Do you want a jack-of-all trades surgeon working on you? I don’t….

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Jack of all trades

Blogging for Edwards & Ragatz has me perusing the news websites daily.  I am always looking for an article that catches my attention, makes me want to read it and hopefully – learn something from it.  I sure did with this opinion piece written by plastic surgeon Dr. Anthony Youn for CNN.  CNN disclaims that his opinions are solely his, but I found that I agreed with the majority of what he was saying…

Dr. Youn writes that he once worked with a plastic surgeon who repaired everything.  He  performed cleft lip and palate repairs, face-lifts, breast reconstruction after mastectomy, and even complex repairs of tendons in the hands and fingers.  His practice wasn’t very busy, so he performed some of these procedures only once every few months. While the breadth of Saul’s practice was impressive, Dr. Youn kept wondering:

How many different types of procedures can you trust one doctor to perform?

Dr. Youn acknowledges that even though  he is board certified in plastic surgery,  and is trained in cosmetic surgery, hand surgery, burn surgery, cleft lip and palate surgery, reconstructive surgery, and microsurgery, you do not want a jack-of-all-trades surgeon working on you. And studies back up his opinion.

A 2007 study from the University of California, Los Angeles, examined 14,000 endocrine operations and analyzed the complication rates when categorizing surgeons based on the number they performed each year.

The group of surgeons with the lowest frequency (one to three per year) was responsible for 15% of all operations but 32% of all complications. This is contrasted with the group that operated with the highest frequency (100 or more per year); they were responsible for 15% of all operations but only 5% of the total complications.  A more recent study out of Tulane University looked at adrenalectomy surgery. Researchers separated surgeons into low-volume (one or less procedures per year), intermediate-volume (two to five per year), and high-volume (more than five per year) categories. The patients of low-volume surgeons were nearly twice as likely to develop a complication as patients of high-volume surgeons.

Author and surgeon Dr. Atul Gawande wrote about this subject in his best-selling book “Complications.” Gawande visited Shouldice Hospital, well-known for having the lowest recurrence rates for hernia surgery in North America. He found that each surgeon performed the same surgery, the same way, 600 to 800 times per year.  This resulted in a recurrence rate of 1%, compared to 10% to 15% at most other institutions. At Shouldice Hospital, repetition breeds success.

There is also the element for you to consider when evaluating your options.  Many health care providers will tell you that some surgeons are just more skilled than others.  There was a University of Michigan study that solidified this opinion.  The study recruited surgeons to analyze videos of other surgeons performing operations and judge them as being more or less skilled based on the quality of their movements during the procedure. They found that surgeons who were judged as being more skilled had better outcomes and fewer complications than surgeons who were determined as being less skilled.

So, what should we all glean from this opinion article?  There’s more to choosing a surgeon than simply the number of procedures he or she performs. Bedside manner, meticulousness, quality of training, technique and the surgical facility all play a part in the outcome you might have.  But, as a general guideline, it’s probably best to consider a doctor who performs a large number of the operation you are considering. Ask your surgeon how many he or she has done before signing up for the procedure.

Just remember the definition of the phrase “Jack of all trades, master of none.” As defined by Wikipedia – it is used in reference to a person that is competent with many skills, but is not necessarily outstanding in any particular one…

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