Different surgeon

I had my RNY 3/25/10 with a local bariatric surgeon.  Due to different insurance plans my husband is having his surgery on 6/23/11 with an out of town surgeon.  I will not post his name, practice or hospital.  I am frankly disgusted.

My insurance required that I attend 2 counseling sessions, 1 sessions with a dietician and 2 visits with the surgeon (initial & then pre-op).  My surgeon's office requires 3 counseling session (private or group), 3 dietary sessions and yes, 2 sessions with the surgeon.  I feel that I was very well informed and ready for my surgery.

My husband's journey has consisted of the following thus far:  1 visit with the surgeon, 1 visit with a dietician and 1 psych consult.  This was to meet his insurance requirements.  His visit with the surgeon only lasted 20 minutes.  The appointment with the dietician was 30 minutes and his psych consult (honest to God, I'm not kidding here folks) was a total of 8 minutes (if that long).

On the 2 hour ride home my husband even commented about how he already knows he's prepared since he's gone to ALL of my appointments with me.  My husband and I can't understand how this practice feels that this is enough education.   Where is the support from his surgeon's practice?  Thankfully he attends support groups with me so he has a good support base once he's post op.

I'm just curious, what did anyone else go through with their surgeon's program?  Am I being "critical" or are my expectations too high? 

Mine was very similar to yours.  My psych consult lasted at least an hour and that was after filling out the 10 page questionnaire.  I also went to 4 group psych meetings on binge eating, endoscopy, blood work at the beginning and end, 2 sleep studies, 2 EKG, cardio consult,  chest xray, ultrasound of liver and gall bladder, exercise class, class on surgery and first two food stages,  clear and full liquids (rest to follow after surgery).  The only thing that was different from everyone going through my surgeon was the sleep studies.  Not everyone has them but I already knew I had sleep apnea I just never did anything about it.

Question:  Is your surgeon's practice a "center of excellence"  and your husband's isn't.  I think that could be the difference.  Some hospitals have a major bariatric program and some hospitals have a surgeon that does bariatrics as part of what he does along with everything else.

My insurance (Tricare Prime) didn't require anything a request from my bariatric surgeon (with BMI of 40 and 1 co-morbidity).  Part of me was relieved that  I was easily approved but then part of me doesn't feel 100% prepared.  Luckily I have a "mentor" who had the surgery 3 years ago who is provide a lot of support and knowledge.  Also, my surgeon operates in 2 cities and the city I am in is not his primary location so I always wonder what I'm missing by not going to his main office.  I have complete confidence inmy surgeon and that to me is the most important.

Good luck to your husband, sounds like he is prepared just by sharing the experince with you.

 With my first surgery I only had an appointment with the surgeon to set a date.  Period.  No nutritional counseling, no psych eval, no testing other then pre op blood work.  I did have a cardiac evaluation just because I was having issues and my PCP ordered it.
I did attend a post op group but that was strictly voluntary, there were no requirements.  I was given a very limited post op diet just covering the first few weeks and I was told to take a multivitamin and some calcium citrate.  I have a very malabsorptive procedure.  I learned on my own that I needed to take more then that.  I learned how to eat a lot from an online group I belonged to and the monthly support group that went out to dinner before the meeting.  Every post op get together had a table laden with breads and desserts.  Almost every one had bathroom issues and several had revisions due to weight gain.
Is it any wonder that I had a revision at 8 years due to nutritional problems, bathroom issues and regain.
Even with my revision there were no requirements for me except that I did see a dietitian 3 times.  They have cut back on the support groups at the hospital and the other support group that I used to go to is over, too.
I do believe that a good program really makes a difference in your outcome.  It is good that at least he has you to help him as far as diet and vitamins go.  
I really believe there should be some kind of uniform education for all WLS patients.  So much depends on it.  I also think that people should be evaluated for eating disorders and given treatment if needed.

This is the funny thing, my surgeon/hospital is working towards becoming a "Center for Excellence" while my husband's surgeon/hospital is already a "COE."

