When it comes to undergoing surgery that’s going to last your lifetime, it’s important to make sure you select your surgeon based on their ability to do the best job for you. We recommend that you do your own homework in finding the most appropriate surgeon for you. Location is important, so if you live in London, how to find London’s best ankle surgeon might be the question on your mind. Equally if you live in Manchester, you would like to find a specialist in Manchester, as for most problems you will not want to travel long distances.
How to find the UK’s best foot and ankle surgeon
Now, of course, personal recommendation by a friend or family member is a great way for you to find a good surgeon. But as you will see from this article, should only form part of your search. Here are some top tips of how you should go about finding the specialist for you whether its a London Ankle Surgeon or a Gynaecologist in Gloucestershire.
Speak to your GP
In the UK, general practitioners or GP’s are the first port of call for any medical problem. In many cases, your GP will have looked after you or your family for a long time and they know you well.
All patients that have seen a specialist come back to the GP eventually. Therefore the GP tends to form their own mini TripAdvisor for health and are an excellent place to start.
If you are being referred on the NHS, you may have less choice as to whom you can see. This is largely because primary care Trusts now have contracts with certain hospital providers, and so you are likely to be referred within contract to your local hospital. There is however the NHS e-Referral Service, which replaced Choose and Book in June 2015 and gives you some choice as to whom you can see.
In many cases, the NHS will refer you to a local musculoskeletal triage service. This is filter to reduce the number of referrals to specialists. This can be useful if you have a common minor ailment such as low back pain. Unfortunately, it can delay referral when conditions are complex such as ankle arthritis or in the presence of deformity.
Even if your GP doesn’t know a specific specialist for your problem, they are good sounding boards for your research.
If you are seeking a private appointment you are likely to also need a GP referral in order to obtain an appointment with a specialist.
Search the Internet
Internet sites can help you find surgeons, but beware of search engines alone. Some of the adverts on Google and other sites are paid for and so it’s important that you read patient reviews on the surgeon and try and find out as much independent information as you can from the web. Chat rooms can be helpful, where patients make personal recommendations based on their own outcome. In addition, if there are several recommendations rather than just one, that is likely to be a more reliable source. Google is clever so if you search London ankle surgeon you may get the same results as searching ankle surgeon London.
Check the surgeon’s credentials
Read the surgeon’s biography. Have they obtained all the appropriate qualifications? In orthopaedic surgery surgeons should have a basic medical qualification such as MBBS, then an orthopaedic Board certification which is known as FRCS(Orth) or FRCS (Tr&Orth) in the United Kingdom. Other surgeons may have an MD, which in the UK is a higher research degree as is a PhD.
Podiatric surgeons are not medically qualified but some work as part of an established orthopaedic network. In this guise, they are very suitable to perform forefoot surgery up to the midfoot providing appropriate governance is in place. Do not be afraid to obtain details of their governance structure and feel free to check a surgeons credentials with the British Orthopaedic Foot & Ankle Society (BOFAS).
You can also check a surgeon’s qualifications on the regulator of doctors, the General Medical Council’s (GMC) website.
Questions to ask your foot and ankle surgeon
It’s always good to have a list of questions to ask your surgeon. Some of these are general questions to ensure you are undergoing the correct procedure and others relate to them being the best person for the job.
It is important to have confidence in the doctor who will be doing your surgery. Whether this is someone you have chosen yourself or a doctor or surgeon you have been referred to, you can make sure that he or she is qualified. This may include any or all of the following:
How many of these operations do you perform a year?
Some operations are uncommon and your surgeon will tell you if this is the case, in which case they will not be expected to perform many of those operations per year. Other operations are more common and although there is no minimum guidelines for the number of procedures a surgeon should perform, where a surgeon does not have a lot of experience, they may choose to refer you to a relevant colleague.
There are a lot of national audits such as the UK National Joint Registry that are worth checking for data. Nowadays most appraisal processes for surgeons involve a review of national audit data as standard so that information should be at hand to you. You may also ask your surgeon about his or her record of successes, as well as complications.
Should I seek a second opinion?
In certain cases, such as complex problems, or revision surgery, you can never have enough opinions and a good specialist would be very happy to recommend another surgeon for you to have a second opinion. Be cautious if they try to talk you out of seeing someone else.
What is the operation being recommended?
A good surgeon will explain the procedure in simple terms that are easy to understand. If not then ask questions until you fully understand.
Is there an alternative to this operation?
Ask if there is an alternative to the surgery being recommended. If your doctor favours one treatment over another do of course ask why and feel free to ask questions about other treatments that you have read about.
Why do you need the procedure?
Reasons to have surgery vary from treating pain, or improving function. It is important that you explain your expectations at the outset, so that your doctor can tell you whether they will or will not be met.
What are the possible risks and complications of surgery?
Surgery always carries some risks, so it is important to weigh the benefits against the risks of surgery.
What happens if I decide not to have the operation?
Before surgery is tried many non-surgical treatments should be considered, such as weight loss, activity modification, pain killers and support braces. Have these been tried and failed?
If you decide, after weighing the benefits and risks, not to have the surgery, what will happen? Could it resolve by itself? Will it worsen? If so what are the implications of that?
What type of anaesthetic will I have?
Your surgeon will discuss the different types of anaesthetic including local, regional, or general anaesthesia. Find out about how your pain will be controlled after the surgery. Prior to the surgery you will have the opportunity of meeting and discussing this with the anaesthetist.
What will my schedule of follow up visits be?
Ask whether you will be seen after the surgery for a wound check and removal of stitches and what the schedule will be thereafter. For most complex foot and ankle procedures you will be seen at 2, 6 and sometimes 12 weeks after the procedure. For certain types of problem, longer term follow up is standard.
Will I need any additional drugs or equipment?
The National Institute of Healthcare & Clinical Excellence (NICE) has set guidance on the use of treatments to reduce the risk of blood clots. Your surgeon will need to risk assess you and discuss the correct options for your case depending on whether you will be immobilised after the surgery.
It is important that you understand this before the surgery so you can plan, both the logistics of how this will be administered as well as whether or not the costs will be covered by your insurer.
You may also need crutches, a special boot or ankle brace and changes of plaster cast. It is important you fully understand these costs before beginning and also checking with your health insurer what they will and will not cover. Knowing this information in advance will help you recover better without the stress.
What are the costs of this operation?
Similarly, it is important to fully understand the costs of the surgery before you begin. In the public sector, this is not relevant as in the UK there is a National Health Service (NHS) free at the point of treatment. In the private or independent sector it is essential you are fully aware of all costs before you begin. The costs include the surgeon’s fee, the anaesthetist’s fee, the hospital charges and any additional drugs or equipment if you require them. In addition, costs may include any follow-up appointments that you require, and whether or not you need to change your dressings, plaster cast or various aids such as walking boots or braces.
Some hospitals will do package costs which include all charges. In others, it is essential you are fully aware of what sort of costs you may be liable for before beginning.
How do I find a surgeon
This article was written by Mr Andrew Goldberg, Consultant Orthopaedic Foot & Ankle Surgeon in London at the London Ankle & Arthritis Centre, a specialist centre which has world renowned expertise. Please contact +44(0) 207 042 1828 if you would like to make an appointment face to face or virtual consultation for a specialist opinion.
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