Endo Battery

Vetting Endometriosis Surgeons Like The CIA: Don't Get Bamboozled by a Medical Madoff: With Dr. Melissa McHale

• Alanna • Episode 168

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Finding the right endometriosis surgeon can feel like searching for a needle in a haystack—especially when you’re already dealing with chronic pelvic pain and the emotional toll of the disease. The wrong choice can cost you years of suffering, but the right surgeon can change your life. In this episode, Dr. Melissa McHale, a gynecologic surgeon specializing in minimally invasive endometriosis excision surgery, shares a proven step-by-step framework to help you confidently choose the right surgeon and reclaim your quality of life.

You’ll discover:

  • Why traditional ways patients pick surgeons often fail—and how to avoid being misled by those who simply tell you what you want to hear
  • How to research a surgeon’s qualifications, training, mentors, and real-world excision surgery experience
  • Where to check public medical board records, license status, and malpractice history for surgeons and their practice partners
  • How financial structures in a gynecology practice can influence care quality and surgical flexibility
  • What a thorough preoperative workup should include, from advanced imaging to detailed preparation
  • How to critically read patient reviews and spot patterns across multiple platforms
  • Why transparency matters—surgical documentation, photos, and post-op explanations are key to trust
  • How to evaluate a surgeon’s communication style and whether they give detailed, thoughtful answers
  • The importance of a multidisciplinary care team in successful endometriosis treatment
  • How to combine instinct and objective evidence when making your final decision

Whether you’re just beginning your search for an excision specialist or are feeling stuck after disappointing care, this episode will give you the tools and confidence to find the right endometriosis surgeon for your needs.


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Speaker 1:

People used to ask me how do I pick a surgeon? And I really, I think historically, have fumbled the answer to that and I don't know that there's really a great framework out there for how to pick a surgeon. There are a lot of lists out there that are like ask your surgeon if they do excision, ask them this, ask them that. But often your surgeon knows what you want to hear and so what are the things you should be looking at? And that book was like total clarity for me. I was like, oh, like now I know how to think about this, and what's ironic is the book I was reading at the end of Summit is actually like the inspiration for the conversation we're about to have, because I was reading Malcolm Gladwell's book Talking to Strangers, strangers and the whole time I was reading it I was like, oh, this, this is like I'm having having a clarity moment here about how we understand other people.

Speaker 1:

And there's this one case of a spy that they talk about a lot, who was a CIA agent, who was also a spy working, you know, for the Cuban government. And why is it that no one picked up on these people being up to no good? And the truth is, some people did pick up on it, the people who hadn't met them, right, the people who were just looking at, like what have they written? What have they done? And people would repeatedly say like hey, I'm pretty sure this is a Ponzi scheme. And then people would go interview Bernie Madoff and they'd be like he's such a nice guy, it can't possibly right, like he said he wasn't going to invade Poland, I'm sure he's not going to invade Poland. And, like you know, we all know how these stories ended. And so Malcolm Gladwell really breaks down like okay, what are the traps that we fall into? And then I tried to you know, sort of use those traps to think about like, okay, what are the ways that you can talk to a surgeon and really think about whether they're the right fit for you?

Speaker 1:

Yeah, I think transparency is essential and, and it's funny, there's transparency in sort of two different senses. One is the obvious. Like I'm transparent about what happened inside your body while you were sleeping. I'm going to give you complete documentation, not the op note. You get the pictures and you get my explanation of the pictures and why I did what I did. It's the. Here's my mental math on whether or not, you need an ostomy and it doesn't matter what the question is. Right, you could ask me any of the questions on those lists of questions to ask your doctor, and I mean some of them have like a very black and white answer, right?

Speaker 2:

Welcome to EndoBattery, where I share my journey with endometriosis and chronic illness, while learning and growing along the way. This podcast is not a substitute for medical advice, but a supportive space to provide community and valuable information so you never have to face this journey alone. We embrace a range of perspectives that may not always align with our own, believing that open dialogue helps us grow and gain new tools. Join me as I share stories of strength, resilience and hope, from personal experiences to expert insights. Strength, resilience and hope, from personal experiences to expert insights. I'm your host, Alana, and this is Endobattery charging our lives when endometriosis drains us. Welcome back to Endobattery, Grab your cup of coffee or your cup of tea and join me at the table Today.

Speaker 2:

I'm excited to welcome Dr Melissa McHale, a gynecologic surgeon specializing in minimally invasive endometriosis surgery. Known for her compassion, patient-centered care, Dr McHale combines advanced surgical skills with dedication to truly listening, educating and creating individualized treatment plans. A graduate at Boston University School of Medicine, she completed her residency at the John Hopkins University Hospital before training for two years with internationally recognized endometriosis specialist, Dr Andrea Vidali. She's also highly skilled in dynamic ultrasound to map and diagnose endometriosis. Dr Miguel takes a multidisciplinary approach, often collaborating with specialists from other fields, and has a special interest in patients with conditions like hypermobility, POTS and MCAS. Her mission is to improve early diagnosis, reduce delays in care and help patients everywhere reclaim their quality of life. I'm thrilled for you to hear from her today, so please help me in welcoming Dr Melissa McHale to the table. Thank you, Melissa, so much for joining me today and sitting down at the table. I think I'm excited for this conversation, for various reasons.

Speaker 1:

Thanks. Thanks for having me. I love your podcast so I'm very excited to be here. That's very kind of you. No, I do, I do. I mean it's great that I get to sort of hear what other people think and how other people do stuff you know. So you know, when you're in the endo world, you want to see the other parts of the world.

Speaker 2:

It's true, I'm excited to welcome you because, first of all, I saw you on social media first time I'd ever seen you, and the thing I loved about you is that you are so funny and personable and yet relatable, and you allow people who have endometriosis to see endometriosis in a different light, that it's not all serious, but there's lessons to be learned in it. How did you get into endometriosis? How did this become a thing for you?

Speaker 1:

Well, actually I first got interested in it in medical school, which I know is like a very uncommon answer because most people are like you know, I had 20 minutes of endometriosis education in medical school. But I got very lucky. I went to BU and I did a rotation with Kip McKenzie who is, you know, like old school he just retired endometriosis surgeon and he basically talked me out of general surgery and into gynecology and like the rest is history. So you know I did that. Then I did my residency at Hopkins and afterwards I trained with Andrea Vidali because I was like I want all endo all the time and you know this is the best way for me to get the skills I need. And you know it's just sort of snowballed. And now here I am, all endo all the time.

Speaker 2:

What keeps you going, though, because this is not an easy field to get into. What keeps you striving for better? What keeps you striving for more?

Speaker 1:

I would say there's two things. One is the patience right. There's nothing more rewarding than hearing back from your patients and I will say a lot of people in my life make fun of me for the texts I get. Like, you know, I'm the only person I know where someone will text me like I I pooped this morning and I thought of you because it didn't hurt, and I'll be like, yes, and my husband will be like what? And then you know the other thing is is honestly. And then you know the other thing is is honestly.

