How do I know if a surgeon is any good?

Ben Lamb and Saiful Miah are Urologists specialising in Robotic Surgery

That’s a difficult question to answer! My advice is to ask another surgeon- “who would you let operate on your loved one?” Quality in healthcare is measured in terms of patient safety, patient outcomes and patient experience. For me, these three factors are key to knowing how good your surgeon is, and you shouldn’t be afraid to ask. In addition, you need to know about the type of patient that your surgeon operates on. It is much more of a challenge to ensure patients are safe, happy and well if they are high risk e.g. if they have more aggressive disease or have other competing health issues. Nevertheless, these patients also need to be cared for to the best of our ability. Below I will try to outline how these factors can be assessed by patients.

Safety:

The easiest way to measure this is by looking at complication rates. Surgery is not without risk, and all surgeons have complications. The key thing is that surgeons should know about their own complication rates, and be honest with patients about them. Great surgeons may have higher than average complication rates, but that may reflect the type of patients they care for e.g. patients who start at higher risk of complications, or who require operations with higher accepted rates of complications. Safety is not just down to the individual surgeon though. It depends also on the team with which they work, and the institution in which they practice.

Patient outcomes:

This is essentially a measure of whether the surgeon achieves their aims (did the patient get better?), as well as any side-effects suffered (for example, in prostate cancer surgery incontinence and sexual dysfunction are expected in some patients, but the fewer the better). The ideal way of measuring outcomes would be to objectively test patients following surgery. This can be done for some, such as blood tests (e.g. PSA after radical prostatectomy), or scan results. For other outcomes, however, objective measurement is not feasible (e.g. erectile dysfunction after robotic prostatectomy). For outcomes that cannot be objectively measured, it is considered to be better for these to be reported by patients, rather than by the operating surgeon, who despite their best intentions will be biased. Patient reported outcome measures (PROMS) are validated methods to allow patients to report their own outcomes using surveys, electronic apps, or questionnaires. These can be collected by the surgical team and summarised to present an overall measure of the outcomes for particular groups of patients, operations and even individual surgeons.

Patient experience:

This is often considered the most controvercial of the three components of quality. Some people have said that how you feel doesn’t matter as long as you get better. In my mind, however, it is just as important that patients have the best experience possible when they see a doctor or have an operation. Health problems can cause a tremendous amount of anxiety for patients, their families, and friends. The way someone is treated during a troubling time can have a lasting impact on their feelings, their engagement with health services and even their recovery long into the future. To be treated with dignity, compassion and kindness is essential and maintains the trust between the patient and their doctor. Patient experience can be captured through feedback forms, complements or complaints, as well as official measures such as the NHS National Cancer Patients Experience Survey. As a surgeon, feedback from patients is very important to let me know what is working well as well as how I can do better. The General Medical Council require doctors to collect feedback from patients for their professional development and revalidation. Many doctors invite their patients to leave anonymised feedback for other patients to view. Examples of such review platforms include https://www.iwantgreatcare.org/ or https://www.doctify.com/uk.

In summary, it is possible to gauge the quality of a surgeon, or a hospital by asking about the factors above. Sometimes these measures will be available directly from a surgeon, or hospital, or via credible websites. An excellent example of this is The British Association of Urological Surgeons (BAUS), which has pioneered national audits of the outcomes of urological surgery in the UK. Every year, BAUS publishes the types of case undertaken, outcomes, complication rates, along with other data, for individual surgeons and hospitals. This is a landmark development in transparency and patient empowerment and is open to public scrutiny.

Finally, don’t be afraid to ask. You deserve to be given reliable information about the ‘quality’, of your surgeon. If somebody can’t or won’t give you the information you need, in order to make an informed choice, then you are dealing with an unknown quantity.

Useful links:

The British Association of Urological Surgeons Surgical Outcomes Audit: https://www.baus.org.uk/patients/surgical_outcomes/

High Quality Care For All, which provides a definition of quality in healthcare: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/7432.pdf

NHS services with ratings and links to healthcare providers: https://www.nhs.uk/

The National Cancer Patient Experience Survey: https://www.ncpes.co.uk/

The Care Quality Commission is the independent regulator of healthcare institutions (NHS and Private) in England, and provides reviews of hospitals: https://www.cqc.org.uk/