Selecting a Neurosurgeon, Part 2

• Investigating the background of your neurosurgeons
• Referrals
• Interviewing the neurosurgeon
• Relocating and finding new neurosurgeons

Investigating the background of your neurosurgeons

Commercial resources

Print resources

• AMA Directory of Physicians in the United States (35th Edition). This four-volume set lists all physicians practicing in the United States, Puerto Rico, the Virgin Islands, and certain islands in the Pacific, or who are temporarily located in foreign countries. The books include listi ngs for both members and nonmembers of the AMA.

  Volume one is an alphabetical listing of physicians by last name. Each listing includes the city and state, and the name of the foreign country where the doctor is located (if applicable).

  Volumes two through four are broken down by geographical area. Volume two contains listings for phys icians who are providing care under federal services--either working for the Veterans Administration (VA) or as a military doctor--and those located in the states of Alabama through Illinois. Volume t hree lists physicians in Indiana through New York, while volume four contains listings for North Car olina through Wyoming and those who are in temporary foreign locations.

  The listings in volumes two through four provide more detailed information than can be found in volu me one. Physicians are listed alphabetically by last name according to the city and state in which t hey are located. Each listing also includes the following information:

  • Primary mailing address for the doctor's practice.
  • Medical school code and year of graduation.
  • The year the doctor obtained his license to perform medicine in that state.
  • Designation of his primary and secondary medical specialty.
  • Type of practice.
  • American Specialty Board Certification code.
  • Listing of any physicians' recognition awards.

    For example, a listing for a neurosurgeon in the AMA Directory of Physicians might be as foll ows:
    DOE, Jane M. 321 ANYPLACE DR. 98227 #026-08-78 L85 NS *20 ?25

  All of the information to decipher the codes that make up the physicians' listing in the AMA Dire ctory can be found in the front of each volume. In the above example, the code #026-08-78 indica tes that this particular physician graduated from Mayo Medical School in Rochester, Minnesota, in 19 78 (026 is the state identifier; 08 is the code for the medical school; 78 is the year of graduation ). L85 means that Dr. Doe received her license in Washington state in 1985. The designator NS means that she is a licensed neurosurgeon. *20 indicates that her type of practice is direct patient care, while the ?25 indicates that she is certified with the American Board of Neurological Surgeons.

• The Official ABMS Directory of Board Certified Medical Specialists. Published annually by the American Board of Medical Specialists, the ABMS Directory is a four-volume s et that lists all board certified medical specialists in the United States. The section on neurologi cal surgeons can be found in volume two (beginning on page 3,673 in the 1998, 30th edition). The ABMS Directory lists the qualifications of each doctor and describes the process that a neurosur geon must go through to become board certified.

  All practicing neurosurgeons who are certified by the ABMS are listed in this book alphabetically by city and state. Information in each listing includes:

  • Year of board certification (or recertification).
  • The doctor's birth date or year, and where he was born.
  • Medical school.
  • Place of internship, residency, and fellowships.
  • Current and past hospital appointments.
  • Academic appointments.
  • Professional organizations the neurosurgeon is a member of.
  • Type of practice.
  • Contact information, including mailing address, and phone and fax numbers if available.

    A sample listing for a neurosurgeon in the ABMS Directory could be:
    DOE, Jane M. Cert NS 85. b 08-30-45 Dearborn MI. MD NYU Sch Med 70. Int 70-71 (U Minn Minneapolis MN) Res NeurS 7 5-79 (Mass Gen Hosp) Fell NeurS 80-81 (Stanford U). Cur Hosp Appt (U Hosp-U Calif, San Francisco, CA). AANS - AMA - CNS - ASA - ACS. U Calif Med Ctr Dep t NS 94143 (415) 555-0000.

  In this example, Dr. Doe received her board certification as a neurosurgeon (Cert NS) in 1985; she w as born in Dearborn, Michigan, August 30, 1945. She received her M.D. from the New York University S chool of Medicine in 1970; interned from 1970-1971 at the University of Minnesota in Minneapolis; wa s a neurosurgical resident at Massachusetts General Hospital from 1975-1979. She also had a neurosur gery fellowship at Stanford University from 1980-1981. Dr. Doe is currently associated with the Univ ersity Hospital at the University of California, San Francisco, and is a member of five different pr ofessional organizations. Her mailing address and telephone number are listed last.

  Some of the more common professional organizations that you will find in a neurosurgeon's listing ar e:

  • American Association of Neurological Surgeons (AANS).
  • American College of Surgeons (ACS).
  • American Medical Association (AMA).
  • American Surgical Association (ASA).
  • Canadian Medical Association (CMA).
  • Congress of Neurological Surgeons (CNS).

• 16,638 Questionable Doctors (and state editions). Public Citizen: Health Rese arch Group, founded by Ralph Nader in 1971, publishes a three-volume set of books which lists doctor s who have been disciplined by state or federal agencies for incompetence, negligence, substance abu se, patient abuse, or the misprescription of prescription drugs. The title of the 1998 edition is 16,638 Questionable Doctors. They also publish state editions of Questionable Doctors. C heck the reference section of your library for the latest edition or call (202) 588-1000 to order. P CHRG can also be contacted by email at public_citizen@citizen.org, or through their web site at www.citizen.org.