Speaker 1:

You know, in in my practice, I have this great community of other people who are just as passionate about, about endo as as I am. And and it's like you know, vicky, vicky Vargas, my, my partners, people hate hanging out with us because all we talk about is endometriosis, like our husband, you know. But but you know, anytime and and you know, vince, my colorectal colleague, vince Obvious, anytime he and I are like, oh, what if we do it this way, we could try this. I'm like we get so into it and it's, it's energizing. And and then you know when, when we have patients who continue with Jen, our nurse practitioner, and she's like she's doing great and this and this with Jen, our nurse practitioner, and she's like she's doing great and this and this, and we're like. You know, this is like this community. It's like we feed off of each other on coming up with the best ways to take care of our patients, and so I would say, like those two sort of different groups of people really keep me going.

Speaker 2:

Yeah, what's funny about that is this ties into how we met, because we met at the endometriosis summit and we met in the elevator and you were going up to go to bed. I was for sure not going up to go to bed, because I don't sleep at the summit, because the people there are my friends and they fuel me and I leave the summit just ready to go.

Speaker 2:

You know like I get ideas and I want to serve people. I want to help people more and I'm re-inspired to continue with advocacy, which is not always an easy thing to do when it's so tiring a lot of times. And so you and I were in the elevator. You were going to sleep. I was not. How. How did you do that? Because I am not someone who, you know, values sleep very well. Sometimes I'm not great at it. I would like to get better at it, but you clearly have mastered this, because I would have not done what you did.

Speaker 1:

Well, I'm, you know, I I've been trying to prioritize certain aspects of my self-care that may have been neglected, particularly through training and things like that, and one of them is sleep right. So, and especially at the endosummit, you're like mind is going a mile a minute thinking about all these different things. And so one thing one of my, like you know, recent past year or so resolutions is working on my sleep hygiene. So I always read before I go to bed and and what's ironic is the book I was reading at the end of summit is actually like the inspiration for the conversation we're about to have, cause I was reading Malcolm Gladwell's book talking to strangers, and the whole time I was reading it I was like oh, this, this is like I'm having having a clarity moment here about how we understand other people, and so what we're talking about today, which is how to, how to, you know, choose the right surgeon for yourself.

Speaker 1:

People used to ask me how do I pick a surgeon? And I I really, I think historically have fumbled the answer to that, fumbled the answer to that, and I don't know that there's really a great framework out there for how to pick a surgeon right. There are a lot of lists out there that are like ask your surgeon if they do excision, ask them this, ask them that. But often your surgeon knows what you want to hear and so what are the things you should be looking at. And that book was like total clarity for me. I was like, oh, like now I know how to think about this.

Speaker 2:

Yeah, if you want to talk about deception in the eye of the beholder, like that relational deception, like you get to know someone and then you know the Bernie Madoffs or the what was it, amanda Knotts?

Speaker 2:

Everyone thought she was, or they thought she was guilty, and so it's about perception, right, like it's about how they're being perceived when you meet them, when you look at them, and if you look at them from a distance or you look at them from a personal lens, how you make your decision making. That's kind of the title of the book, right?

Speaker 1:

Yeah, so the whole point of the book is basically why is it that we are so bad at interpreting the behavior of people we don't know and we can never sort of do a good job of assessing whether someone is trustworthy, whether someone is capable, and so you know, with the examples you've talked about, those, those all come up in the book, right, and there's people you know like people who are up to no good, like the Bernie Madoffs or the Hitlers or whoever of the world, right, there's this one case of a spy that they talk about a lot, who was a CIA agent, who was also a spy working for the Cuban government, and why is it that no one picked up on these people being up to no good? And the truth is, some people did pick up on it, the people who hadn't met them no-transcript.

Speaker 2:

Find a surgeon.

Speaker 1:

So the first step really is establish whether or not this person is qualified, right, and so you know some of the things. It's like do the background research on this person right? Like, did they go to medical school? Right? Like, yes, I'm sure they did if they're a surgeon. But like, where did they go? Where did they do residency? Did they do a fellowship? And then, who taught them to do endometriosis surgery? Right, Is this something that they learned in fellowship Did? Is this something that they learned in fellowship? Did they have a specific mentor? Did they learn it after fellowship?

Speaker 1:

Like, really try to figure out. Like, okay, if even most fellowship trained gynecologists in the US don't know how to do a complete excision of endometri, find anyone at the University of whatever who you would trust to do your surgery, OK, well then, if this is where that person trained and they taught them everything they know, is this person really qualified or not really Right? And sometimes someone got extra training after fellowship, they were mentored by somebody, these kinds of things. Sometimes someone got extra training after fellowship, they were mentored by somebody, these kinds of things. You know, everyone has a different journey and it's not always necessarily about where they did fellowship. But figure it out. Don't be afraid to ask like when did this become your focus? Is this something you learned on your own? Did somebody teach you? Did somebody mentor you Right?

Speaker 2:

If you wouldn't let their mentor operate on you, consider whether or not they should operate on you. Right, like you know, and some of who's not. How do we decipher that as a patient if we don't really you know, like you and I, we're kind of in this endo community, pretty thick into it, you know. So we know who's really good, we know who's credible. But for people who don't know and they're just starting this journey how would you go about figuring out if someone is credible or not?

Speaker 1:

starting this journey. How would you go about figuring out if someone is credible or not? So there's a few different, you know a few different things you can look at. Right, there's all these different lists, right, people talk about lists on social media and those kinds of things of who is qualified, who believes in excision, all those kinds of things. Right, you can look at the sort of reputation both from patients and we'll get into that more later in our discussion like what are their reviews, that kind of stuff. But also what do other doctors say about them? Right, because often you know you can sort of tell what doctors associate with other people whose whole world is endometriosis. Right, if somebody is spending all of their time with other people who totally focus on endometriosis, it's because they're like you and me. They feed off of constantly thinking about how to get better at providing endometriosis care. Right, if they're totally on their own nobody refers to them, they're not doing all of these things to forward their knowledge then you know that should give you pause.

Speaker 2:

Yeah, Is there. I mean we talk about red flags with surgeons. We've talked a little bit about, like you know, if, if you don't trust them or you're not, you wouldn't have the other surgeons, what are some other red flags when people are researching these surgeons that we should be aware of?

Speaker 1:

Yeah, that gets into the next element that I think you should be discerning online, which is whether or not somebody is trustworthy. Right, is the surgeon trustworthy? And so you obviously like look up, you know, okay, you're vetting a surgeon. You have their name, you have every name they've ever had. Right, like, I changed my name when I got married, so like my medical degree is not under my current name. Right, like, come up with every name for this person and their partners. Right, who else is in the practice? Because birds of a feather flock together. Right, and if one of their partners is sketchy and they're they're endorsing their partner, their partner might cover them when they're on vacation. Right, you might be rounded on by the other people in the practice. So you look at everybody who they associate with and then you're looking that person up.

Speaker 1:

Right, every medical board complaint is a part of the public record. Right, and every medical license is a part of the public record. So, for example, I'm licensed in five states New York, new Jersey, maryland, the District of Columbia and Virginia. So you can pull my license from every single one of those places and you can Google Melissa McHale Medical Board, Virginia. Melissa McHale Medical Board, maryland. See what comes up, right, if my license has been suspended in Maryland and I'm, you know, and that's why I operate in Virginia, that's something you should know about. My license has not been suspended anywhere. I don't have it.

