Your internist has determined that you have cancer of the pancreas and has referred you to a surgeon. You visit the surgeon, who agrees with the diagnosis and suggests making arrangements for an operation at your local hospital.
Understandably, you would like to know whether the surgeon has carried out many operations for pancreatic cancer and how those patients have fared—but you are too embarrassed to ask such questions.
In October, the online version of the journal PLoS Medicine published a transcript of a debate held among medical professionals about this issue of differing skill levels among surgeons. Dr. Leonidas Koniaris, a cancer surgeon at the University of Miami School of Medicine, along with medical student Ms. Nadine Housri, argued that the initial surgeon you contact has an ethical obligation to tell you the name of at least one other surgeon who has considerably more experience operating on cancer of the pancreas.
Further along in this article, Dr. Robert J. Weil, a neurosurgeon at Cleveland Clinic, argued that a number of obstacles would prevent the first surgeon from comparing your surgical outcome at his hands with the results likely to be attained by a more experienced surgeon at another hospital. And last, bioethicist David I. Shalowitz held that it would be an unacceptable conflict of interest to expect surgeons and hospitals to provide information about other surgeons and medical centers.
What should you do, then, if your surgeon does not volunteer information about her own experience and that of other surgeons? Even if the risks of using your local surgeon may be higher, you still might not want to pursue the issue further if you prefer to be treated close to home, where it is easier for your family and friends to visit.
Otherwise, I urge you to make further inquiries. Practice may not always make perfect, but, as in many other endeavors, surgical performance does improve with greater experience. And a number of studies have confirmed that outcomes for cancer surgery and other surgical procedures are usually better at hospitals where they are performed more often. In addition to greater experience on the part of the surgeons, such hospitals also have greater expertise in other critical areas such as nursing, intensive care, and respiratory therapy.
Deciding on the best place to have surgery performed is not easy. Various Internet sources compare outcomes among different hospitals, but the data are difficult to interpret. Outcomes vary with the methods used at different sites, and surgical results also depend on the level of difficulty of the procedure—larger hospitals, for example, might have a higher percentage of more complicated cases.
I suggest that you first ask for this information from the surgeon to whom you were referred. Should that surgeon hesitate to provide the information you want, make an appointment for a second opinion from another surgeon.
And, although I readily admit that my long association with Johns Hopkins has prejudiced my views, I recommend that you visit at least one major medical center as close as possible to your home.