Online resources

• American Association of Neurological Surgeons (AANS). The AANS web site has a search able directory of neurosurgeons available at server400.aans.org/FindaNeurosurgeon. Here you can search by area code, last name of the neurosurgeon, city and state, or by country (for locating neurosurgeons outside the United States). When you click on the "Search" button, you will b e taken to another page that lists the name, phone number, and address for the neurosurgeons that ma tch your search criteria.

• American Medical Association (AMA). The AMA' s Web site offers a greater amount of d etail than the AANS site. If you go to the AMA homepage (www.ama-assn.org/), click on the "Do ctor Finder" link to the physician search page.

  Once at the search page, you can either enter the name of the physician you are trying to find more information about, or enter your city and state for a list of physicians in your area. For example, if you enter your city and state and click "Neurological Surgery" for the medical specialty, the sea rch results page will list all of the neurosurgeons in your city. If you click on the link for the n ame of the neurosurgeon, you will be taken to another page that lists the following information:

  • Address and phone number for the neurosurgeon's office, including a link to a location map.
  • Neurosurgeon's gender.
  • Year and name of the medical school the doctor graduated from.
  • Listing of where the doctor performed his medical residency training.
  • Primary and secondary practice specialties.
  • Major professional activity, i.e., type of practice.
  • Board certification confirmed (this should say "Yes" next to it; if it says "No," you should look for a different neurosurgeon).

National Practitioner Data Bank

Referrals

Physician referrals

The neurosurgeon our family doctor referred us to was a real problem. This guy had no personality, and wasn't interested in fielding questions from us about how many patients he's treated with hydrocephalus. We knew after a few short minutes we were in the wrong doctor's office, so we thanked him for his time and left--and never returned.

When we got home, we called our family doctor and relayed our experience with the first neurosurgeon to her. She apologized (though we weren't blaming her for anything), and said that she'd do a more thorough check before giving us the name of another.

After a few days, she called us and gave us the name of another neurosurgeon. But instead of just gi ving us the name and number, our doctor told us that she had interviewed three neurosurgeons in our area, looked into their background, and found out which hospitals they worked out of. In her opinion , this neurosurgeon was the best of the three. Needless to say, we were impressed. We trusted her op inion, even more this time since she'd taken the time to find the right doctor for Amy.

Insurance provider/HMO referrals

Your insurance provider has a business relationship with the neurosurgeons it covers. All physicians covered by a medical insurance company or an HMO have been screened to ensure their quality and cre dentials meet the guidelines of the plan. By contacting your insurance provider's customer service c enter, you can also ask some preliminary questions about the neurosurgeon, such as:

• Do you know if this neurosurgeon treats patients with hydrocephalus? If so, do you k now how many patients are under her care?
• Does the neurosurgeon have more than one location for her practice?
• Which hospitals does she have admitting privileges for?
• How long has this neurosurgeon been covered by your insurance?
• Have you had any patient complaints against this doctor?

It is also a good idea to ask your insurance provider or HMO if it provides coverage for neurosurgeo ns who are located out of your plan area, and what its terms are for seeing a physician outside the plan. This is particularly important if you want to see a neurosurgeon at a university medical cente r.

Word-of-mouth referrals

While sitting in the waiting room at the neurosurgeon's office, I noticed another mom sitting across from me with her son. His head was partially shaved, and he had a fairly large scar at the top of h is head. This was only our second time to see this neurosurgeon, and we still weren't sure whether w e liked him or not. I asked the mother if her son had hydrocephalus, and she said yes. When I asked her what she thought about the neurosurgeon, her face lit up, and she went on and on about how wonde rful he was with her son. That pretty much sealed the deal for us.

• How long have you been seeing this neurosurgeon?
• Did he diagnose your condition (or shunt malfunction/infection) promptly and accurat ely?
• Do you feel comfortable talking with this neurosurgeon about problems you are experi encing?
• Does this neurosurgeon communicate well with you and with other members of your fami ly?
• Do you feel the neurosurgeon shares information with you openly and honestly?
• How does this neurosurgeon relate to children? (If applicable.)
• How does your child like this neurosurgeon? (If applicable.)
• Does he believe your concerns and answer your questions in a manner that you find ac ceptable?
• Has this neurosurgeon ever operated on you? If not, what is your relationship as a p atient with this neurosurgeon? If so, when was the last operation performed, and what was it?
• How many times has this neurosurgeon operated on you? Did you feel the operation was necessary? Did the neurosurgeon attempt to treat the problem by another means prior to opting for s urgery?
• Do you know other patients who see this neurosurgeon? If so, what are their opinions of him?

I advise a person to contact Best Doctors, the American Medical Association (AMA), or simply do some calling around. If the office secretary is unable to provide you with some simple facts, etc., then see if you can get an appointment for an interview of sorts. Some doctors have no problem with doin g this. An excellent way of getting a referral is to go to the neurosurgical ward/floor of a hospita l or medical center and speak with the head nurses (or neurosurgical nurses) to see who they would r ecommend. (This is an excellent way to find a neurosurgeon as the nurses really know who is the best surgeon, if he cares, if he deals only with children, etc.)

