Would you pick your builder out of the Yellow Pages without first checking them out or taking them on personal recommendation of a friend or trusted colleague? I wouldn’t!  Just as it would be crazy to presume that all builders are equal, so the same applies to surgeons. The ‘Certificate of Completion of Training’ that is awarded at the end of a UK surgeon’s training denotes that they have successfully completed one of the very best surgical training schemes in the world. However, sadly, being on the Specialist Register of the General Medical Council means somewhat less than that, as EU law dictates that the UK has to allow anyone onto the GMC’s Specialist Register if they are on the Specialist Register of their own country, elsewhere within the EU. I can assure you, being on the specialist register in many European countries is NOT the same as completing specialist training in the UK!

Even amongst UK-trained surgeons there is enormous variation. In major cities the population is big enough to justify surgeons sub-specialising in specific narrow areas – areas that they therefore get very good at. In smaller towns and rural areas, often it is more generalist surgeons that are required.

‘Choosing the right (best) surgeon for your knee operation is by far the most important decision that you can take.’

The advances in knee surgery are tremendous, and the surgical techniques intricate and demanding. If a patient requires difficult or complex knee surgery then they should really consider very carefully the training, experience and sub-specialist skills of the surgeon under whose care they are entrusting themselves.

Sadly, certainly in the NHS and also now to a lesser degree in the private independent sector, there seem to be all too many ‘experts’ with a ‘specialist’ opinion on what’s right and what’s wrong in knee surgery.

‘The only true specialist when it comes to knee problems and knee surgery is a Consultant Orthopaedic Surgeon specialising in Knee Surgery!’

Within the NHS services are blatantly being rationed. In many areas patients’ access to knee arthroscopy is being restricted to try and save money and patients are being denied treatments that can decrease their pain, cure them of mechanical symptoms (such as catching, giving way or locking), increase their function, enable them to return to sport and/or employment and keep their knees going, delaying the time when they might need something bigger and more drastic such as a knee replacement. Whilst rationing in any ‘free’ service is almost an inevitability, what is unforgiveable is that some people should dress this up by suggesting that treatments (or even specialist opinions) are being withheld because they might not be effective.

People spend a great deal of time researching and debating, and a great deal of money buying their car – which they are likely to change every few years anyway. Why do some people not afford themselves the same common sense, value and priority when it comes to something far more important and far more serious such as surgery, which can potentially seriously affect their lives not just for the short term but also for the very long term too?

But how do you know which surgeon you should actually go and see? …. This is a difficult question to answer. How do you know who’s any good? How do you know who’s safe? How do you know who’s going to give you the best service and the best outcomes?

The traditional route for getting to see a Consultant Specialist is to be referred by one’s GP. This is one of the best and one of the safest options for a patient. GPs spend years in a practice gradually developing a knowledge of which surgeons in their locality are best for what particular problems, who gives the best service and whose complication rates might be lowest. This kind of ‘soft’ knowledge may be hard to accurately define and quantify, but it is actually a ‘deep knowledge’ that is incredibly important and valuable, and for most people their GP remains the trusted gatekeeper of their health and their best interests.

The other very important route for patients to be referred to a consultant is via their physiotherapist. Very much like GPs, a good private physiotherapist will most certainly have their patient’s very best interests at heart and will only refer to consultants who they know are safe, who do a good job and who are best for whatever specific particular problem their patient might have.

‘Trust your GP and your Physio – they’ve got your best interests at heart!’

The other routes to finding the right consultant for your particular problem are to follow word of mouth from friends, colleagues and family, which is normally a reasonably safe option. Alternatively, many patients are now quite proactive about their own health, and take to researching both their problems and their consultant via the internet – and a consultant’s website usually gives a reasonably good window into what they and their practice are likely to be like (though one should beware of websites that have clearly been put together solely by marketeers, offering advice that has clearly not actually been written by the consultant themselves).

Sadly, within the NHS the GP-to-specialist relationship has been all but destroyed by politicians, PCTs and managers trying to ration access to consultants by imposing layer upon layer of obstructions in patients’ paths, with for example referrals being diverted to things such as ‘Community Based Triage Clinics’ run by physiotherapists. One of the main selling points of private medical healthcare has been the patient’s ability to pick and choose their own consultant, and to see the consultant of their choice.

‘Sadly, in the NHS it now seems the norm for patients’ access to Specialist Surgeons to be restricted by layers and layers of obstructive bureaucracy. This rationing of access to proper expert specialist services is an attempt at short term cost savings that can have potentially devastating long term costs and consequences…’

Very worryingly indeed, we are now beginning to see some insurance companies increasingly interfering with the natural flow of patient care by actively trying to divert their policy holders away from what they perceive to be the more ‘expensive’ consultants, with patients instead being sent to ‘cheaper’ consultants. Not only does this remove patient choice, but it is also potentially deeply dangerous — are the cheapest consultants really actually the best for you to see? Consultants’ outpatients fees are generally not very high and it is difficult to understand how patients can fail to appreciate the danger of saving pennies over something where their life and limbs are at stake, and the very false economy of going ‘cheap’ initially but then potentially suffering terribly later, and therefore accruing far greater costs for second opinions, re-do revision surgery and further time off work etc in the future if things don’t actually go well.

‘Now even some insurance companies are trying to actively divert patients to the cheapest consultants instead of to the most appropriate or best…’

There is no ‘right or wrong’ way of going to see a consultant. However, being entirely passive or even worse, allowing oneself to be dictated to and directed by an FSA regulated non-medically-qualified insurance company clerk/advisor, purely on the base of short term costs, is most certainly not the most sensible approach.