. I did manage, through severe pain and illness from an extremely pissed off liver, while being situated on the operating table, if I’d be able to play the bagpipes when it was over.
The OR staff gave me several style points for pulling that off.
I had a complicated cholecystectomy that kept me hospitalized for a week with a JP drain. My PCP suggested the surgeon he would choose if his gallbladder were bad. But he warned me the surgeon had no bedside manner. I heard/read the same elsewhere.
When I met with the surgeon he was upfront about his bedside manner. I told him, “I don’t want or need you holding my fucking hand.” We got along fine.
My knee surgeon had the reputation of being cold and not having a good bedside manner. I didn’t have a problem with that because a) my mommy was there in case I needed to be coddled, and b) he did a great job and I had a fast recovery. Also, he was honest and up-front about what he was able to do and what I’d need to expect down the road (total knee replacement).
I think it’s totally fair to ask how much experience he has with the procedure and how long he has been doing it for. However, note that neurosurgery residency is a grueling seven years (or 6 years, in Ontario) of 100-hour work weeks, so it’s not like he’s just been doing the procedure for 10 months.
I personally don’t think the last question is really worth asking. As GrumpyBunny said, residency training is far more important than medical school. MCAT scores may predict performance in medical school to some extent, but I really doubt that his success or lack thereof in synthesizing organic chemistry compounds and solving physics problems 12 years ago has much bearing on his current surgical skill and knowledge. Some Canadian medical schools don’t even look at MCAT scores, btw.
Canadian students have an especially hard time getting into local medical schools and may have to go to the Caribbean. I’d be more impressed that he was able to get into a neurosurgery residency after attending a low-prestige Caribbean school.
The medical school wouldn’t bother me, assuming his residency was at a decent institution and not at the Advanced Institute for Neuro Things in Barbados.
The 10 months experience for someone working very close to my spinal cord would give me pause.
Number of the same procedure done and complication rate are key, though you have other good questions that should be answered readily.
There are online sources regarding hospitals and infection/complication rates.
Ten months as a neurosurgeon and a Caribbean medical school? No. A few years of practice are in order before I’d even come close to allowing this doctor to do do surgery on my spine. Sure, his guinea pigs have to come from somewhere or we’d have no experienced surgeons, but if it were me I’d be more concerned with maximizing my odds of living and walking in the future, which means the surgeon with the most experience doing this procedure possible.
If this neonate of a neurosurgeon is the only one willing to operate on you, that’s a big red flag in and of itself, not a reason to have it done by him.
I can help you with this one, at least, as I had the procedure on my L4/L5. Prior to the surgery I was bed-ridden for several weeks. Really intense pain.
After the surgery, the only recovery was from the incision. There was a lot of me that had to be cut through to get at my spine, and so that took a while to heal. However, the relief in my leg was immediate. I was hobbling around on a walker just a few hours after waking up from the procedure. It was about a week before I could walk unassisted, and the first night after the surgery I couldn’t leverage myself back into my hospital bed without help from some nurses.
If I’d been less fat at the time, it might well have been an outpatient procedure.
Fair warning, the waking up part was hellacious. The nerve was inflamed and I woke up legit screaming.
One of the reasons doctors may be reluctant to do the procedure is that there isn’t good evidence that it helps. Therefore it may not matter where the surgeon trained.
For some reason that I don’t remember, it was sort of a tradition for the patients to ask the gastric surgeon that did my bypass how soon we could have sex after surgery. His response was, “I’d wait until you get into the recovery room.”
I had a microdiscectomy a few years ago- seeing as I had it through the NHS, I didn’t get to choose a surgeon.
Fine by me; I was given the global success rate, centre success rate and told a breakdown of the most likely outcomes. I think I was introduced to the surgeon, and probably was asked if I had any questions, but I don’t remember- the whole team introduced themselves, and everyone kept asking if I had questions. For me at the time, I couldn’t even stand up, and was at quite high risk of getting nerve damage from the disc rupture, so it was a bit of an obvious call.
For me, it was an immediate success; from being unable to stand upright and being in severe constant pain for about a month, I woke up pain free and able to walk within a few hours.
I was at the extreme end though- my surgery was performed within 24 hours of seeing a consultant as I was the worst case on the waiting list, obviously the risks/potential rewards are different for different severities.
mrAru had his third hernia repair [I keep telling him that his guts hate him and keep trying to make a break for it. 2 were standard inguinal - the first one the mesh came loose and the second one repaired it, this third one was where is old appendectomy gutting took place.] While sitting bedside while the doc came in for his release exam a few hours post-op, I asked the doc if they were planning on inventing a surgical zipper for cases such as mrAru’s [he has quite the collection of abdominal scars from a really invasive appendectomy with a second entry and extra drain sites for visual interest, and now 3 hernia repairs] He unfortunately admitted no zippers were being developed.
I would have no hesitation about a doctor who went to a Caribbean med school–I have worked with and trained several, and they’ve all been excellent. And if he got into an American neurosurgery residency he would have to have been an extraordinary med student.
I also wouldn’t be concerned about him being just out of residency. That means his skills are fresh and he’s up to speed on the most modern and evidence-based way of doing this procedure, whereas an old-timer may have done more of them but may be stuck in old ways. The residency program wouldn’t sign off on him if he couldn’t do this procedure, nor would the hospital.
You could ask how many of these he has done and whether he has seen any significant complications. But as others have said, the bigger question is what you can realistically expect after the surgery, and what happens if there’s no improvement.
My dad was a visiting lecturer at that school for a year or two. He’s an extremely qualified orthopaedic surgeon (now retired) who has operated on a number of worthies including a few royals. His advice was not to worry too much about the school and focus more on the residency and board certification.
Speaking for myself, however, I would go find a doctor you’re comfortable with. If you go into the procedure assuming it will fail, it will. By the way, do I win something for correctly diagnosing your disc issue in the original thread?
