I'm putting this in the open discussion area because it pertains to all the doctors, therapists, and surgeons that we see.

Many people are nervous about using a provider who hasn't established a track record. My surgery was with Dr Oates, a relative newcomer to the MTF arena, but a world class leader in men's reproductive health; he knows his way around a penis. Before the procedure, he introduced me to a medical student who was going to be in attendance. Someday she may operate on one of you. 

So how do you feel about giving a new provider a chance and letting them build their skills on you? Here's my take. I have a relatively new and young primary care physician, she's great. Dr Oates and his staff are great, although there was a pronoun slip from a prep nurse just before surgery. No biggie. I'm sure that will become second nature for them after awhile. After all, it was a parade of men through their office before Dr Oates branched out. Bottom line, I don't mind being a bit of a guinea pig to smooth the road for those to come.


So what are your feelings on your providers level of experience?

Hugs, Devlyn

Devlyn,
   On one hand, a person who has done a million surgeries knows all the in's and out's (the pun here is gravy), has all the tricks stashed away in that proverbial bag of tricks. On the other hand, a new doctor is freshly trained, wants to prove herself/himself and perhaps nervously wants to do the best job. Does that nervousness hinder a good job? Does the older doc's confidence become cockiness? It is hard to tell. I had just this choice considering my GCS. I went with experience. I have no doubt the younger surgeon will be excellent. I think another factor in my decision was that my surgeon was trans as well. I figured there was low probability of her doing it just for the money. She had to see it in a highly personal way, or so I hoped. I would be open to the younger docs for other things though.
Moni

It depends on what it is and if I had a choice. If it was hrt and they did what I wanted that would be fine, mainly because I can double check things adequately. For GCS, I'd certainly try to avoid it.

I'd expect any surgeon to have assisted and then performed surgery under supervision, before starting out on their own.  Hopefully, they'll work in a clinic with a more experienced surgeon for a while too.

Don't forget, they all have to start sometime and if they don't get patients, they don't get experience.

Exactly. A student opens and closes a lot of bellies (or penises) before they take anything out.

Quote from: Devlyn Marie on September 17, 2017, 11:09:31 AM
Exactly. A student opens and closes a lot of bellies (or penises) before they take anything out.

Studentship or traineeship in medicine is pretty straightforward. There is a fairly strict learning curve and seniority. In practice the senior registrar is probably the 'best' surgeon on the team as they are the one in the most advanced level of learning, has fewer management problems, isn't the head of the department and doesn't do all of the teaching and financial management. On the other hand the senior consultant may have designed the technique, taught everyone, runs a Unit of XXX people, manages a budget, argues with politicians, saving up for retirement, getting divorced and their golf handicap is crap and needs working on.

I still remember my first foray into theatre. She was a tiny prem with a known heart defect. No one could find a vein and the consultant paediatrician surgeon just said, get my senior registrar. This hippy came in, took a needle and got a vein while whistling a happy tune and then walked out.

My perspective as a physician:

Bad surgical outcomes occasionally happen.  Most of the time, an adverse outcome does not result from any particular deficit of judgment or lack of technical skill on the part of the surgeon.  Instead, it usually owes to factors (for example, the patient's capacity to heal) that are often hard to predict and harder to control.  For this reason, it is important, as a patient, to understand that there is no such thing as risk free medical intervention, and to know the potential risks of the procedure you are considering.  In other words, you might be one of the unlucky few to have a certain complication, but odds are that the complication is not because your physician screwed up, or didn't have enough experience. 

Malpractice cases almost always involve more than a bad outcome.  There are actually three legal elements that must be present to prove malpractice, but in a less technical sense, malpractice almost always follows some sort of breakdown of communication or toxic communication from the physician.  Patients will usually accept a bad outcome, but they will not accept a bad outcome from a jackass.

As I was shopping for surgeons for my upcoming FFS/BA (four days from now!!), I definitely considered experience, but not simply the number of years in practice.  I consulted three physicians, one of whom had clearly been in practice longer than all the others.  Two performed their cases in outpatient surgical centers and one in a hospital setting.  The most experienced physician proposed a technique of brow lift that is far more common for cis-women than it is in trans women.  He also made a misogynistic comment during the consult that really rocked my confidence.  When my wife and I left the office we both said, "No way" as we walked out.  I ended up going with a younger physician with an easy manner, an obvious attention to aesthetic detail and a bit of training under Dr. Spiegel during his residency.  The downside of this choice is that he may not have yet encountered the sort of surgical event that happens only once in 1000 cases.  On the other hand, I think he has sufficient training and judgment to navigate it. 

