There was a recent paper published in the Archives of Surgery by a group from Dartmouth Medical School that asked the important question, “Who chooses where you have major surgery?” The answer may or may not be surprising, depending on one’s “consumerism” the authors concluded. It turns out that 31 percent of patients said their doctor made the choice; 22 percent said they alone made the choice; 42 percent said it was a team effort between the patient and doctor; and 5 percent said others like family made the choice. Men, patients in poor general condition, and patients who are acutely ill tended to rely more on their physician to make the decision. It is important to know who chooses where you have major surgery because results differ by surgeon and by hospital for an identical operation. Patients wanting the best possible outcome should choose the surgeon and hospital where results are the best. Interestingly, in a national phone survey of Medicare recipients, only about a third of patients decided for themselves. What they based their opinion on is not known, nor is it known what decision makers based their recommendations on. However, increasing amounts of information is being published that can help patients, families and doctors decide where to have elective surgery. Medicare or CMS is making information available to help patients select hospitals. Because Medicare is the preferred insurer for most elderly patients, having this information available is an important component of healthy aging. The data that CMS makes available is not surgeon specific, but it is hospital specific in many outcome domains. Following are a few Web sites that offer hospital and doctor performance outcomes: Questions that need to be asked by patients considering surgery are:
- Is the surgeon board certified or has the surgeon received special training in the procedure to be performed?
- Is the hospital accredited?
- How many similar operations has the surgeon done and how many are done each year at the selected hospital?
- What results are obtained with regard to major complications and death?
Some of these questions can be obtained from sites listed in the table. If the answers found on the Internet differ from what has been reported by someone referring you to a surgeon or hospital, be careful. As we continue to enter the “information age,” it is increasingly important — in the interest of healthy aging — to demand answers to important questions. The wealth of available data about hospital performance will increase dramatically, and patients and doctors should use it when deciding where to go for surgery. | 
