Author Topic: How do you know if your physician has enough experience?  (Read 4455 times)

lrobie

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How do you know if your physician has enough experience?
« on: February 12, 2012, 10:22:43 am »
As I stated in a previous post, my neurosurgeon at UPMC stated that "we" have done 1-2 AN surgeries a month or about 24 per year.  The neurotologist stated that he has done 100s of AN surgeries.  UPMC is rated very high for their Gamma Knife procedure, but I'm not hearing anything specific to AN surgeries.  In the latest U.S. News report, UPMC rated #12 out of 5,000 hospitals.  They rated #2 for Ear, Nose & Throat and #10 for neurology/neurosurgery.  Looking at those numbers, they look great.  But how do you really know?  What were your numbers for the facility that did your surgery?  Is there a magic number to look for?

Thanks in advance for any information.

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

mindyandy

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Re: How do you know if your physician has enough experience?
« Reply #1 on: February 12, 2012, 10:53:51 am »
I know Dr Friedman quoted they do 200-300 a year. That's the facility not him himself.
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

TJ

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Re: How do you know if your physician has enough experience?
« Reply #2 on: February 12, 2012, 10:55:51 am »
Lisa

I did not have surgery, I had CK.  In my opinion I think that what you think about the doctor and how comfortable you are with them is most important in making a decision.  I know that just about everyone says to go where many are done, but that does not mean you would not have an excellent outcome with someone else.  Every doctor and every facility has to start somewhere.

I can tell you that my CK was done by a doctor that had limited experience at the time.  Mine seems to have come out just fine.  Now that same doctor has done hundreds of them, so according to the definition he is experienced now.

TJ

Jim Scott

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Re: How do you know if your physician has enough experience?
« Reply #3 on: February 12, 2012, 02:16:47 pm »
When I questioned the (highly recommended) neurosurgeon that I hired to perform my AN debulking surgery about his experience, he smilingly replied that he had been performing AN surgery since 1973 (this was in 2006) and had performed the operation thousands of times.  I was convinced - and my confidence was amply rewarded. He did a masterful job.  No facial issues, no headaches and a rapid recovery followed by (pre-planned) FSR.

As for choosing surgery vs radiation: my AN was 4.5 cm when discovered and pressing hard on my brain stem.  Surgery -the sooner the better - was my only option.  I underwent the surgery (Retrosigmoid) three weeks after my diagnosis.

Jim
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

rupert

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Re: How do you know if your physician has enough experience?
« Reply #4 on: February 12, 2012, 08:01:10 pm »
Lisa,   While I believe UPMC has done the most GK procedures in the country and their reputation precedes them,   I have never found much information on their surgical procedures on these forums and how many they have done.   They told me they did about one a week.  I'm not sure if that was the procedure I was going to have or that was all procedures.   Interestingly, you would think if they were doing a couple a month there would be more people on these forums that would post about their experiences there,   but I have found very, very few on here. Maybe one.  I"m not sure what I think about that in terms of good or bad.   My thinking is there are not a lot of problems and that is why there are no posts.  You would think there would be some though.

mk

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Re: How do you know if your physician has enough experience?
« Reply #5 on: February 12, 2012, 08:05:52 pm »
This question has come up quite often. The total number of surgeries is important, as well as the frequency, but another factor is the "most recent experience". For example a older neurosurgeon may have done a larger number of AN surgeries during his/her career, but a younger one may be doing a lot of them during the last few years, therefore having more recent experience.

Keep in mind too, that comparing all neurosurgeons to HEI in terms of number of AN removals is not always a fair comparison. HEI does only these types of surgery, whereas most neurosurgeons specializing in skull-base surgery do other tumors too (pituatary, meningiomas etc.). So the frequency of AN surgeries may not be the same, but this doesn't mean that they are not equally skilled.

The criterion I used when deciding upon the neurosurgeon was outcome based. I tracked down posts from here, old patients, the "rate my doctor" website, word of mouth etc. and I chose the doctor who in my view had the best record in terms of outcomes (patient satisfaction, speed of recovery, least complications etc.).

In terms of UPMC, I think there was someone who had surgery there quite recently (I think in the summer), and did quite well. You may want to track them down.

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

lrobie

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Re: How do you know if your physician has enough experience?
« Reply #6 on: February 12, 2012, 08:40:39 pm »
That was SarahinPA.  She moved to another state I believe and hasn't posted since.  She did have some complications and used the same two surgeons.  I think maybe she had a blood clot or pneumonia.  I did find her posts helpful.  There was a younger girl, Bets, who also had her surgeries there, three of them. 

Bryan - I believe you're right in that when people don't have problems or don't feel the need for support, they don't go to forums like this and we never hear about their good outcomes.

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

CHD63

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Re: How do you know if your physician has enough experience?
« Reply #7 on: February 13, 2012, 06:41:09 am »
Or, we stay on to try to help offset the negatives, and give patients hope and hopefully a better balance of the realities of having an acoustic neuroma.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

lrobie

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Re: How do you know if your physician has enough experience?
« Reply #8 on: February 13, 2012, 08:31:31 am »
I truly appreciate all of you who have stayed a part of this forum/AN family.  Without you, our support system wouldn't be as big.   :)

Lisa 
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

luttman

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Re: How do you know if your physician has enough experience?
« Reply #9 on: February 15, 2012, 07:40:44 pm »
UPMC was the first hospital in the country to have gamma knife and they have treated over 1,500 people with ANs. UPCM  had a contract with gamma knife that they could not use cyberkife on intracranial tumors until a couple years ago. UPMC has only treated about 150 ANs with CK. There is some controversy, but I believe that the headframe with the GK gives it better accuracy. Ultimately the proof is in the results - of the technology and the doctors.

http://www.acousticneuroma.neurosurgery.pitt.edu/reference.html#11

http://www.researchgate.net/publication/6428729_Long-term_follow-up_of_acoustic_schwannoma_radiosurgery_with_marginal_tumor_doses_of_12_to_13_Gy

leapyrtwins

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Re: How do you know if your physician has enough experience?
« Reply #10 on: February 16, 2012, 03:34:52 pm »
IMO, there is no magic number that determines whether a doc has "enough" experience.

That's not to say though that you shouldn't find a doc who is experienced and qualified, as the ANA powers-that-be recommend.

A good place to start is on the main page of this website under the physicians/medical facilities area.  Docs/facilities here aren't endorsed by the ANA - they don't do that - but they are considered Centers of Excellence which means they pass a set of rigid standards set down by the ANA.

To this day, almost 5 years post op, I have no idea how many ANs my doc has surgically removed.  He came highly recommended to me by my ENT (a doc I've known for over 33 years).  At my first appointment when he and I talked about his experience and qualifications I was confident he could do the job.  I'm extremely satisfied with my outcome and think I chose wisely.  In addition, post op when I finally heard about the ANA, I found his name on the ANA "list".

Jan

Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

 


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