This post repeats a lot of what I have posted on the Internet, outside of this blog. I’ve been meaning to add this here for a while. I’m not going to pretend I’m some kind of expert on any of this; it’s just based on what I have seen and experienced.
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Picking a doctor
There is no one miracle worker for every case out there. I wish with all my heart there was. It is best to consult with a LOT of doctors. Really spend a lot of time on this, travel if needed. It can take years, and be pretty horrible. Try to get a doctor referral, and consider using a surgery consultant.
Other patients’ experiences
I’d watch out for old photos or reviews, unless they showcase some big problem with the doctor and not just the procedure that day. Do the pictures on the doctor’s site ever change? Can you see a trend in the reviews?
Email other patients who have left reviews on Yelp, RateMDs, etc. http://messageboards.makemeheal.com/rhinoplasty/thomas-t125574-30.html#p1203059 If they had a bad experience, they might be reluctant to respond. If the reviewer or poster is an astroturfer, they may not respond at all. Several people have told me they suspect that some of the “concern trolls” (their term) who email them may be working for the doctors, especially if they ask about their surgery date.
The “new star” – all of a sudden, a doctor no one has heard of is suddenly having multiple glowing reviews all over. All their patients seem thrilled. I would say to wait at least a year, year and a half for the initial wave to calm down and see if any troubling patterns emerge. Just give it time and maybe you can get them during the sweet spot of their medical career. It is very easy to get excited about someone new who seems great, or even someone old who is suddenly getting lots of hype. I really hope you are luckier than I was.
Online reviews
I suggest you research reputation managers, doctoring the web, and astroturfing.
Check out this post by the late Dr. Frank Ryan (RIP):
http://dr-frank-ryan.blogspot.com/2009/12/truth-about-message-boards-and-plastic.html
I would take reviews from people in the early post-op period with a grain of salt, since swelling can hide a lot of things.
Also, watch out for the neg-poz-poz pattern: http://messageboards.makemeheal.com/rhinoplasty/are-the-reviews-ratemds-com-trusted-t136169.html#p1079005 , and for disappearing negative reviews and reviewers – they may have been legally threatened, sued, or offered a settlement with an attached gag order. Here’s a list a blogger compiled of doctors who sued patients: http://blog.ericgoldman.org/archives/2011/09/request_for_hel.htm
Disappearing positive reviews may also signal that there is some astroturfing happening if the review site is weeding out fake reviews, although this is controversial. Yelp.com seems to have a good, if a bit overly zealous filter from what I can tell. Their reviews seem the most accurate to me at this time. Check out this video about Yelp: http://www.youtube.com/watch?v=Dqi-jjbEKcs
General red flags
My experience on red flags and consent forms in other posts here may also be helpful to other patients with other doctors.
If the doctor is being disrespectful to you or other patients in the consult, do you think that doctor will improve after the surgery, especially if you have complications? The saying about how “only surgical skills matter, I don’t care about bedside manner” may not be true for every surgeon out there.
The office staff may give you some clues, too:
http://messageboards.makemeheal.com/rhinoplasty/have-found-possible-help-michigan-t139245.html#p1092843
http://messageboards.makemeheal.com/rhinoplasty/flipping-mad-insight-please-t149936.html#p1166919
Robyne on PlasticSurgerySpot wrote about this: http://www.plasticsurgeryspot.com/nose-surgery-primary-revision-rhinoplasty/1221-advice-best-rhinoplasty-surgeon-please-2.html
To me, one of the acid tests is, how does that doctor react when the patient is legitimately unhappy? http://messageboards.makemeheal.com/rhinoplasty/two-great-doctors-very-different-reasons-help-t153947.html#p1201905
Is it difficult to communicate with them? This can be a real problem down the road if you have complications and need help. Have you heard of botched patients who suddenly can’t get a return call or email?
Has there been a big change in attitude at any point? Did they go from nice to nasty, or vice versa, or have you heard that about them from other patients who had problems? http://messageboards.makemeheal.com/rhinoplasty/flipping-mad-insight-please-t149936.html#p1166885
I suggest you research confirmation bias in medicine.
Consent forms (hidden gag contracts)
http://messageboards.makemeheal.com/rhinoplasty/medical-gag-order-t141277.html
http://messageboards.makemeheal.com/rhinoplasty/beware-papers-you-sign-intellectual-property-t141260.html
Patients should keep an eye out for the word “copyright” in consent forms. In the examples posted online at MMH, the key phrase of this is located in the middle of a large paragraph. Ars Technica did an article on this topic: http://arstechnica.com/tech-policy/news/2011/05/all-your-reviews-are-belong-to-us-medical-justice-vs-patient-free-speech.ars A website has been set up to help patients understand these forms: http://doctoredreviews.com/
These types of forms have been called things like, “Mutual Agreement to Maintain Privacy”, so it is not like they have “GAG ORDER” printed on there. The copyright stuff is buried in the forms. Google the phrase 'mutual agreement...' and you can see some on doctors’ websites. If you can, request that their consent forms be mailed to you at the time you make the first appointment.
Residency programs
Check out which PS programs in the area may have residents rotating through. You may need to check BOTH the Plastic Surgery and Plastic Surgery-Integrated programs for EACH school nearby to see if your surgi-center might have residents rotating there:
http://www.acgme.org/adspublic/ <- click on “Accredited Programs” under “Search” to start. This can be tedious, but at least you’ll know whether a “private” clinic or surgi-center has residents.
Many of the best surgeons also train others. There seems to be no reliable way to find out if a particular surgeon is directing a fellowship with another doctor.
I wish you luck and I hope this post benefits other people.
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