I hope I'm right, and after the smoke clears, I will be happy to share my recommendation (or non-recommendation) here.

Quote from: rmaddy on September 17, 2017, 12:12:25 PM
I ended up going with a younger physician with an easy manner, an obvious attention to aesthetic detail and a bit of training under Dr. Spiegel during his residency.  The downside of this choice is that he may not have yet encountered the sort of surgical event that happens only once in 1000 cases.  On the other hand, I think he has sufficient training and judgment to navigate it. 

+1 for a new surgeon who has trained under a more experienced and respected surgeon. The training programs last several years and are very comprehensive.

The surgical techniques keep improving every year and in a sense, we are all test subjects. I first considered SRS over 50 years ago and the surgical technique at that time was terrible. It wasn't until recently that I became aware of the dramatic improvements in genital surgery. Current technique and some personal issues finally led me to transition.

I think we all hear these same names of doctors who advertise directly to us and forget that there is a pool of more local experienced surgeons nearby, at least when it comes to facial surgery. I'm no where near ready financially, nor do I have insurance that will cover it, but I'm looking into facial feminization for down the road. While looking into some of those surgeons that market towards the trans community I found some disturbing issues with some.

Plastic surgery in the US can be practiced by an MD with surgical training, or just a DMD with a fellowship training. Here in lies the problem. I certainly wouldn't want a dentist who forays into plastic surgery doing bone work in my head! That is what some of these plastic surgeons are.

Looking into surgeons' backgrounds I have found that locally there are MDs with cranial facial surgical specialties. These doctors practice plastic surgery of all kinds but have the skill and practice to reconstruct an accident victim's face and skull parts. That is the kind of doctor I'm interested in seeing. In St Louis I've found a practice of plastic surgery whose doctors are also listed as the plastic surgery staff at the larger medical school in the city. There are other plastic surgeons in the city, but most do not have cranial facial experience.

Josie,

My physician trained in cranio-facial reconstruction in a reputable program. 

I don't have a problem with someone relatively recently finished with training, so long as the training that they received was on target to what I am having done.  After all, I was in the same boat 24 years ago. 

In some ways, particularly in terms of technical skill and sheer amount of knowledge stuffed into my head, I was a better doctor then than I am now.  I still feel quite competent in the skillset necessary for my job and I keep up on my education and certifications, but I don't do some of the critical care procedures now as often as I used to.  On the other hand, the "art" side of my job--listening empathetically, discerning a patient's fears and addressing them to their satisfaction, etc--has flourished over time.  I'd rather be the doctor I am now, but I was d_____ good back then too...just in a different way.

Quote from: rmaddy on September 18, 2017, 11:04:30 AM
I'd rather be the doctor I am now, but I was d_____ good back then too...just in a different way.

But who would you rather have treating you?

Still being in an early stage of transition, I've worked with practitioners who have an understanding without succinct knowledge.  My primary has been working with the Trans community for years (at the largest LGBT clinic in New England), but he didn't know anything about bicalutamide.  And then the pharmacist got super awkward when I asked her how the doses/effects compare to that of Spiro. 

My therapist has worked with Trans people before, but I think only to a minimum extent.  She's very supportive and eager to learn, which sometimes makes me question how much I'll receive as her client as a result. I don't want to be her teaching assistant, as I'd like to be counseled the way I need which brought me to her in the first place.

Aside from those, I've been working with an electrologist who has had trans female clients for a couple decades.  The person she practiced under when she was licensed in the 80s was the only person for miles who would even see Trans women as clients.

Surgeries though?...Hoo, no idea.  Perhaps I'm early enough that by the time I get there, there will be enough to go on for success/expertise from advice of friends I make along the way...

Quote from: AnonyMs on September 18, 2017, 11:15:00 AM
But who would you rather have treating you?

The current me, but that is a matter of personal preference.  It's not because I'm technically more skilled now--I probably was more so back then.  Experience taught me some things, but mostly empathy.  If I perceive that a physician has that, and the appropriate training, I'm good to go.

I went to Dr. Spiegel for my FFS. Dr. Spiegel and his fellow worked on my face.