Speaker 1:

Go, please, you won't find anything, but this happens, right, like I see patients who have seen physicians who have lost their licenses in some states and the patient has no idea until after the surgery didn't go very well, right. So look it up, right. How do they have any medical board complaints? It's something you want to know. And does anyone in their practice have any medical board complaints? And then also, part of the public record are court cases, so you can google their name and malpractice, google their name and lawsuit, google their name and the major newspapers of where they live, right, right, all of these things like it's. It's going to come up if they're getting into trouble or they're getting sued. A lot, right, like this kind, this kind of thing. It's, it's not a secret, and so if you go looking for it and and they have, you know, a track record of this, you'll find it, yeah, and I think that's and you have to look at that.

Speaker 2:

And then you have to look at what the complaint is, because I do know like there's certain providers that say, do excision and others that don't believe in excision and they're like they're taking too much tissue, do excision, and others that don't believe in excision and they're like they're taking too much tissue, like there is that element of it. So you have to kind of like is this valuable information to me? Is this going to break my trust or is this going to? Is this, you know, skill set or is this you know? So I think that you have to look at all of that. It's not just like, oh, they have a complaint, I'm not going to use them. You have to look through that.

Speaker 1:

Yeah, of that. It's not just like, oh, they have a complaint, I'm not going to use them. You have to look through that. Yeah, absolutely, there's a difference between you know, they lost their license for gross negligence and, like someone sued them over something that wasn't malpractice and, like you know, it didn't go anywhere. Obviously, like, every surgeon has complications Every single surgeon if you're doing high volume of surgery, you're going to have complications, and the more complex the cases you're taking on, the more likely you are to have complications, right. If you're doing ablation of endometriosis for people who don't have complex disease, you're going to have a really low complication rate, right, but that's not what you want, and so I think it's very important to like read these things and take them with a grain of salt. If someone got sued over something that isn't a known potential complication of something and it wasn't malpractice, obviously that's not a reason to not see a surgeon.

Speaker 2:

Right, and that's, I mean, malpractice is one thing, and so you just have to kind of weed through that, and that's what's tricky about this disease is like if you aren't familiar enough, it can be challenging, and that's one thing that I always tell people like get a community, talk to those people in the community. You know, I think understanding the surgeons and how they operate is is key. The other thing that I think is important is not everyone has access to pay out of pocket, or they don't have access to be able to, you know, see a specific surgeon. What would your take be on the financial aspect of that too, because that does play a role in how we choose our surgeon.

Speaker 1:

And I think it's really important, as a patient, to both think about your financial limitations and also think about the financial pressures that a surgeon might be under right and it's not. You know, this is not something where I would say to you like, do or don't have surgery with someone based on the financial setup of their practice, based on the financial setup of their practice, but it is something to be aware of, right. Do they own their own practice or are they owned by private equity? Do they work for a for-profit hospital? These are all things that it's just important to know, because someone both faces different pressures of how long they get to spend with you and how many cases they have to do a week, and all those things based on who they work for. And similarly, like you know, if they work for in a practice where the people making most of the decisions are either people in finance or hospital administrators, those people are going to say you can't cut this person a discount for surgery, no matter how bad their case is, no matter how much they're suffering, no matter their financial limitations. It costs what it costs and that's not up to you, right? Surgeons who own their own practice do have more wiggle room. And so, as you're thinking about what your financial barriers are, also ask them when you make an appointment.

Speaker 1:

You can ask what it costs to see the doctor. You can ask what the out-of-pocket cost for surgery is and you can say do you guys ever offer discounts for people with financial hardships? Do you offer payment plans? These are all reasonable questions to ask. It's not insulting to ask how much it costs, right, just like if you were, you know.

Speaker 1:

If you're buying or paying for any other service, it's reasonable to ask what it costs. You can ask your doctor what it costs and if they can't tell you or no one you know often it's not the doctor who knows who who has that conversation but if whoever the administrator is or the coordinator or whoever can't tell you how much it costs, then you know that's sort of oh like. They often can't tell you specifically, right? Often it's going to be like well, your deductible is this and your out-of-pocket maximum is this, right, they can't always tell you exactly what the cost is going to be, but they should be able to set reasonable expectations. And if you're paying, if you're self-pay because you don't you know it's an out-of-network practice and they don't, you don't have out-of-network benefits, then yes, it should be a specific dollar amount. This is what it's going to cost you.

Speaker 2:

Right, Well, and I think too, is it worth when we're talking about the trustworthiness, is it worth? Looking into what doctors are being paid from pharmaceutical companies or surgical companies. Things like that Are those things that we should be looking for as well when we're looking at the financial aspect of finding a surgeon.

Speaker 1:

I think looking at whether or not someone is paid by a pharmaceutical company is always valuable. I don't think it disqualifies a surgeon, right. But if you know, if your surgeon got fit you know $15,000 last year from the makers of Lupron then like you should ask them like how does this impact your practice? What do you do with this? You know and, again, you should feel at liberty to ask your doctor about those kinds of things.

Speaker 2:

Yeah, I think one of the things that you know we kind of alluded to this a little bit, but the surprise billing aspect of endometriosis. So asking what your price is going to be for this surgery also means that you probably need a preoperative workup to know exactly what you're going to be charged for. How do you recommend going about that Is this, you know, figuring out how your provider the one that you're considering is practices. Do they do imaging first? Do they do the price check first? Like, what is your recommendation for that aspect of surgery and pricing?

Speaker 1:

I mean, I think it's very reasonable to ask like what does the appointment ahead of time cost, right? And then what is? You know what the workup is often is determined by the visit you have with the doctor, right? Some doctors are doing like dynamic transvaginal ultrasound and really like mapping endometriosis in the office and those kinds of things. Some doctors aren't doing that, right, and people obviously charge differently sometimes depending on whether or not they do the ultrasound, but sometimes they don't right, sometimes it's included in the visit, but certainly I wouldn't choose a surgeon because they do less workup and therefore the workup is cheaper. Right, because you know and I think we'll get into this more later but preparation is essential for surgery and I think that I'm a big believer that all of the preoperative workup is critical. And so you know, depending on who you are and what your case may need, the workup may be different the workup may be different.

Speaker 2:

Yeah, it's interesting that we are like talking about the workup, because it's not something that I had really considered prior to my excision surgery and I wish I would have, because I think it sets patients up better, knowing what they're going to have done in the operating room, and I think that if you're on the same page with your surgeon you have a better outcome. You know, I think that just planning is huge and so, looking at, okay, how do they, how do they do the billing for this and do they include the preoperative imaging or consultation or whatever I think that's, I think that should be part of the consideration in choosing a surgeon. Um, because I think it speaks volumes about their approach to your care. It's individualized at that point. Just that's my personal take on that.

