Tuesday, March 23, 2010

Finding a Surgeon - How?

There is just so much to write here. So much!

If your insurance is paying for your surgery the first thing is to determine your surgery type. The second thing to do is to find out who your insurance company contracts with and get that list. Go to every seminar for every doctor. Avoid the band mill type places, find a doctor that does all the major surgery types. If you want Gastric Bypass and you go to a surgeon that only does lap bands do you really think that doctor is going to try and sell you bypass? Of course not.

Doctors put on seminars for one reason and one reason only. To sell themselves to patients. They are not doing these seminars for your benefit, it is a method to give the same lecture to a group of people. It's a method of advertising. The doctor is selling his service, in this case Weight Loss Surgery. He is not going to use an expensive mode such as a seminar to talk you into going to one of his competitors.

Doctors are in business to earn a buck, that's okay. That is the profession they chose just like you chose the profession you practice. There is no rule that says a doctor cannot earn his living practicing his trade. But the bottom line is it is still a business and run like a business. The doctor is just like the car dealer, a Toyota dealer is not going to encourage you to buy a car they do not make, they are going to encourage you to buy a Toyota. A Band doctor is not going to talk you into Gastric Bypass if he does not do Gastric Bypass. He is going to emphasize all the good parts of the surgery he does do and brush off the procedures he does not do. You would do the same in his shoes.

This is why you choose a surgery type first and then you choose a surgeon. YOU are the person that has to live with this surgery type for the rest of your life, make it the right surgery type for you, not the surgery type that is in the best interest of your doctor's bank account.

So you have insurance (those without insurance or without WLS benefits on their insurance plan will be discussed further down.) and you need to find a surgeon. You have picked out your surgery type and you have a list of the doctors that contract with your insurance plan. You have ruled out the doctors that do not do your surgery type and you have gone to their seminars.

Do you need to *like* your surgeon or is it more important that his surgical skill is tops? Well, the answer to that is both. There are so many surgeons out there that want a piece of the bariatric money pie that there is little need to go to someone that is really nice but lacks in experience or skill. There is also little need to go to someone that is great in surgery but is a butt in his office. You have a right to both. The reason you want a skilled and experienced surgeon that is someone you like and respect as a human being is because if you have any other surgery type than a sleeve, you will be getting to know your surgeon well. All surgery types except sleeves require a lifetime of aftercare. Bands need fills and various check ups, Bypass and DS need labs for life. Now, with that said many bypass and DS folks do have their PCP do annual labs but if those labs are not up to par it is typically the bariatric surgeon that changes the vitamin regimen. If you do not like your surgeon you are not likely to go for follow up appointments and you are not likely to be honest about concerns and medical problems, weight loss or weight gain. So it really is important to find a surgeon you can be honest with, share personal thoughts and feelings, and overall just someone you feel comfortable with.


Welcome to my world, the world of self pay.

Most people do not have WLS coverage even if they do have insurance. Most have insurance through an employer and it is the employer that needs to pay an additional premium on top of major medical for WLS benefits. With the economy today people are lucky to have basic insurance. Employers are saving money anywhere they can and sadly, that includes WLS premiums. It is not the insurance company that isn't offering it for group plans, it is the employer who can't pay the expensive premiums.

Private policies typically do not cover WLS for reasons explained earlier. So the bottom line is that we have a lot of people that have no insurance or they have insurance and no WLS benefits. They are self pay. If they do not have access to Medicaid or Medicare, and their insurance does not pay they are left with self pay. The downside to that is they are self pay, the upside to this is that they can virtually go to any surgeon they want and - in any country. I'll discuss that later in a section for Medical Tourism. But for now we are looking at US surgeons.

So you now have decided on a surgery type, you have obtained a list of all the bariatric surgeons on your insurance plan, you have ruled out all those who do not do your surgery type, and you have been to their seminars. You have ruled out those that give you the heebie jeebies, those that are so arrogant that you can't stand being in the same room as they are, doctors that do not answer questions in a way that makes you feel like you are walking away with more knowledge than you walked in there with, and you have narrowed your list further. Now what?

Now you start your research.

Sit down and make a list of things you require of your doctor and a list of things that you prefer in a doctor. For example, it might be something like this:

I require from my doctor:

1) FACS affiliation
2) ASMBS affiliation
3) A minimum of 500 (name your surgery type) procedures
4) A hospital instead of an outpatient surgical center
5) An office staff I can deal with and tolerate
6) (List your requirements)

I PREFER my doctor have:

1) A location reasonably close to my home (depending on surgery type this may or may not be possible.)
2) A nutritionist on staff vs. at a different location
3) A psychologist on staff vs. at a different location
4) ALL aftercare included in the cost of surgery (Get this in writing)
5) Support groups held weekly/monthly
6) (List your preferences)

This allows you to narrow the list down further.

Myth Or Fact?

All doctors are ethical and would never lie about affiliations? What do you think?

