Brian’s Essays #9: **Choosing a treatment provider.**
This essay is a bit of a long one and is where I am going to be a little bit critical of certain aspects of the medical world. Please excuse me.
As I stated at the start of this series, I have several medical professionals in my family. For example, my step-son is a Surgical Urologist. I also have an OB/GYN and several nurses as relatives, so I get to hear all those stories about patients that "circulate among you" (and do excuse THAT pun).
One of my objectives is not to pay lip service to the phrase "Informed Consent", I actively seek knowledge out. Anyone is free to ask about their condition in here and yes, we don’t say it enough; "See a qualified Vascular Surgeon who specializes in Varicose Veins", but how to know who is qualified? I hope to answer that in this essay.
As patients, we have choices and options over any medical service or treatment we receive just about anywhere in the world. I know that in some countries for social, financial or political reasons there may be limited or even no choice at all, but with just a couple of exceptions, that is not the case for most people. Mindful then of the availability of choice, how do we exercise that choice?
Most of us have what is called a "General Practitioner", "Family Doctor", or "Primary Care Physician" or some other term that effectively means the same thing. In my case and at my Primary care doctor, I usually prefer to see a particular "Nurse Practitioner". She is very experienced and knowledgeable as well as being able to form an initial diagnosis and prescribe a range of medications for the most common of ailments seen in a family practice and refer to specialists if needed. I know that she is not a full ‘doctor’ due to her family commitments and desire to hold a job that allows her more working flexibility and less stress than if she took that additional step.
Her availability can often be as much as a full week sooner than the actual ‘doctor’ of the practice too. This is crazy considering her level of ability is so high. She will also not hesitate to call in the doctor if she needs to verify something or consult with him over a possible course of treatment. She is an outstanding bargain if you like, with high quality and speed or quick access. It was during a visit to her, that I mentioned my legs, the ugly blue veins and how they felt. It took her no more than 3 seconds of looking at them for her to decide I needed to see a Vascular Surgeon.
There is more to this than I just described. The brief history is that 20 years ago, I was living in the UK. The local NHS trust never had any money for what they considered to be "merely cosmetic procedures". I even moved from one outer London borough to a different county entirely to see about treatment for my slowly forming Varicose Veins. I then discovered that my new county of residence was deeply into playing "Post Code Lottery" over such treatments and certainly not keen on anything for Varicose Veins in people aged under about 60 and I was in my early 40’s. At about this time I was divorced from my first wife and I moved my residence to the USA where I married my second wife.
For a little over 15 more years, I just lived with the heavy feelings in my legs and the slowly increasing reduction in ability to move that my Vascular condition brought with it.
I ended up not being able to walk up more than about 20 steps at a time before my legs were a throbbing mass of pain. All of us with this condition know first hand about the various symptoms so I won’t go into that any more, but the reason I mention them is this; **Insurance** and denials. Even with the great medical insurance both my wife and I have here in the USA and we both feel we actually have lucked into good insurance schemes, most (if not all) insurance **will simply deny you if you use the words **"**cosmetic**" **or** "**looks**" **at any part of the approvals process.** One must never dare to mention those two words. Only ever discuss the real effects on ones life from a demonstrable symptomatic point of view.
How to choose a good surgeon…
Do your homework before you even go to the family doctor seeking a referral. Know who is and is not on your medical insurance plan. Don’t just take the one at the top of the list when you are looking to get referred at your family Practitioner’s office. Go to the clinics (at quiet times) and talk to the receptionists about the practice. Compare the quality of the paperwork they offer patients (both the glossy stuff and the after care instructions) between practices. Can you even get to talk to the practice manager and maybe even the surgeon him or herself before you get the referral? The better clinics will be delighted to have you in and talk through any worries and concerns you may have. Then you know (not guess) where you’ll want to go.
What is this "homework" I talk about?
Recommendations, personal experience, qualifications, and a host more factors come into play. I discussed this somewhat in my Essay #5 about the dirty little secrets of all this, but lets just re-state one of the most important things that I feel applies here: Try to avoid ‘corporate’ clinics.
These are the clinics that advertise on billboards, TV, local radio stations, in glossy magazines and so on. What I mean is go to another city (or what we in the USA call a "media market") where the TV and Radio stations are different. You’ll see adverts for almost identically named clinics, often with the same logo, typeface, and even the same words and slogans. Many of these places have high advertising budgets and of course have to pay the invoice every month to the media companies as well as franchise fees and so on. Note that I did say "many of these places" which means not all of them. You may get lucky but lets not spin the roulette wheel if we can avoid it…
Try to find a Vascular Surgeon that comes highly recommended **BY OTHER PATIENTS**. Check out the medical groups for your local areas. Do you live in NYC? Don’t ask in a group specific to California. Check out who has won local awards for excellence from his or her peers, not from the media. Why is this? While I cannot prove any particular case, it has been said that such media based awards go to those who buy the most advertising that year. No need to take that roulette wheel either is there?
Try to find a surgeon who is attached to and maybe even employed by a major hospital system. For example, as a Dallas, Fort Worth area resident, I chose this doctor because he is a board-certified vascular surgeon (not all are) and is Chief of Vascular Surgery at Presbyterian Hospital of Dallas. He therefore knows more than or is at least more practiced than the average surgeon who is still learning or is recently qualified. He is a graduate of an Ivy League university (Stanford), so has the academic ability a good surgeon needs. He served his fellowship at the University of Texas Southwestern Medical Center. By the way, **Fellowship training** is a part of the process of becoming a specialist physician. Sorry to those who know this already, but us patients generally don’t realize that a "Fellow" in the medical context usually has two additional years of specialist training. My surgeon is a member of the Society of Vascular Surgeons, Texas Medical Association, and Dallas County Medical Society.
All the above sounded much better than "…is a recently qualified general surgeon and has expressed a desire to help people." Oh yes, that was how one clinician described himself. I won’t include a cartoon here, but if ever there was a resume that was worthy of a "facepalm" then that one was it.
Does my surgeon do everything himself? Is he omnipresent in the clinic? Of course not. His main clinic location is attached to the hospital building however and when his staff are working on patients (to do an ultrasound for example) he has been in the room and verifies what the radiologist is seeing. He trains others and can have his students in the procedure room (with the patients permission of course) and instruct them in how procedures are done. At the initial consultation, he took the time to explain how veins work, how the valves inside them often do not work and various other terminology he would be using, as well as treatment options and recommendations and most importantly WHY he was preferring one option over the others that he could have done.
This is the kind of surgeon you want to be looking for when I say you need to be ***choosing** *a treatment provider.
Good luck – this can be a minefield – so tread carefully and go slowly, so you’ll reduce the chances of finding one of the ‘not so good’ surgeons. … See MoreSee Less
Hello! I wanted to share my before and after pic of my left leg. I had ablation surgery done 6 weeks ago. I feel sooo much better and am so happy to be able to exercise again without pain, but the vein is still more visible than I expected. At this point it’s purely cosmetic, but I have to admit, I want a normal looking leg again☺️. What follow up procedures have people had post ablation surgery, and was it worth it/ expensive? I have my follow up with doctor soon but wanted to get some opinions before. … See MoreSee Less