Speaker 1:

Right, and I totally agree with you. I think you know you can figure out that financial piece before you decide to meet with them. But once you have made the decision to meet with a surgeon, that's when you should be looking really hard at what is their preparation like for your surgery, right? How are they building that mental map that they have of what they're going to expect and how are they talking to you about it? Right? I don't think it's ever fair for a surgeon to ask you for a blank check, to do whatever with no preparation ahead of time, right? You know, I have a colorectal surgeon in my practice, which means that, like, if you need a bowel resection, you're going to get a bowel resection, but you should be prepared for how likely it is that that's going to happen, right, and so that's what I find is essential. Is that expectation management? So when I'm doing the dynamic ultrasound in the office, I'm actually looking at your rectal wall, right, like I can look at the muscular wall of your rectum and I can trace it from you know where it leaves your body, all the way up to your pelvic brim. And so there are patients where I can say, like, look here, like see this line, we're following it up and right here it's fused to the back of your cervix and see this bump here like this is something that looks like an endometriosis nodule, and based on that, I stratify you as higher risk for needing some type of bowel surgery.

Speaker 1:

Right, and then we get into the different types of bowel surgery. What do I think you need, right? Most likely the most common type that we do in our practice is a discoid bowel resection. And so here you know, here's what that looks like. And if your disease is more extensive, then you would get a segmental. If it's less extensive, then you would get a shaving. But I stratify you as highest risk for needing this type of bowel surgery rather than just saying I don't know, we'll see when we get in there, but we're prepared for anything. You could wake up with a negative you know negative pathology. Or you could wake up with an ostomy and you know who knows. Right, that's not fair. That is not fair because at this point we have the tools to be able to give you appropriate expectations about your surgery. Imaging is not perfect. Doctors are not perfect. Surprises happen. But we should be able to stratify you as high risk or low risk for bowel surgery, for example. Right so that you can go into it knowing what you're going to expect.

Speaker 2:

And there's usually indications of deeper disease in imaging and if you know what you're looking for, you can tell pretty instantly, like that there's going to be more significant disease than superficial. And that's where, like I think that conversation always comes up a lot of times is, like imaging is it useful, is it not? Well, it probably is if you have deep infiltrating endometriosis, like, I think it's a good map to be able to see and if you have an expert looking at it, they'll know.

Speaker 1:

Mm-hmm, a hundred percent. And this is something I get into. Anytime I talk to someone who says, like you know, I had prior surgery, I had a myomectomy or something and then we discovered, surprise, stage four endo, like it's. It's not usually a surprise, you know, like it's. This is one of those things where it's like if you close your eyes and cross the street and you get hit by a truck, like surprise you were hit by a truck, right.

Speaker 2:

Right, that was the surprise.

Speaker 1:

Right Like it shouldn't be a surprise. Right Like good. If, if we hold ourselves to the higher standard of like needing and, like I said, like surprises do happen. I don't mean to say that I've never gone into a surgery and been like man. This is worse than I expect. No, that definitely happens. We all know endo is a tricky, tricky disease and our imaging for endometriosis is notoriously bad but it is getting better. And there's a difference between saying our imaging isn't perfect and so I'm not even going to try to look, I'm not even going to try to stratify your risk, and saying, based on all of the information we have, here's my expectation of what your surgery is going to look like. If it's more, we're prepared for it. If it's less, great. But here's what I think, based on my hundreds of cases of experience, what I think you know, this is my expectation of what your surgery is going to be like.

Speaker 2:

Yeah, I also think that it's imperative, before we even get to that step, to really read what other patients are saying. Like we talked about this a little bit, because I feel like you're going to get a good sense of how a practice runs and how a doctor practices by listening to the other patients. Now, take it with a grain of salt sometimes, because there are going to be those patients that nothing is going to be right and maybe it wasn't a good fit. Maybe they didn't. They weren't a good fit for this provider, but what do you suggest for people when they are seeking out advice from other patients? How, how would you go about that and what are some things to listen for that would make a red flag or a green flag for people?

Speaker 1:

For sure. I mean, first of all, look for the consensus, right, and the consensus means go to more than one source, right? Somebody may be like loved on Facebook and they're hated on Reddit, right? Or their Google reviews are great, but you know, again, a lot of these things. People find ways to curate reviews and that kind of stuff. So, like, look for lots of different sources, right, and then don't, you know, read the whole review.

Speaker 1:

Don't stop at like I had surgery and it was great, right, because sometimes it's like I had surgery yesterday and it was great and you're like, okay, you may still be under the influence of anesthesia if you had, if you like, just woke up from surgery and you're writing this review, right, and it doesn't really speak to, like the long-term experience of how you feel, and that's okay, it's, it's perfectly fine to write a review that just says, like they were a compassionate doctor, they got me in for surgery, the hospital took good care of me, like these are all important factors, like what was your experience at the hospital? What was your experience getting ready for surgery? But it's not a global review of, like, the ultimate result and, similarly, sometimes people will write a horrible review and it's mostly about the hospital rather than surgeon, or it's mostly about the billing office or the coordination of the surgery, right, Like things that are often outside of the surgeon's control, especially if they work for a big organization. If your surgeon works for a hospital, they're not in control of who's scheduling the surgeries or what time your surgery was, or the billing or any of those things. If they work for such and such hospital, all of those things are out of their hands. So, especially if they have bad reviews working for that hospital and they don't even work there anymore, definitely I would write like don't, don't bring that review into your thought process. Yep, and sometimes, you know.

Speaker 1:

Another thing to keep in mind is sometimes there will be. They'll say like this doctor is wonderful, and then when they describe the course of treatment, it gives you pause, Like we were just talking about you know surprises If they're like the doctor was wonderful, they believed my pain, they got me in for surgery, and then they were surprised that I needed a bowel resection so I have to come back for surgery in a month or two, but they were really fantastic, right, like that's something that should give you pause. And again, I'm not saying that should disqualify them as a surgeon, because surprises happen. And so if your surgeon was surprised and the general surgeon on call is someone they don't trust to operate on you, you would rather come back for another surgery than a bad surgery, right? And so in that case, ask the doctor about it.

Speaker 1:

You can say, like, how often do you get surprised? What happens if you get surprised? Who do you call if you need help? And again, look at reviews for the whole team. Look at you know, are they using the same colorectal surgeon over and over again? Does that person have good reviews, right? These are really really important things because you know, endometriosis is a team sport.

Speaker 2:

Right? Well, I think not. Every person is going to mesh well with every surgeon. Do you think it's reasonable for people to get multiple consultations with different surgeons? Is that a reasonable thing for patients to do in seeking their care?

Speaker 1:

Totally.

Speaker 1:

I mean I think, listen, you need to have peace in your heart about your surgical plan. It's okay to be nervous for surgery. It's normal to be nervous for surgery. But if you meet with a surgeon and something doesn't seem right, or they said something that gives you pause or you're just not sure, if you trust them, by all means get another opinion. I think sometimes people say you have to have multiple opinions. I don't think you have to have multiple opinions. If you feel confident, right, the doctor has gone through your case, they've reviewed your symptoms, they've reviewed your imaging. You feel at peace with the plan. You've connected with that surgeon.

