How to Choose the Right Surgeon

Let me test my readers to gauge how skillful you have become in choosing wisely in the Byzantine medical universe.  You develop abdominal pain and, although you are not a trained medical professional, you fear that you have appendicitis.  There are two surgeons available and you want to engage in due diligence to ascertain which physician should be granted access to your abdomen.   A quick internet search uncovers the following data.

Surgeon A:  Twenty patients had proven appendicitis.  This surgeon operated on all of the patients.  No case of appendicitis was missed. 

Surgeon B: Twenty patients had proven appendicitis.  This surgeon chose to operate on 18 patients.  Two cases of appendicitis were missed.  

Before reading on, think to yourself which surgeon would you choose?

While this is not a trick question, I wonder how many readers were entrapped to select Surgeon A.  Who wouldn’t choose a surgeon with a 100% track record?  I wouldn’t.  I’d place my belly under the care of Surgeon B.  I’ll explain why.

The question is not how to use these instruments, but when.

While I have been truthful here, I haven’t divulged the whole truth, and many readers may not have thought to ask for critical additional information.  If a surgeon has what sounds like a perfect record of never missing a case of appendicitis, then something is wrong, because no surgeon can achieve this result.  Physicians, as members of the human species, are just not that good.  In addition, some cases of appendicitis are not typical and won’t be recognized as appendicitis even by seasoned doctors.  It is understandable that in such a case, a surgeon may elect to keep his or her scalpel securely holstered. 

The question that patients need to ask is how often the surgeon operated for suspected appendicitis, but no appendicitis was found.  Follow along with me here.  Assume that Surgeon A sees 100 patients with abdominal pain, but only 20 of them have appendicitis.  The other 80 have simple stomach aches and do not need surgery.  Surgeon A takes all 100 patients to the operating room and removes every appendix.  He can truthfully state that he didn’t miss a single case of appendicitis, but he has operated on far too many patients who did not need surgery.  His ‘perfect record’ is the result of over-operating.  

Surgeon B who sees the same 100 patients might decide to operate on 21 patients, 18 of whom had true appendicitis and 3 of whom did not have the condition.  He doesn’t have a ‘perfect record’ since he missed two cases of appendicitis, but clearly, he is the superior surgeon.  The vast majority of Surgeon A’s patients who went under his knife didn’t need to be there. 

A surgeon who operates on every patient will never miss a case.  While his surgical technique might be exemplary, his medical judgment is in critical condition.

Avoid being seduced by medical statistics that promise perfection.  This caveat is especially true now that physicians and hospitals are rated on the internet.  The stats you read might be true, but they may not be the whole story.