Interviewing the neurosurgeon

Whether you have an existing relationship with a neurosurgeon or are a new patient, it is always goo d to know who you are dealing with. Often, your neurosurgeon will know far more about you than you k now about her. If you are going to see the neurosurgeon for the first time, there are some very simp le questions you could ask to help you get to know her better.

Before you start asking questions, ask your neurosurgeon if she has time to answer them, or if she w ould prefer you schedule another appointment when you could come back to talk with her. Neurosurgeon s are often short on time and book appointments close together on days they are seeing patients in t heir office. If the sole purpose of your visit is to ask questions, let your neurosurgeon's receptio nist know that your visit is for a consultation and that you have some questions you would like to a sk. The receptionist might try to get you to ask her the questions, but be persistent on scheduling an appointment with the neurosurgeon. After all, if you need surgery, the receptionist won't be the person performing the operation.

Once you have an appointment with your neurosurgeon, it is a good idea to make a list of questions t hat you want to ask. Possible questions are:

• Where did you go to medical school?
• Where did you perform your internship and residency?
• What are your research interests?
• Do you specialize in any other form of surgery (i.e., vascular surgery)?
• Are you board certified?
• Which professional medical organizations are you a member of?
• How many years have you been a practicing, licensed neurosurgeon in this state/province?
• How many patients under your direct care have hydrocephalus?
• How many shunt placements/revisions have you: Assisted on? Performed?
• How many shunt operations have you performed: In the last year? In your career?
• When was the last time you placed or revised a shunt?
• Which hospital or hospitals in this area do you have admitting privileges for?
• Are you familiar with the third ventriculostomy procedure? If so, have you ever performed one? Was it successful?

If a neurosurgeon performs very few shunt operations in a year (less than ten or twenty), you might want to look for another neurosurgeon. You need to have a neurosurgeon whose shunt placement and rev ision skills are up to date. For some neurosurgeons, particularly pediatric neurosurgeons, it's not uncommon for them to perform fifty or more shunt operations per year.

Knowing how many patients with hydrocephalus your neurosurgeon has under her care is also important. Some neurosurgeons would rather focus on treating conditions of the brain other than hydrocephalus. If the neurosurgeon indicates that she doesn't treat many hydrocephalus cases in a year, ask her if she could recommend another neurosurgeon in the area who does.

You can also find out many facts about a neurosurgeon before you go in for an interview--including e ducation, certification, and pending legal actions.

Relocating and finding new neurosurgeons

The first person you could ask would be your present neurosurgeon. The neurosurgery community is fai rly tight-knit, and it's possible that either he or another neurosurgeon he knows may know of someon e in the area where you are relocating.

In preparing for a move from Washington state down to California, we asked my wife's neurosurgeon at the University of Washington if he could recommend a neurosurgeon in northern California. As it tur ned out, one of his colleagues had just accepted a position in the neurosurgery department at the Un iversity of California, San Francisco, so he gave us his phone number and email address. He also hel ped transfer her records down to the new neurosurgeon as soon as we had made an appointment.

Next, you will need to call each of the neurosurgeon candidates to schedule appointments. When you c all to make the appointment, be clear with the receptionist that you are new to the area and that th e purpose of your visit is for consultation purposes only. If possible, try to see all candidates on consecutive days. That way, your medical records and films can be transferred from one to the next, allowing the new neurosurgeon to have enough time to review them. Scheduling the appointments a day apart also helps you keep your impression of them fresh in your mind, and makes it easier for you t o make your final decision of who will be your neurosurgeon.

When we relocated to a new city, I had a terrible time trying to find a new neurosurgeon. I was told by my previous neurosurgeon to locate a new one as soon as possible. He said the main reason for do ing this would be so he could transfer my records and MRIs so the new neurosurgeon would be up to da te on my case history. I tried to schedule a consultation visit with a new neurosurgeon, but it took over a month to get the appointment. On the morning of the appointment, the new neurosurgeon's off ice called to tell me that they had not received my medical records or MRIs yet and asked me to trac k them down. When I phoned my previous neurosurgeon's office, they informed me that the doctor I was about to see had never requested any records or films! Luckily, I had copies of my records with me, so I just brought those to the appointment.

When I got to my appointment, the neurosurgeon's receptionist was rude with me, and so was the neuro surgeon. Talk about making a bad first impression. And to make matters worse, the neurosurgeon actua lly had the gall to ask me what I was doing there. When I told him that I had just moved to the area from out of state and that I wanted to establish a rapport with a new neurosurgeon in the area, he went off on a tangent about only being available to his family "twenty-four hours a day, seven days a week, and not to patients." All I was looking for was to have a neurosurgeon who would know my cas e history in case of an emergency, not someone I could call every time I had a headache! He must hav e thought I was a hypochondriac or something, but I can tell you, I'm never seeing him again or reco mmending him to anyone else.