Speaker 1:

I don't, you know, if you're suffering and you want to have surgery soon, I don't think you have to wait two months to get a second opinion from someone else, just so that you know another doctor can rubber stamp that plan Like no, that's not necessary if you feel peace in your heart. But if you don't get another opinion, you don't owe the doctor anything. And you know, I tell people all the time if you're sitting in the doctor's office and you're having a visit and they say something where you're like this is not like, this is not for me, I'm good it's. This is not algebra class. Like you don't have to stay till the bell rings, you don't have to stay till the end of the appointment. You can say to somebody like, thank you so much for your time. I appreciate you know, I appreciate everything that we've talked about, but I'm I'm all set, I'm good and you can excuse yourself Like you don't. You don't owe your doctor anything.

Speaker 1:

At the end of the day, especially with surgeons, you're interviewing them for a job. Right, the job is to be your surgeon. And so like yes, do a background check, check their references, interview them. Are they qualified for the job? It's the same thing. You're hiring someone for a job. I'm not saying you should be rude. Don't say to them like you seem like you don't know what you're doing, goodbye, it's not necessary. We're all doing our best.

Speaker 2:

I promise it's not necessary, right Like we're all doing our best. I promise there there are those too that you're like are you?

Speaker 1:

are you in this for the right reasons? But you're typically, if you get to this point, that's not most people. That's not, you know, and and I that is something I think it's important to talk about Most doctors. We didn't go to medical school so that we could have a sneaky cover to hurt people, right Like. No, we wanted to like.

Speaker 1:

Doctors want to do the right thing, they want to help, and I do feel that the vast majority of bad endo care because, at the end of the day, there's a lot of bad endo care out there and it doesn't come from a place of malice. It comes from a place of lack of education, lack of skill, lack of training, lack of time on the part of the doctor. Is the doctor accountable for not getting more skills and training and all those things? Yes, the doctor is, but you know, we're all. We're all humans, you know, and we're all trying to do our best and we all have a lot of different pressures on us. And so, at the end of the day, if a doctor doesn't seem like the right fit for you, it doesn't mean that they're a bad person or a bad doctor. It just means that you should politely say thank you so much for your time. I'm going to go now.

Speaker 2:

Yep, well, and that's like. I mean, this is like after you've had surgery and we talk about even, like if you've had one surgery and it didn't go well, and then you go see a new surgeon and they found all this endometriosis. Do you take that paperwork back and say, look, they found this. Is that part of education? Because we hear this all the time. Right, like we should be part of that change. We should be the ones pointing out the flaws, if you will, and I don't think it's a flaw, I think it's, it's an educational moment. Not everyone is, you know, too keen on learning from patients, but I do think that that is, if a, if a provider is willing to learn from you, I think that's a good thing too, in my opinion.

Speaker 1:

I, I totally agree, and I think this is one of those things where, like, some doctors are open minded and some doctors are closed minded and everyone's going to respond differently to that kind of feedback. And you know it has to do probably with their ego and their training and their belief system and what they had for breakfast and how their day is going right, how they're going to respond to that. But it doesn't hurt them for you to tell them those kinds of things. I think the thing that's challenging is you don't know why it is that the doctor didn't help right or didn't do a good job right. Is it because they don't have the skill to remove all of your endo? Is it because they didn't have the skill to remove all of your endo? Is it because they didn't even see it? Or, like, I know a lot of doctors who I actually think do have the skill to remove endo but they firmly believe it doesn't help. The only thing that helps is removing the cysts and removing any of the other disease. It doesn't help the patient feel better and so we're not going to subject them to the surgical risk of doing it, and so in those cases the thing that makes the big difference is to say to them, like I went, I had surgery, they removed all of the other endometriosis and now I have my life back. And you can always frame it to somebody as like it seems like maybe this isn't your area, because I went and I had complete excision surgery with another surgeon and now I can do this and I can do that and I can take a poop without pain and my life is great. And so you should refer to Dr So-and-so next time, because I think your patients will have a very different experience. And I will tell you, as a doctor, I also do this. So I had a, you know, and there's a classic example. There's a, there's an OB, a general OBGYN in this area. She's a great doctor. I I would happily like have her be my, my general OBGYN.

Speaker 1:

And I saw a patient of hers and she had had, you know, surgery for endometriosis. It was minimal, they did mostly ablation. Patient didn't feel better and then she ended up, you know, ivf cycles. Later she comes to me and I could see on her MRI was red as normal. I looked at her MRI. I was like right there, you have a nodule, it's on your rectum, it needs to come out Like you have invasive disease right here.

Speaker 1:

We went, we took, you know, I did the surgery. She got a disc bowel resection. She felt like a new person and I took the video and I went to that OBGYN's office and I was like, hey, you know your patient, so-and-so, I just want to show you. I brought lunch, right, she knew I was coming, I brought lunch. Let me just show you the pictures from her surgery. This is what I found, this is what I did, and she's coming back to you now for her well woman care. Of course, the patient went back for her well woman care and felt like a different person, and now I get referrals from that doctor all the time. I operated on one of her family members, right, and so, like there is a change, it is possible for that kind of education, both from doctors and from patients, to make a really big difference. But you know it takes work.

Speaker 2:

Would it be worthwhile and I just thought of this Would it be worthwhile to ask your surgeon hey, would you be willing to have like a meeting with this other surgeon so that we can go over my care or this other provider to go over the care that you provided for me, to give them a better picture? Is that reasonable or is that kind of like? Yeah, probably not.

Speaker 1:

So it depends. So I do this anyway most of the time, whether the patient asks me to or not. If I know the doctor or I have like a contact thing, I will reach out to them and say hey, I saw your patient, I want you to know X, y, z. And I do this the most, I will tell you with the fertility docs. The fertility docs in my area are some of them. It's like funny, some of them, I'm friends with them and so the patient will be in my office and they'll be like well, what do you think that my IVF doc would say about this? And I'll be like, well, let's ask her. I love that doc would say about this, and I'd be like well, let's ask her. And then we make a plan together, right. And I think that that's actually like those are the people who get the best care. When me, the patient and the REI are all on the same page. We make a plan together. It's like, okay, we're going to do this, we're going to do this, and then, like, you're going to feel better and you're going to have a baby and ride off into the sunset, right.

Speaker 1:

Whereas there's other fertility docs where I'm constantly like you know, I have their email address and if you look at our correspondences, it's just unanswered emails from me being like I wanted to update you about your patient. So you do that though. Oh, I'm, I'm such a pest, um, but a polite pest, I really. I tried, I tried to, you know, I tried to channel my sort of inner puppy. When I'm such a pest, but a polite pest, I really I try to. You know, I try to channel my sort of inner puppy when I'm like, hey, I just some doctors are really receptive to it, some doctors are not. And there are some doctors where I will tell you I don't, I do not try, I do not even try anymore. I know they don't want to hear it, and that's fine, you know, and and that's that's tough If a patient asks me to, then even if it's someone who's on my you know my do not engage list, I'll do it Right.

