January 01, 2011

Should You Have Surgery Far From Home???

I am in the fortunate position of seeing patients who live locally as well as a handful who travel across one or more state lines to see me on a weekly basis, as well as the sporadic few who come from even other countries.

When patients travel great distances to see a doctor, this puts the physician in a particularly humbling position. However, it also places additional strain on how care can be provided efficiently and reasonably when geography logistically makes it difficult.

To begin, why would a patient even want to travel great distances to see a doctor? The basic answer is due to the perception that they would receive better care than can be obtained locally. If true, such long distance travel is justified. After all, if you have thyroid cancer and there are no surgeons who can remove this cancer, than by all means, travel is merited.

However, too often, I see patients travel great distances to see a surgeon due to the perception that this one particular doctor is better than the one found locally, EVEN if the local surgeon is quite competent. Here is where the decision to travel becomes... well... less logical, especially if the surgery is for a routine problem.

IF there's a local competent surgeon, I feel it is ALWAYS better to get the surgery done locally. Why? Because if there's any problems after the surgery, it can be easily addressed quickly and with minimal fuss. If the surgery was done hours away, think of the travel, expense, missed time from work, etc NOT just for the surgery, but for any post-operative problems that develop. Oftentimes, the patient concern ends up being unfounded and only reassurance is required, but in order to make that determination, the surgeon needs to do an exam. Imagine the frustration of the patient when a surgeon requests a visit before answering a question about a post-surgical concern... hours of driving to the office, waiting in the exam room, being seen by the surgeon for a few minutes only to hear that everything is fine and normal, and finally driving hours back home.

Even in the hands of the BEST surgeon, problems can arise after surgery. Is the surgical wound becoming infected? Where is that fever coming from? There's a little drainage occurring... is that normal? Why is the skin red? There's a lot of pain and his medications aren't working.

To complicate things further, narcotic pain killers can NOT be called in by federal rules. A hardcopy prescription is required. Now, wouldn't that be mighty inconvenient if a patient (who mind you is in pain), needs to drive hours to the surgeon's office just to pick up a hardcopy narcotic prescription.

The logistical difficulties of dealing with post-operative care after patient discharge is tremendous for both the surgeon as well as the patient if the distance between the two is large.

Now when should a patient travel to have their surgery done?

DO travel to see a surgeon when your local surgeon feels it imperative that you do so either due to the complexity of the problem or inexperience. Especially, if the local surgeon is well-respected and honest. This serves two purposes... you get the surgery done by the best possible... AND, if any problems develop after surgery, your local surgeon is in the loop and can probably handle most routine post-surgical concerns.

I should state that I HAVE performed surgery in patients who live hours away (some even an airflight away) but I ALWAYS encourage patients to try and get the surgery done locally if at all possible due to the reasons stated above. If a competent local surgeon is not available, than that's fine. But if competent local surgeons are present... I do my best to steer patients to get the surgery done locally as it IS for the patient's best interest.

I have also referred patients to other surgeons a long drive away due to one reason or another, even if the patient desperately wants me to do the surgery. I'll be the first to admit if I lack experience to address a given problem. I also follow-up in stating to the patient that if there's any problems that occur after the surgery, to please return to see me rather than making a long-distance trip as there's a good chance I'll be able to address the concern. Everyone wins this way.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Dr. Ordon plastic surgeon said...

Post operative care is also very crucial and important so anything that has to be done should be well in consultation with the surgeon.

Anonymous said...

"IF there's a local competent surgeon," . Now how the hell will I know the answer to that important question????????????????????????????????????????

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