How can you tell if a surgeon is good?

[alprazoslam]

---

Members don't see this ad.

As stated above there's a fair bit of variance. If we whack out a big mass in the neck and throw some soft tissue up there sure we can be done in sub 8 hours. If we end up doing bony work with a difficult inset it can take 16 or 24 or whatever. At our county hospital there's a lot more vasculopaths and bombed out necks than at the mothership. I do think most of our H+N guys at main campus are better but I dont think it's an apples to apples comparison and going by timeline you'd be judging the wrong things. At the county hospital also we have inconsistent scrubs so whereas at main campus all the equipment is set and the circulator knows exactly what positioning needs are, our head and neck anesthesiologist gets them under fast and keeps them down, we waste a ton of time at county because we are missing 30 pieces of equipment every case, we dont roll into the room until 30 mins past start time, the scrub is trying to hand you some crazy ass instrument from like an ortho tray, and the patient is getting off the table half the case cuz anesthesia sucks. It all adds up. It's not that the surgeon is terrible.

Also at the county hospital residents have greater autonomy. Yes, it takes me probably an hour longer than my attendings to do a neck dissection. Probably 30 mins longer to isolate vessels for anastamosis. I screw up a lot more often. But I can do a case skin to skin at county vs at main Im just doing parts with the attending guiding everything so it's substantially faster.

So again, you may have a lot of experience but you really dont have a grasp of subtleties. It's not a knock on anesthesia itself, just that it's not possible for someone outside the field to really understand.

how much do crna suck vs anesthesiologists

 

[Wordead]

none of those are subtleties. no one is judging from one surgery or from one experience. and no one is saying we are 100% absolutely certain about a surgeon sucking. i would argue that some of what you mentioned reminds me of a surgeon mentality that i often hear. "my patients are sicker", "i take more complicated cases" , 'my equipment sucks'. as if those things do not happen in other hospitals.

not having equipments causing delay in starting the case doesnt even count since thats not surgical time.

and i was just using flaps as an example. maybe it wasn't the best example since its a complicated surgery. but the point is anesthesiologists often have a pretty good idea of which surgeon sucks because they are in the OR way more than any of you, and they work with every surgeon and they are also MD so they aren't as dumb as surgeons think they are. you can use your subtleties argument in a n=1 scenario but when the n is large, and a surgeon tries to justify their crappiness with their patients are super sick and complicated and the equipment sucks, most of the time i call BS

Im not comparing my results so Im not sure why I'd be biased. I don't care if one attending is better than another. I see cases between different hospitals and patients are sicker at the county hospital than the main where most are insured wealthier population. I also don't understand why you think this is an attack on anesthesia and that I'm calling you guys dumb; that's not the case at all. I respect the good anesthesiologists. But if you're saying that an anesthesiologist fully grasps every ****ing surgery known to man since you guys rotate through cardiac, transplant, ENT, neuro, etc etc then I don't know what to tell you. Let's be real. Never in the history of a free flap has an anesthesia frontliner been present for the entire case. Usually at least 2-3 different people rotate through not taking into account the various breaks and lunches and whatnot.

how much do crna suck vs anesthesiologists

Theres good and bad of both. I dont see as big of a difference as you'd hope honestly.

 

[anbuitachi]

Im not comparing my results so Im not sure why I'd be biased. I don't care if one attending is better than another. I see cases between different hospitals and patients are sicker at the county hospital than the main where most are insured wealthier population. I also don't understand why you think this is an attack on anesthesia and that I'm calling you guys dumb; that's not the case at all. I respect the good anesthesiologists. But if you're saying that an anesthesiologist fully grasps every ****ing surgery known to man since you guys rotate through cardiac, transplant, ENT, neuro, etc etc then I don't know what to tell you. Let's be real. Never in the history of a free flap has an anesthesia frontliner been present for the entire case. Usually at least 2-3 different people rotate through not taking into account the various breaks and lunches and whatnot.



Theres good and bad of both. I dont see as big of a difference as you'd hope honestly.

that is fine but the point isn't that anesthesiologists understand every aspect of every surgery known to man. thats not the point... not sure why that is constantly brought up. the point is how good anesthesiologists are at determining which surgeon sucks. im not talking about 1 surgeon taking 20 minutes longer than another in a flap. what i am saying is if anesthesiologist says a surgeon sucks, then probably the surgeon sucks. for those surgeons not mentioned as being bad, it doesn't mean they arent bad. it doesnt take much knowledge about your field for anthother MD to see who probably sucks

same with anesthesiology. surgeons dont know the details of anesthesia either and that's expected. but if you routinely get one anesthesiologist which has a mucher higher N of patient bucking during surgery than other anesthesiologists, perhaps that one sucks. yes there are a lot more details, but if you have a good sample size, a lot of the others possibilities can be excluded.

 

[Wordead]

that is fine but the point isn't that anesthesiologists understand every aspect of every surgery known to man. thats not the point... not sure why that is constantly brought up. the point is how good anesthesiologists are at determining which surgeon sucks. im not talking about 1 surgeon taking 20 minutes longer than another in a flap. what i am saying is if anesthesiologist says a surgeon sucks, then probably the surgeon sucks. for those surgeons not mentioned as being bad, it doesn't mean they arent bad. it doesnt take much knowledge about your field for anthother MD to see who probably sucks

same with anesthesiology. surgeons dont know the details of anesthesia either and that's expected. but if you routinely get one anesthesiologist which has a mucher higher N of patient bucking during surgery than other anesthesiologists, perhaps that one sucks. yes there are a lot more details, but if you have a good sample size, a lot of the others possibilities can be excluded.

I guess fundamentally you are addressing "can anesthesia tell if someone really sucks" whereas I'm addressing "can anesthesia tell if someone is good" which are different. We probably aren't disagreeing all that much.

 

[nimbus]

Everyone who works in the OR can tell you which surgeon has more bringbacks for bleeding and infection. And the surgeon who somehow ends up with all the “really hard” (their words) gallbladders that take 2-3 hrs with blood and bile spilling everywhere even though the other surgeons mostly get routine ones that take 20-30min. Some surgeons are slow because they should probably be doing something else. Same for anesthesiologists. We had one a while back who could sometimes have an Aline in the patient by the time the neurosurgeon was finished evacuating the subdural.