Speaker 1:

I also, you know, anytime I operate on someone, I also I have like a very set like. This is how we do it I walk out of the OR with a really big stack of pictures and I sit down with the family member and I make them take their phone out and they take a video of me going through the pictures. This is what it looked like before, right? And I have a very set, like I take a picture of this and then I take a picture of this and right. So I go through all the pictures, saying these are all the before pictures, and then I go through the after pictures. These are all the same things photographed after the surgery and that's yours, right? And so I'm like take this video wherever you want, show it to any doctor. You see, I'm proud of what I do, and so every patient of mine has a video of me like chit-chatting with their family going through pictures in office, Like when we are talking about our care, like do you take surgical images?

Speaker 2:

How many surgical images do you take? Do I, am I going to have access to these images? Those are all things that you should have access to. But to get clarification from your surgeon on because I mean, I'll tell you I've had multiple surgeons and I don't have as many pictures as I should. And, and I think, if you have to have a follow-up surgery of any kind or follow-up care, it's really helpful to know what people have done inside your body, and that is taking ownership of your body and knowing what's happened in your body. Having those images and having those videos or whatever are very, very helpful. So asking those questions, I think, is key.

Speaker 1:

Yeah, I think transparency is essential and it's funny there's transparency in sort of two different senses, right. One is the obvious. Like I'm transparent about what happened inside your body while you were sleeping. I'm going to give you complete documentation, not the op note. Right, like you get the pictures and you get my explanation of the pictures and why I did what I did, and then you know.

Speaker 1:

There's also what Malcolm Gladwell talks about in his book as transparency, which is, can you actually see through the person's face to see what is going on inside of them? Right, because there are people he uses the example friends right, like you can watch friends with the sound off and you know exactly how everyone is feeling and what everyone is thinking based on. Like you know the way that David Schwimmer's face looks. Right, with a doctor, you can't always do that. Right, because someone will seem super, super confident even if they have no idea what they're doing, and so he gets very much into ways to figure out if someone's you know, outside matches their intentions. And I think that that's sort of the really important thing, and I think that one of the best ways to assess that actually is watching how they answer questions. You know, and I think this is again, once you've gotten to the point where you did all of that vetting beforehand, right, you read all the things online, you looked them up, you've read their reviews and all that stuff. If you like what you see, meet with them. If you don't like what you see, that's when don't go see them, right, like, don't say, like, you know, I don't really, they don't really seem like they know what they're doing online. But I'm just gonna meet with them and see you know what, what it you know. Maybe maybe I'll feel like I trust them. If I meet them they'll convince me. Otherwise, you don't want to be convinced they're not qualified. You don't want to convince you that they're qualified. That's exactly what you don't want to do. And so I think you know I mean it's sort of like the classic, like the.

Speaker 1:

He writes a lot about this spy who people would be like she's doing a lot of things that really make it seem like she's a spy. And then people would meet with her and be like are you a spy? And she'd be like no, I'm not a spy, no, I'm not a spy. And people are like OK, good, most of the people thought you're a spy. She was totally a spy, right, and so same thing, right. If they seem not qualified, don't meet with them. But then, once you do meet with them, then you're looking for transparency in their answers. And so the classic example I give I'm going to give you three answers to a question and I hope that you'll see which one of them is obviously the most transparent, because I've heard all of these answers all the time.

Speaker 1:

Patients ask am I going to need a colostomy? One of the answers is I don't know. Our imaging is really unreliable, so like, it's not likely, because most people don't, but it's always possible, right, right, that's one answer. Another answer is no, you don't need a colostomy, right, no way, yeah, Another Right. The third answer is there are two cases in which I I need to use a colostomy in my surgeries centimeters from the anal verge.

Speaker 1:

In those cases, you will need a temporary protective ostomy for eight to 12 weeks to allow that anastomosis to heal and then your colostomy will be internalized. Based on your imaging, based on my ultrasound of your rectum and all of these things, right, I stratify you as very low risk for having invasive disease of the rectum within five centimeters of the anal verge, because I felt like I could see the muscular wall of the rectum within five centimeters of the anal verge, because I felt like I could see the muscular wall of your rectum very well at that level. The other instance is if you have bowel surgery and then you have a complication with an anastomotic leak, where you have to be readmitted and in order to allow that leak to heal, you need a temporary protective diverting ostomy for 8 to 12 weeks that's internalized later. In my last 100 cases an anastomotic leak has not happened. So it's possible, but the risk of this in your case, even if you need a bowel resection, is very low.

Speaker 2:

Right.

Speaker 1:

Yeah, I mean, I feel like those three answers are really different and I feel like if you hadn't heard the third answer, you may have accepted the first or the second answer, right, right, but the third answer is the most transparent. It's the like here are the. Here is here's my mental math on whether or not you need an ass and an ostomy. Right, right, it doesn't, and it doesn't matter what the question is. You could ask me any of the questions on those lists of questions to ask your doctor, and I mean, some of them have like a very black and white answer.

Speaker 1:

Do you do excision or ablation? You can't really expound like ablation doesn't work, so I don't do that. Right, but for a lot of these other more in-depth things, what are you going to do if you don't find endometriosis? Or you know I have a hypermobility disorder? How does that impact my care? Any of these things? There's a lot of different ways surgeons can answer those questions. Look for the one that is transparent. How are they thinking about this, as opposed to are they just trying to answer the question as quickly?

Speaker 1:

as they possibly can to get you to sign up to have surgery or what have you?

Speaker 2:

Do you think it's valuable to look at their social media accounts? Because you have social media which, by the way, if you don't follow Melissa, you need to, because I'm telling you, I laugh every single time that you post something. It's so funny and so relatable and it's one of my favorite things when you come up with something new, like the home Depot one, I was dying, that's like four times.

Speaker 1:

It was so I I have so many stories for you about I go to home Depot a lot. I'm one of those people like I. You know I secretly love plumbing projects, both internal and external, but I know right. But I have had seriously at both in Home Depot and in the garden center. I get stopped all the time wearing scrubs and people will be like do you work here? And I'll be like no.

Speaker 2:

Thank you, but no.

Speaker 1:

What is it about me that made you say like, oh that woman, she works here.

Speaker 2:

She works in the plumbing department with scrubs on.

Speaker 1:

Although I will tell you the other funniest thing that happened to me at Home Depot. This is like a total non sequitur, but I was replacing a lock on one of my doors and I asked the man who worked there, who was like an older man, like where do I find this? And he was like you know, I want this one in this finish. And we went to that aisle and he was like, oh, it's up there and you know how it's like those big stack things. It was on like the second stack and and there was not one of those moving staircases in the aisle. And he sort of looked around a little bit helplessly and I and I was like was like hold this. And I handed him the other thing that I was, um, that I was holding, and I climbed up the the display, like up the little shelf.

Speaker 1:

I climbed up to the second level, I grabbed the lock I needed and I climbed back down with it and he looked at me and he said you know, nurses can do anything. You're like that's. And I and I said I, I agree with you, but I happen to be a physician, and he goes oh no, I'm so sorry. It was like he knew. He knew in that moment that, like you saw a young woman in scrubs and he automatically assumed, like she must, she must be a nurse. And it was one of those, like I could tell the whole way home that night he was going to be like I feel so bad.

Speaker 2:

It was very funny, but it also means that you're going to age so gracefully because you look so young that you didn't it doesn't look like you went through medical school, right.

