Should you get a second opinion?
If surgery has been recommended to you, I think a second (or even a third) opinion is an excellent idea. Very few things in medicine are black or white, and there is a lot of room for differences of opinion. In the present managed care medical environment, many doctors will not take the time to discuss your situation with you. And many have not taken the time to be trained in the new minimally invasive treatments available. For most doctors, if they do not know how to perform a procedure, they will not discuss or recommend it to you.
When a new patient comes to see me for a second opinion, we ask them to bring all the notes from previous doctor’s appointments and any test results that are relevant to the problem. If an ultrasound or MRI has already been performed, I like to look at the films myself so that I can come to my own conclusions about the diagnosis.
After a complete examination, we go back to my office to discuss the issues and answer any questions you might have. I often use illustrations to demonstrate what those findings are. At this point I make a list of one or more possible diagnoses and outline the treatments available for each problem. To be complete with this list, I usually include even those treatments I would advise against or those the patient has eliminated. Together we then go through the list and come up with a short number of options that are both medically sound and personally acceptable to the patient.
Family members or friends are welcome to join you and this is sometimes helpful to make sure all your concerns are addressed and to help you remember what is said. I usually suggest that you not decide on any specific course at the time of the first visit. I think these decisions are usually best made in the comfort of home, when there is time to think. Women are welcome to call me with any additional questions they might have.
What if you decide that surgery is right for you?
If you decide that surgery is right for your situation, you will need to choose the doctor to perform your surgery. There are a number of factors that should influence your decision. The first is to choose a doctor who will perform a procedure that fits your particular situation and problem. In most cases, you should have more than one option from which to choose.
The next concern is the skill of the surgeon. How many procedures does the doctor perform a month? How many procedures like the one you are requesting? How many of these procedures have they performed in women with problems like your? How many complications has the doctor had and what kind of complications were they? Studies show that experience makes a surgeon better. Surgeons who perform procedures frequently have lower rates of complications. But surveys show that many gynecologists perform less than one or two major operation a month. Choose your surgeon carefully.
It is also important to feel comfortable with your doctor. Do you get an opportunity to ask questions and are they answered? Is the doctor available by phone?
If you decide to have surgery, another visit should be set up with the doctor you have chosen to go over the specific details of the procedure you are to have performed. Again, it is nice to have someone accompany you. Once a decision has been made, we go over a paper called the “Informed Consent”. Filling out this form, if properly done, encourages a frank discussion of what you should expect from surgery. It allows the doctor and patient to go over the details of the operation to be performed, the specific risks of the procedure, the alternatives to the surgery, and the possible consequences if the surgery is not performed.
Effect of Surgical Volume on Outcomes
Authors: Wallenstein MR, Ananth CV, Kim JH, Burke WM, Hershman DL, Lewin SN, Neugut AI, Lu YS, Herzog TJ, Wright JD.
Study from: Columbia University College of Physicians and Surgeons, New York,
Journal: Obstetrics and Gynecology. 2012;119:709-16.
Problem: Studies from other surgical specialties show that surgeons who regularly perform operations have better results than those who perform surgery less often. This issue has not been studied for laparoscopic surgery for gynecologic procedures.
Study: The authors examined the hospital records of 124,615 patients who underwent laparoscopic hysterectomy from 2000 to 2010. The influence of surgeon and hospital volume on complication rates and costs was examined.
Results: Low-volume surgeons had a complication rate of 6.2% while the rate for high-volume surgeons was 4.2% (one-third lower). Complications during surgery, medical complications, long hospital stays and blood transfusion rates were less frequent for high-volume surgeons.
Women operated on at hospitals that did laparoscopic procedures frequently were 18% less likely to experience a complication than hospitals that did the procedures infrequently. The cost of surgery was $867 lower for high-volume surgeons than for low-volume surgeons.
Authors’ Conclusions: Performance of laparoscopic surgery by high-volume surgeons and at high-volume hospitals is associated with a reduction in complications and lower costs.
Dr. Parker’s Comments: Unfortunately, this study deals with laparoscopic hysterectomy rather than the uterine-conserving procedure laparoscopic myomectomy, but the results should be the same for all advanced laparoscopic procedures. As demonstrated for chess masters, virtuoso musicians and airline pilots, it takes thousands of hours of experience to gain expertise. Surgical experience accumulates over years and results get better when procedures are performed on a regular basis. Determining the skill and experience of a surgeon is vital information for you to have. Some questions you should ask any doctor who you might consider to perform your surgery:
1) How many of this specific surgical procedures does the doctor perform a month?
2) How many of these procedures has he or she performed on women with conditions or problems like yours?
3) How many complications have occurred with this doctor’s surgeries, and what kind of complications were they?
You can see more about this topic here: Questions Everyone Should Ask Their Doctor Before Surgery
It is your body and your health and you have a right to ask these questions.
By William H. Parker, MD
Clinical Professor, Obstetrics and Gynecology, UCLA School of Medicine
Director of Minimally Invasive Gynecologic Surgery, UCLA Medical Center, Santa Monica
Page last updated: January 31, 2014