It is a MYTH. Many doctors will claim affiliations they do not really have. In order to be FACS one must meet very specific requirements. Many doctors will claim this affiliation but it's not true, they keep the affiliation until www.FACS.org catches them and requires they remove these letters from the end of their name. ASMBS is the same.

Doctors also claim that they have performed many more surgeries than they really have. This one is very hard to verify one way or another. I know of one Las Vegas surgeon that claims hundreds and hundreds of sleeves but as of today's date he has done a grand total of "3" sleeves. Yes, three. Yet when you call his office the staff will claim hundreds and hundreds of sleeves AND this doctor is a Center of Excellence. Scary, right? It is scary.


You cannot verify all doctors for FACS or ASMBS affiliation.

MYTH. You most certainly can verify this information.




Just go to the websites and do a search of your doctor, verify what you are being told is truth.

Please remember, the doctor will have a coordinator. It is his/her job to sell you surgery after the seminar. Sometimes they will tell you anything you want to hear just to sell you surgery. Yes, they will lie.

The bottom line here really is to know how to verify what you are told and NOT to believe everything you are told just because it comes from the MD office.

You should also get about 10 references for these doctors. Notice, I did not say you should get references FROM these doctors, I wrote to get them FOR these doctors. If you ask the office staff for 10 references you know full well they are going to give you patients that are thrilled to death and never had a problem. You need to find your own references. Go on various boards, find people that tend to be a bit quiet and shy. You see, there are a LOT of patient coordinators posing as patients on various message boards trying to recruit patients to their offices. There are not many doctors that use this method, but they are pretty easy to find. They invite each person to go to their doctor, only their doctor is the best, they cannot suggest anyone else in the whole wide world other than their doctor. Stay away from those folks. Find people that suggest several doctors, people that the majority of their posts are NOT about their doctor. Contact them and ask if you can talk to them on the phone.

There is a reason I suggest you talk to them on the phone. I recall when I was researching for my own surgery, one of the doctor's offices that I called I requested 10 references. They gave them to me and I contacted each one by email. All had wonderful things to say about the doctor. Real or fake? Fake. Upon looking at the IP address for all 10 references it was the same. It was the same person with 10 email addresses.

I'm telling you, the world of bariatrics is a cut throat business and you really can't be too careful. This IS your health, your life, and your future, take the time to do the legwork. Be paranoid, assume everything you are being told is a lie. Verify everything for yourself and take nobody at their word. These are businesses trying to survive in a bad economy, it's not just used car salesmen that are less than honest, it's many people and many businesses.

Does this mean every doctor will lie to you? Of course not, most will not lie. But the key here is that YOU do not know which are telling the truth and which are lying.

What about a death stat? What if a doctor has had a death? Does that mean he is a butcher that you should stay away from? Of course not. Not all deaths are the fault of the surgeon. Some people are *really* high risk and without surgery they will die. With surgery they are extremely high risk. What does a surgeon do? Refuse them a chance? Or take the chance?

Not all complications are the fault of the surgeon. A surgeon can give all the right pre op drugs to prevent blood clots but there is no promise that the body won't throw one anyway. Is that the fault of the surgeon or is that something that is sad but it happens?

What about leak stats? If a surgeon has had a leak does that make him a horrible surgeon? Not necessarily. Some leaks are the fault of the surgeon, some are the fault of the patient, and some are not the fault of anyone, they just happen. So what you are looking for are trends. Does this doctor have a ton of leaks? Higher than the average of less than 1%? There is a learning curve to every surgery type. Your doctor has to go through the learning curve just like everyone else. Make sure you are not his learning curve.

I will post an article on Researching Mexican LAP BAND surgeons as well as one on Researching Mexican SLEEVE surgeons. These articles will help you regardless if you are staying in the US and having surgery under insurance, self pay, OR if you are leaving the country for surgery.


Anonymous said...

What wonderful information. Thanks for taking the time to instruct us.

WASaBubbleButt said...

Thank you!

Anonymous said...

OMG, thank you so very much. This is the most information I have received that is non bias. I can not thank you enough. 3yrs ago I chickened out on my lapband surgery. Let people in my life talk me out of all WLS. Since then I have lost and gained even more again. I am now at over 50 bmi and am considering a DS. Again people are trying to discourage me, telling me all i have to do is eat right and exercise and that i just dont stick to it long enough. Last weight loss was my highest at loss of 60lbs, but gained back 80lbs. sure is frustrating! so, thanks again for all the info.

WASaBubbleButt said...

Please don't let people talk you out of WLS! Honest to goodness you get your life back!

DS is a good surgery type but you must stay on top of the supplements, it's not an option. For your BMI it's probably the one surgery that will get you where you want to be and stay there. Don't let others discourage you, go for it and get your life back!

Nickngraysmom said...

Thank-you so much! I am doing a lot of research before I start my wls journey. This has been very informative! Who was your doc? Did you love him? How did it go?

WASaBubbleButt said...

Nickngraysmom: I had Dr. Juan Arellano and Aceves. I had a great experience both times, once for a band and once for a revision to a sleeve. If you want to chat, let me know. I'll call you anytime and tell you anything you want to know.