Speaker 1:

You know I, yes, but like it gets it's I get a little bit weary with. Like you know I. I get, you know, called. I get referred to as the medical student and the resident and the nurse, and you know the the janitor will call as the medical student and the resident and the nurse, and you know the the janitor will call me baby. I mean it's like in the hospital, and then people will be like that's the attending is her case. That's, oh, that's amazing.

Speaker 2:

Anyway, we digress back to choosing a surgeon. This is what happens at the summit. This is why we stay up so late And'm like, okay, is this, can we verify that this is actual good information? And you can do that. You can look at studies, you can look at verified resources and sources of information and see, kind of, if they're saying the similar things. And then sometimes you know I'm maybe a little bit different in this, but I do write comments, questioning sometimes some of these doctors hey, you said this in this post, what do you mean by that? Because that's valuable information.

Speaker 1:

Yeah, and I think it sparks a great dialogue, right, I think that that's really important and also, I think you know, some doctors incorporate patients into their social media. Some doctors don't, right, and some doctors sort of present things in very different ways, and I think that that's really important. You should look at it. You know this is this is how they conduct themselves and, as you mentioned, I'm the kind of person who, like my sense of humor, comes through most of the time, even even when I'm your doctor, obviously, like when something serious is going on, I'm not like, but I'm but um, at the end of the day, I do. You know that that is, it's part of who I am.

Speaker 1:

If that rubs you the wrong way, I'm not your girl. You know, everyone sort of sees, sees different elements of their doctor, whether they're incorporating, you know, are they posting on social media when they're in the, or Are they put you know, like all these different things, and then think about you know what your experience is going to be like as a patient and some people will be drawn to different things. Like I said, there's no one right answer, there's no one right way to do social media, no one right way to present yourself, but when you're the patient and you're looking for a surgeon again, it tells you a lot about who they are Right.

Speaker 2:

Yeah, I think it gives you a good picture into what it would look like for you as a patient in that operating room and as a patient of theirs. But I also think you have to follow that up, if you go to those providers, in how you talk to your surgeons. What are some things that you should be asking the surgeon in the room to best prepare you for your surgery?

Speaker 1:

Yeah, I think these are things that are really individualized, right, and I tend, you know, again, I do tend to struggle a little bit with, like, what are the questions you should ask your surgeon, because, again, a lot of surgeons know what you want to hear, and this is another thing actually. Again back to Malcolm Gladwell's book. He talks about how people behave when they're interrogated. Eventually, when you interrogate someone, even if they're like a really stoic person, most people will crack and they're just going to tell you what you want to hear, Although he does actually get into this really interesting thing about male and female prisoners of war and how the female prisoners of war were a lot less likely to crack when they were being tortured. And if you torture the other people that they're imprisoned with, the men would like give up national secrets to have them not torture the like female POWs. But the female POWs would be like go ahead, torture them, you'll be fine, I'm not saying nothing. Fine, I'm not saying nothing, anyway, but the point is, you know, with a lot of these lists, I think sometimes, like your list should be about you and what your concerns are, a lot of people will go and they'll print out five different lists that they found online and they'll ask every single question on the list to try to give their doctor, like you got an A plus. You knew all the answers. Your doctor knows the answers, and it's really about how they answer the question. How do they talk to you about this, rather than do they promise to only do excision? Yes, they should promise to only do excision, but it's more than that. It's really how much does it seem like they know about your case?

Speaker 1:

I think it's more important what your doctor asks you often than what you ask them, and you should be watching them, you should be paying attention. Like, did they ask me about my bowel symptoms? Did they ask me about my bladder symptoms? Did they ask me about my fertility goals? Did they ask me about whether you know if I don't want children? Like, do I want my tubes removed? They should really be asking you about how you feel and what your goals are, and then that should lead to an organic conversation with your doctor about, like, oh, how does this impact this? What's your approach to that? And the doctor should be giving you, like, a thorough, well thought out answer.

Speaker 1:

Why do you remove the cervix at the time of hysterectomy? Here are all the advantages to doing it. Here are the disadvantages to not doing it. You may have you know, you may be worried about this, you know urinary incontinence or prolapse or sexual function or these different things Like they. It's almost like they should be anticipating your questions even before you ask them.

Speaker 1:

I believe that some of the best doctors are the ones where you're not going to have a lot of questions for them, because they're going to almost anticipate what your concerns might be about the procedure that they're talking about. And there are times when I'll say to a patient, like, what questions do you have for me? And sometimes they'll be like I don't know, I'm like really overwhelmed and I don't have a question for you right now. And I'll be like, okay, a lot of patients at this point in the visit ask me about surgical recovery or they ask me about this. And they'll be like, yeah, let's talk about that. If the visit is incomplete and your doctor says, do you have any questions? And you don't ask them a question, they shouldn't be like, okay, well, call me if you do. Bye, right, like no, they should be making sure that you understand the whole care plan, and so I think that that's sort of an important thing to think about.

Speaker 2:

I never even thought of it that way. I guess I always. You know, in my mind I was always like you should go prepared, but I mean you should, but also like you should they should too.

Speaker 1:

They should be prepared. Yeah, you should be. You should be watching your doctor. It's again. They're not there to take a test. They're there to educate you about what they have to offer and how they can help you, and so if they're not doing that, then something's missing here.

Speaker 2:

Yeah, and I also think it's fair to ask them who is working with you, who's on your team? It sounds like I'm going to need a Bauer section. Do you have someone that you trust that does that, and what's their name? I think it's fair to ask who's going to be in that room with you for surgery.

Speaker 1:

A hundred percent, a hundred percent. And and you know they should be naming names right I mean, when someone asks me, who does a bowel resection for you, vince Obvious, does my bowel resections. He's. He's in my practice. The reason he's in my practice is because he's really good at this right. We did, however, many bowel resections together before we decided to be partners because now we were watching each other, and same thing with Vicky. We all have watched each other operate and we know how good the other people in the practice are.

Speaker 1:

No one should be deciding to be partners with somebody who they've never seen operate. That makes no sense. You, as a surgeon, you're vetting your partners and so you never want the surgeon who is going to do your surgery to be like I'll call whoever's on call for a bowel resection. I don't know who that will be on the day of your surgery, but like it'll be fine. And yes, there are times when things that will happen unexpectedly and intraoperative consults for whoever's on call do happen. That does happen.

Speaker 1:

It's not like you can have, you know, a thoracic surgeon and a diaphragm reconstruction person and a general surgeon and a colorectal surgeon and a vascular surgeon and a urologist and a gynecologist in the room for every single surgery. It doesn't work that way, right, but sort of knowing, like, okay, who are the other people I'm likely to need and who would that be, and then you know sort of going from there and again, how does your doctor handle this and part of it's also where does your doctor operate? If your doctor's in a hospital where, like, if they call whoever's on call, that person's going to be good or they know those people, that's a very different situation than you know. They operate in a place where, like, they don't have any friends right.

Speaker 1:

Doctors should have friends. They should have lots of friends in other specialties.

Speaker 2:

Yes, and they don't. You don't want to have a doctor. So, side note on this, I saw, like this, this doctor was doing a live and I think he was. I don't know what kind of doctor he was, but he was like cussing out his nurse for a section.

