Choosing a Surgeon
Choosing the right surgeon for you can make your weight loss journey a success. Your surgeon not only prepares you for and performs the actual weight loss surgery, but usually remains active in your care for months or years after surgery. Your surgeon should be highly qualified and have a personality that you can work with.
Where do you look to find possible surgeons?
- Your primary care doctor
- BariatricPal.com weight loss surgeon directory
- Lapband.com website, if you're looking into the lap-band
- Any friends, family members, work colleagues or other acquaintances who are bariatric surgery patients
- Online search engines
- Your healthcare plan may have a list of approved surgeons, and you might not have much choice of surgeons or facilities if your health care coverage includes your weight loss surgery
Weight loss surgery is likely to be safer and lead to better weight loss if your surgeon is highly qualified. In general, more experienced surgeons with more comprehensive post-surgery care programs are better choices. Asking the right questions can help you decide whether a surgeon is highly qualified.
The left column of the following table lists important questions to ask potential surgeons when you're trying to choose one. The right column explains the questions and the "right" answers.
|Do you work in a Center of Excellence?||The answer should be "yes." A Center of Excellence (COE) meets criteria that help ensure a high quality of care at that facility. The COE criteria are explained below on this page.|
|What board membership(s) do you have?||Surgeons should be certified by a major national organization, such as the American College of Surgeons (ACS), Royal College of Physicians and Surgeons of Canada (RCPSC), American Osteopathic Board of Surgery (AOBS) or American Society of General Surgeons (ASGS).|
|What kind of ongoing education and certifications do you maintain?||Surgeons should regularly participate in training programs and other educational opportunities to stay current. Advances in bariatric surgery can make it safer and more effective, and you want your surgeon to know the latest techniques.|
|Do you have a formal bariatric patient support program that starts before surgery and continues for years after surgery?||The answer should be "yes," and it should include surgeon appointments, nutritional counseling, access to a mental health professional and support group meetings. Surgery itself is only part of your journey; your pre-surgery preparation and post-surgery follow-up are just as important in your success.|
|How much experience do you have with bariatric surgery in general and the specific type of weight loss surgery that I'm interested in? How many bariatric surgeries have you performed, and how many procedures do you perform in an average month?||Your surgeon should focus on bariatric surgery, and ideally on the specific type of weight loss surgery that you're interested in. More experienced surgeons tend to have lower complication rates and better weight loss. Most people recommend choosing a surgeon with at least 100 bariatric surgeries. That's not a requirement, though, and having fewer 100 surgeries can be okay if the surgeon has good training and good patient recommendations.|
|Do you primarily do bariatric surgeries?||The answer should be "yes." You want your surgeon to be focused on obesity treatment, not on other conditions. The majority of your surgeon's surgeries should be weight loss surgeries.|
|Is your facility (clinic or department) dedicated to bariatric patients?||The answer should be "yes." These facilities have more amenities for obese patients and staff are trained specifically for them. You are likely to get better care when the facility is dedicated to obese patients.|
|How do you choose which procedure to perform on a patient?||Your surgeon should consider your personal needs and your risk factors. The choice of surgery should be a joint decision between you and your surgeon.|
|What is the average weight loss of your bariatric patients after a year and after five years?||Your surgeon's patients' average weight loss should be consistent with the numbers you've seen for each type of weight loss surgery. Ask about the five or ten-year numbers to make sure that your surgeon's patients have good long-term results and that your surgeon continues follow-up care and contact long-term.|
|How long is the average hospital stay? What percent of patients need to have second surgeries?||You want the answers to be on the low end. Shorter hospital stays and fewer second surgeries are the result of lower complication rates.|
|What percent of your patients are not hitting their weight loss goals? Why does that happen? What do you do when a patient's weight loss is not on track?||The majority of patients should be hitting their goals. Failure to hit weight loss goals should be for reasons outside of the surgeon's control, such as lack of patient compliance with the diet. If the surgeon doesn't know why patients are unsuccessful, you might suspect that it's because of poor surgical procedures. Patients whose weight loss is not on track should be offered extra help with diet. Psychological counseling can also help with behavioral issues.|
You and your surgeon are a partnership, and you need to be able to work together. Think about whether you can see yourself working long-term with each potential surgeon that you consider for your surgery. You're going to be working with your surgeon before and after surgery, and you'll get the best results if you respect and trust your surgeon.
Two-way communication is important. You need to feel comfortable asking your surgeon questions; your surgeon needs to be able to answer your questions in terms you can understand. You need to be able to express your concerns to your surgeon; your surgeon needs to be able to reassure you.
Center of Excellence in Metabolic and Bariatric Surgery (COEMBS)
The Center of Excellence in Metabolic and Bariatric Surgery (COEMBS) program can provide further help when you're choosing a bariatric surgery surgeon, program and facility. The program is offered by the American Society of Metabolic and Bariatric Surgeons (ASMBS) and the Surgical Review Corporation.1 It's designed to promote high-quality care and better patient outcomes.
Any surgeon or facility can achieve COEMBS by meeting certain criteria relating to:
- Surgeon, nurse and support staff experience with bariatric patients
- Appropriate equipment for obese patients
- A comprehensive follow-up program including support groups
- A high volume of bariatric surgeries
- Contributing to the BOLD outcomes database, which is a collection of information on weight loss surgery outcomes
Looking for the COEMBS designation when choosing a surgeon or facility for your weight loss surgery can improve the care you get. The COEMBS designation can be especially helpful when you are going abroad for your surgery and you won't be able to meet the surgeon or tour the facility in person before making your decision.
COEMBS Overview. Surgical Review Corporation. web site.
http://www.surgicalreview.org/coembs/overview/. Accessed February 27, 2013.
Choosing a Facility: Location
Your surgeon's facility also affects your choice of surgeons. Usually, a nearby facility is best. You will need to travel to the facility not only for surgery, but also at least once before surgery for your pre-surgery appointment(s) and tests and multiple times for follow-up appointments and tests. Your support group meetings may be at your surgeon's clinic, too. All of these trips are easier if the hospital is close to home.
The exception is if you are getting your surgery done in another country. In that case, your postoperative care program will take place at a different location than your surgery location. Your postoperative care program should be based near your home.