How good is my surgeon?

An excellent starting point to finding out if your doctor is any good is to ask for their PROMS reports, and in the case of surgery, for their most recent individual 'Joint Registry' outcome reports.

Due to the amount of time they take and possibly other concerns, some doctors are reluctant to use medical patient feedback mechanisms, such as Patient Reported Outcome Measures (PROMS) to provide patient insight into indicators of their individual 'doctor performance'. However, an article in the BMJ states, that in contrast, "many patients welcome PROMs and believe that they need to be used routinely in their management".

What are Patient Reported Outcome Measures (PROMS)?

As knee surgeon, Mr Rajaratnam explains in his article - what are Patient Reported Outcome Measures?; "There is a drive towards more transparency in health care and both individual practices and hospitals are collecting soft and hard data from their patients to make sure that their operations and interventions have really worked. On some reporting systems patient feedback are often displayed on digital review platforms, but often only seem to showcase the highly positive reviews". 

Mr Rajaratnam goes onto state, "The most trustworthy outcome measure are therefore PROMS collected by an independent body such as the National Joint Registry (NJR)".

What is a good doctor?

The question, what is good? has major philosophical ramifications, after all what is good for one may be  bad for another. 'Good' is therefore highly subjective and is often related to meeting and managing expectations. On the other hand, there are some clearer and measurable 'good' outcomes such as how quickly the operation has to be repeated, how soon you can drive - or climb the stairs, and whether there has been a return of full physiological function. So, the tools need to measure both patient-related and professional standards.

Measuring both surgical outcome and patient satisfaction

Patient involvement is central to the development of PROMs. The patient has there own expectations and should be considered as ‘experts’. Defining the importance of commonly used outcomes, such as revision rates or length of hospital stay are essential 'value' parameters.

How much time will your surgeon give you?

Of course, another factor to consider is the amount of time your surgeon is prepared to spend with you - especially when discussing the risks and benefits of the various treatment options. A good example to illustrate this is the application of 'bespoke' surgery, or custom-made implants. By definition, these types of tailored treatment approaches will naturally require a lot more time to discuss and prepare than will 'conveyor belt' surgery.

Knee surgeon , Mr Ian McDermott says, "Make sure that the timing of any surgery is appropriate and that you’re offered the best specific option for you, personally, as an individual, with the best prosthesis".

Patient power and the medical consultation check list

In order to achieve the best outcome, the patient needs to understand that they have a key part in the overall management. Patient have choices and the only way to ensure that you have the necessary data to allow 'informed consent' and 'informed decision making' is to ask questions. An excellent stating point is to review questions prior to consultations, for example, The Medical Consultation Checklist, or for heart related conditions - The Cardiologist Consultation Checklist .

Of course an excellent starting point is to also ask your doctor or surgeon for their PROMS, and in the case of surgery, for their individual JRI reports.


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