Speaker 2:

It was like something that she couldn't control and he live streamed this and I'm like, if he's treating his staff this way and the people in the OR this way, Does he have your best interest in mind? I mean, we don't always have access to that, but it was just one of those things that I was thinking to myself. I would never want someone to operate on me that treated someone else like that.

Speaker 1:

Yeah, I think a hundred percent. I think a lot of this is about the doctor's mindset and how, whether they're humble enough to have friends because they know they can't do it all themselves. I, like, loved my medical school. I think BU is the greatest place on earth, and my advisor, when I first got there, we called you know, hi, Dr Wittsberg, it's nice to meet you, blah, blah blah. And he was like you got to call me Bob, because I'm a big believer that if some people on a team are using an honorific and some are not, that creates a power imbalance and in the circumstance of a power imbalance, people are less likely to speak up in the event of a patient safety issue. This has been demonstrated. This is not a like. I think there's data to support that. If the nurses and the medical students are calling me doctor because I insist upon it, then they're less likely to say hey, do you see? Like you know, do you see that over there? That's concerning the doctor should not be yelling, they should not be intimidating people. They should. They should behave in a collegial way.

Speaker 1:

There's a lot of hierarchy in medicine and some of it's there for a reason, but not the toxic kind. There's everyone. Any person who's involved in patient care can prevent a medical error. They can, and medical errors are a big deal and they happen all the time to all of us. Nobody, nobody, is safe from medical errors, even with the best surgeon in the world. And so, at the end of the day, like if your doctor is treating everyone in a collegial way, such that you know, okay, if someone in the world and so, at the end of the day, like if your doctor is treating everyone in a collegial way such that you know, okay, if someone in the room is concerned and they bring it up, the doctor's going to take it seriously. That's huge.

Speaker 2:

That's huge. Well, and I also think that that gives you power in the relationship. Now, I don't want to say power, but balance in the relationship between you and your provider, because if you, if they are on a power struggle, they're not going to want to listen and have you be part of your care, and I think that we need to be the ones driving the train in our care a lot of times.

Speaker 2:

I think that makes a huge difference in how we drive that train, and if we have that co-pilot or whatever it is in a train, I don't know what it is A teammate, have that co-pilot or whatever it is in a train I don't know what it is A teammate Teammate, I think your success is going to be significantly better in your care all around. Is it important for us to talk to our providers about other providers that they work with? Is that a deciding factor for a lot of people, as far as like, if you're having a hysterectomy and you have to have a nephrectomy?

Speaker 1:

You don't have to have a nephrectomy unless you have cancer or a familial cancer syndrome and someone tells you you have to have a nephrectomy, I think you should get a second opinion. That said, it seems like what you're getting at is postoperative management, right, like if you're having ongoing symptoms after surgery, how is your doctor going to handle that and do they have a plan? And I think that that is. It's one of those things where it's tough, right, because some people do travel for care and it's important if someone's going to travel for care that they ask you about this. But obviously there's more barriers there, right. But, for example, in our practice we have someone built into the practice. We have a nurse practitioner who focuses on hormone replacement therapy, hormonal suppression for people who need it, a lot of sex medicine, right, sexual pain, that kind of stuff, and then just a lot of the non-surgical elements of pelvic pain, and we have her there specifically for this reason. Not only is she more available than a surgeon to help patients with this on an ongoing basis, she's actually better at it. Like, at the end of the day, like I'm a big believer in staying in your lane If a problem is not surgical, someone who's not a surgeon is often the best person to deal with it.

Speaker 1:

And so often when people go to the surgeon, the patient will say I'm still having symptoms, and the doctor will be like well, I guess you failed surgery. And it's like no, you failed surgery, like get out of here, right, and sometimes the answer is like no. Pelvic pain disorders are like bananas. They often grow in bunches and so the right answer is like okay, we fixed this element of it, what things might remain that can be treated to actually get you feeling better, and who's the right person to quarterback that part of your care? Because often the answer is the surgeon's not the best person for that.

Speaker 1:

And it's OK for your surgeon to not be everything. You know everyone and everything for your care Right, and I don't think it's wrong. But your surgeon should have a plan. They should have somebody where, like this is the person that we have available to you to manage this on an ongoing basis for you. And sometimes if you travel for care, then if they have that person in your practice, for example, with us, you can see that person in consultation and then you can do telemedicine with them going forward, because you've met them and there's so many murky laws around telemedicine, but at the end of the day, like often, doctors can have a plan for this if you ask them.

Speaker 2:

Are there any other pieces of advice or tidbits that we can take away to help us navigate finding the right surgeon or provider for us?

Speaker 1:

I would say you know, this is one of those things. Again, go through all of these different things. Look at the objective things. If the objective things don't add up, then you meet them. If you meet them and your gut tells you something's not right, listen to it. You need to feel like you have a therapeutic bond with your doctor and so, at the end of the day, I'm not the right doctor for everybody and I'm okay with that. Look for someone who is the right doctor for you. We're all you know everyone's looking for something different when they're seeking care and it's okay to listen to that feeling. Be like you know what they're really qualified, but something about them rubs me the wrong way. You can find another really qualified person to see. Don't trade the qualified person for an unqualified person who seems really nice Please don't do that. But you can find a different really qualified person who you vibe with Right and that's who you should go with.

Speaker 2:

Yeah, and these are all things that I think we've heard like the general answers, but these are also tangible things that we can do to find a really good provider for us. But it is going to take a little bit of work. If you want quality care, I think we have to put the work in, unfortunately, to find that. But, that being said, you have created a document where people can take this and kind of go down the list and it kind of explains different pathways to figuring out if someone is the right provider for them. So everything that we've talked about today, you have been amazing to put into a form that people can take and they can fill it out for themselves so that they can just map out their plan and map out their provider to figure out who's best for them. So thank you for doing that. I will put that on my website. I will put that on the bottom of this description of the episode so you can find it there as well.

Speaker 2:

Last, pieces of advice or pieces of wisdom that you would want to bestow on someone. What would it be?

Speaker 1:

I would say if you're not finding what you're looking for, keep looking. There are people out there who can help you. Don't settle yeah.

Speaker 2:

And then also go follow Melissa on her Instagram, which what is your handle? This is Dr Melissa McHale. I didn't have, like a creative thing. I couldn't do it. The creativity is in the posts. Okay, I try. They're so fun and and so I think that it's good to just laugh in this disease because it can take a toll. So I appreciate when, especially, doctors come with humor. I don't know why it just brings so much joy to me. So thank you for doing that and thank you for taking the time to do to sit down with me and to go over all of this and to make a sheet for us to learn more. This is going to help so many people who have felt like maybe some of these answers weren't answered before.

Speaker 1:

There you go, so thank you so much for for doing yeah, thanks for having me, thanks for having me. This was, this was great yeah.

Speaker 2:

You're welcome back anytime. You're welcome to sit with me at the table. Oh, be careful I know it could be really random. Honestly, with my ADHD, we could have a great time. Until next time, everyone continue advocating for you and for others.