I went to Dr. McGinn for my GCS and BA and she did not have a fellow. I would have not had an issue if she did have a fellow. Her PA-c at he time in the OR was Brianna and she only had about 4 months with Dr. McGinn.

A good question Devlyn,

I just had gcs last week performed by Dr. Ley, an associate of Dr. Meltzer. In choosing a surgeon, my wife and I wanted certainty of exceptional skill. First off, for personal preference we ruled out Asia. While I have traveled extensively in Asia  and love the region, the parts of the medical world that I have seen there do not offer me confidence (strictly a personal choice and no judgement on those that have pursued that path). We also wanted experience. There are several teaching universities that are adding transgender surgeries but we had the same reservations. Our list was boiled down to Dr. Bowers, Dr. McGinn, and Dr. Meltzer for the primary reason that they are the names in the field and I didn't want a significant opps and redo on this procedure (at the time I was planning for a full gcs). It happens that I was able to interview with Dr. Meltzer first and he introduced me to Dr. Ley. While Dr. Ley has less experience in this particular procedure than the other surgeons she has excellent qualifications, training and experience in both cosmetic surgery as well as reconstructive surgery and she has been with Dr. Meltzer for some time now. Plus I was able to take a year off the wait list time of any of the other surgeons on my list. The fact that I liked her and that I believe (reported to me but not told to me by her, it is her story to tell) that she is also transgender had me/us very comfortable with our choice. Her treatment and compassionate care has proven it to be a wise choice so far.

So, new doctors and new program, scares me too much. Newer but experienced doctor trained by legend of the field, no problems, someone that can relate to me and knows what I am going through, great contribution.

Quote from: rmaddy on September 18, 2017, 02:20:32 PM
The current me, but that is a matter of personal preference.  It's not because I'm technically more skilled now--I probably was more so back then.  Experience taught me some things, but mostly empathy.  If I perceive that a physician has that, and the appropriate training, I'm good to go.

As a patient I don't understand the value of empathy over technical skill?

Quote from: AnonyMs on September 18, 2017, 11:02:37 PM
As a patient I don't understand the value of empathy over technical skill?

I can't prove that there is any.  How you weigh empathy into the decision is up to you.  Think about a few of scenarios though:

Doctor #1:  has an impeccable resume and track record, but he has been sent to sensitivity training 4 times and acts like you are wasting his time in the office.

Doctor #2:  absolute teddy bear; trained in the management of type 2 diabetes, but feels immense compassion for trans people and wants to help them by doing surgery.

Doctor #3:  has an impeccable resume and reputation; not personable and doesn't show much compassion, but isn't obviously sociopathic.

Doctor #4:  good training; credentials solid, although maybe not as impressive on paper as #3; warm and reassuring in person.


It's pretty easy to pass up on #1 and #2 for any major procedure.  The question is whether choosing #4 (as I did) is a reasonable choice.  It comes down to your opinion on to what extent a doctor with an excellent reputation is actually better than one with a good reputation.  From where I sit, the answer is, "not different enough to make it worth flying around the world."  I have both professional and personal reasons why I think that is the case, but I know others feel differently here, and I won't belabor it any further.

rmaddy, I'll just get it out of the way and say I'm probably not very normal in the way I think. I start from a basis of no confidence/trust, but also no choice, and work my way up from there. Personally I want someone who's going to do the best job and I weigh that far above anything else. The difficulty is in working out who that is, which is incredibly difficult and realistically I can never be sure. Its all shades of gray.

I do make a conscious effort not to allow a doctors personal skills to influence my opinion. With GP's, who I have the most experience with, I always do my best to double check if they know what they are doing and if/when I find them making a mistake I drop them and find someone else - between myself and family I've seen have some serious mistakes with unpleasant consequences and on a couple of occasions that could have been fatal.

I don't have much trust in paper qualifications by themselves - I work with plenty of highly qualified people and there's a massive difference between them.

I'd probably not mind a sociopath for a doctor as long as our interests aligned, but since I couldn't work that out I might not risk it.

Back to the original topic, and given the way I think, the problem for me with new doctors is that I can't evaluate them.

As you can probably guess I tend to make like complicated for myself.

Very interesting topic.  Thanks Devlyn for starting it.
Paige

My own position is that I'd be happy to have someone less experienced work on me,  as long they could demonstrate a consistent and successful path in their development until then.

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