Well, I do feel very fortunate that I was so well educated.  I have been very lucky and I have worked my butt off (literally, lol) to get where I am.  I even speak at WLS seminars my surgeon's office has.  I can't thank Southern Tier Surgical Center, Dr. T and Mickey McCabe enough.

The only thing my surgeon's office required was a half day of education on the surgery itself, post-op diet, etc., and a meeting with the exercise physiologist 4 weeks AFTER surgery.  She also has an informational handbook that is very thorough, however.  That was followed up by one visit with the "nutritionist" at 6 months out.  Mine was by phone (and lasted all of 5 minutes) because they had one dietician quit.

My insurance company requirements, however, required 3 visits with the surgeon, 3 with a dietician, and 3 with the exercise physiologist.  The 3-month "multidisciplinary" program was a joke from a nutritional standpoint because what I was given to follow was a general diet that merely emphasized caloric restriction and spreading out my carbs throughout the day.

Lora

Hello,
My doctors office is a COE.  Before I could even be seen I had to attend a 3 hour seminar about the types of surgery's they offered.  Then I could call the next day and set up an appt to be seen ( with a 4 month wait!!!)  At the dr appt we went thru all my problems and based on that she ordered the specific testing needed. Required were 3 NUT appt's, ekg, endoscopy and pshyc eval which was 6 hours long!!!!!  Then based on NUT results she decided I was a compulsive eater since over the years i've been anything from 140 to 250 lbs.  which I totally agreed w/her so she sent me to classes to help control it.  Then after that I could make final appt w/dr and got the 2 week diet that day and made appt for operation. 

Wow...after reading all of the comments above I don't know whether to be happy or sad that my pre-op stuff is taking so long!  First, it took 3 months to get the appointment with my surgeon, then a whirlwind month of:  Endocrinologist, Cardiologist (twice), Dietician, Nutritionist (twice), sleep study (twice), psych evaluation, fitness center evaluation, Gastrologist - EGD, colonoscopy, bloodwork and two support group visits.  Now I'm waiting another 6 weeks for the next A1C test to see if insulin will being me down to the 8 range so she'll schedule my surgery.  Yes, it's frustrating but I do know that I've learned more in the past six months about my body and what I'm capable of doing if I work at it.  For now I'd rather be over-informed than under and know that the decisions I'm making is what's best for me. 

It's good that your husband has learned from your experience and the support you can give each other has got to be a good thing! 

This is how things went for me.

My family Dr. reffered me to my surgeon. When the nurse called she was told that they would contact me with a packet of information. About 7 days later I got a LARGE package with tons of papers to read and sign. It told me everything from pre op to intra op to post op! I was very well educated. Once I filled out all the paper work and mailed it back they called me within 2 days to set up a seminar I was to attend. I went and there were probably 30 other people in the room. It was (not my surgeon but a surgeon from the practice) 1 surgeon, 1 nurse, 1 dietician and a physcologist. Each one spoke and there were power point presentations, handouts, and demonstrations with a model of a stomach. Then at the end of the seminar if you wanted to set up an appointment you would see the nurse. I had my first visit with the surgeon to see if I was eligble. Then I had all the blood work, visit with anesthesia, psych eval, dietician consult. Then I went back for my second visit with the surgeon and they called it decision day. It was the day I was to tell him if I def. wanted the surgery, him to tell me if I was approved or recommended by all others and for me to tell him if I wanted RNY or Lap. Then they submitted to insurance and once approved I had 1 more visit with the surgeon and 1 visit with the phycologist. So that's 3 surgeon visits. Each and every time I stepped foot into that office they explained the procedure from start to finish. Being that I am in the medical field and actually work in OR I have seen many surgeries and actually have worked in the OR with my surgeon and he knew that but he still made sure I understood 100% what was going to happen to me. I have to do 4 group sessions with the phycologist and had my first one two weeks post op. The next 3 are 3 months, 6 months, and 12 months post op.