When would you worry about doctor and office?

on 3/7/23 8:39 pm, edited 3/9/23 5:37 am

Hello, I want to get the gastric bypass surgery. I've visited with 3 surgeons so far and the each kinda had their own issues.

The first was very cavalier and that spooked me. The second was nice but he used old research to justify the surgery and that kinda worried me. Plus he never responded to things he wanted me to do and alert him about via Mychart. That to me spoke to what I could expect post surgery. The next fellow was in the same practice but he's very disorganized. Many people have raved about him as a provider/surgeon. But to me while he does give me a sense of ease. His office is very disorganized. They told me to contact this one secretary but she then never answers the emails I was told to send her. I'm then told to email the administrative assistant but it takes days to get a response and then when I do response to her response usually I get nowhere. I have tried to call but it just rings. They mentioned email is best. I need a lot of visits with the doctor to qualify for surgery. Due to this I thought we'd have a lot of time to discuss my concerns. But each time I go in or have a video visit the sessions are mostly without the doctor. Either it's the Nurse practitioner who is very nice or the weigh-in RN. Everything is just kinda jumbled and it's scary.

Some things that concern me are that the practice has no requirements for me to diet or lose weight before surgery. I just can't gain weight. The doctor sometimes mixes up the surgery we decided on. He'll say sleeve all while we decided the rny is best for me. He seems to really rely a lot on the staff to do the organizing and stuff which is fine but it's still his job to know this stuff. They also have me planned to see a nutritionist but not until we are a few months in.

My sibling is in a program and the interactions he has are very different. He had to lose weight, had to attend many seminars and had to see a nutritionist many times.

I'm told the difference is that I'm in a big city and my sibling is not.

What do you folks think?

on 3/9/23 10:52 am - CA

It is important to be comfortable with your surgeon and their practice, as you will be (or should be) dealing with them quite a bit these next couple of years, and ideally, forever if they provide the kind of continuing follow up that is very helpful for long term success, particularly with a malabsorbing procedure like the RNY or DS. You will probably have numerous appointments pre-op, and then several during your post op weight loss phase, and the better practice will follow their patients annually forever (this is a very useful thing over time, as questions come up that you or your PCP can't answer, so it's good to have the bariatric surgeon available to weigh in, so to speak, on any issues that come up.)

I is not unusual to deal mostly with PAs, NPs and RNs, particularly in larger practices, and they are often more communicative than their MD bosses who often don't have the time to answer piddling questions and explain things in human terms - this applies to many specialties, not just bariatrics - so I wouldn't be overly concerned about that. But it is good to get some facetime with the surgeon to get a feel for how he works and how comfortable he makes you feel in his hands.

Pre-op requirements vary widely practice to practice - my doc is one who takes the attitude that if "you could lose weight on your own, what do you need me for?" I an somewhat skeptical of those who have strict pre op weight loss requirements "to show that you are serious" or whatever - how serious can you be if you're willing to have your insides reworked to lose? These pre op weight loss requirements seem to mostly put a lot of additional stress on the patient for little in return - it doesn't seem to correlate much with more or less post op weight loss. I am, however, a fan of making a serious nutritional effort to reform one's diet and habits for the long term, as that is a major long term success factor; a quickie fad diet to lose 10% doesn't help anything. The best programs that I have seen work with the patient to move their dietary habits toward the good. My wife and I did something like that on our own, aiming to move our diet in the direction of what it should be 5 or 10 years later (rather than next month or next year) and that worked well - enough for me to attain a moderate level of weight stability and control after moderate loss (5-6 years of no regain, though not much additional loss) to go with the more moderate VSG over the stronger DS. Additionally, if after a reasonable habit reset effort, there was minimal resulting weight loss, then that can be a clue as to the need for a metabolically stronger procedure; certainly a point of discussion before making a final procedure decision. Some people's metabolism is just more heavily damaged from their obesity journey that they need more help than others - it's good to find this out before going down what might be the wrong surgical path.

In short, I do favor some intensive pre op work to get you ready for your post op life and hoped for success, but that doesn't mean there's a need for a blanket loss percentage requirement.

Good luck in getting through all of this....

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


on 3/11/23 7:42 am
WLS on 07/15/22

Hello and welcome.

It sounds like you do not have a dearth of choice in this scenario, so ultimately it could be based on the skills of your surgeon- how many procedures have they completed? What's the complication rate? What do other patients say? What's the support and follow up at the clinic look like, and how much motivation do you have to close the gaps? What are your deal breakers, and what can you work with?

It does sound like the choice is yours, which might be a nice problem to have. In my case, the practice was dictated by my insurance and if you want coverage, you go to the center of excellence prescribed. My surgery might still be waiting if I didn't take matters into my own hands and just start calling them to ask about it. I also ask a ton of questions and leverage every single thing they offer.

A lot of this process is how proactive you are and choose to utilize it. For some reason it seems a lot of practice staff are notoriously hard to track down, and surgeons often come with an implanted chip the size of Texas on their shoulder. Maybe fourth time is the charm, in your case?

I hope you find what you're looking for, and that you can move forward in a way that works for you!

HW 282, LW 123.4 (8/29/23), CW 144.4

Pre-op-33, M1-12, M2-17, M3-14, M4-11, M5-14, M6-5, M7-6, M8-5, M9-22, M10-6, M11-5, M12-2, M13-2, M14-5

on 4/19/23 8:45 pm

I think diet is very important, even though doctors ignore it

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