Michigan Vascular Access, PC is a full-time, dedicated dialysis access practice, and Dr. Webb is one of few surgeons in the area who focus their practice on these patients.
Dr. Webb speaks:
“Focus is one of the elements of expertise – it is easier to master a limited area than to be an expert in everything. As a general surgeon in the country (rural Illinois, 1997-2000) I can attest to that – I took care of hemorrhoids, hernias, lumps, bumps, appendicitis, hot gall bladders, breast cancer, skin cancer, colon cancer, auto accidents, industrial injuries, and the occasional ruptured aortic aneurysm. It was very difficult to feel like a world class expert in every area.
Now, all I do is dialysis access, and I have been doing 15 to 25 dialysis access cases a week, week after week, a thousand cases a year, for the last 16 years. Eventually, you reach a point where you have seen nearly almost everything at least once”.
Volume is another element of expertise – more volume leads to experience – more experience leads to better results – better results leads to greater recognition and more volume.
Dr. Webb says: “One day a patient’s wife asked me ‘How many of these procedures have you done?’, and I could not give even an approximate number, though I had done a lot. That ignorance was a problem. Since that time, I have made it a point to track, and periodically publish my numbers (see MVA newsletters, and ‘Case log’ in ‘Experience’)”. These are very big numbers, but that is not the whole story.
It is not enough to say how many case you have done, but people are also interested in the outcomes – “How did your cases turn out, and what can I expect?” It is my position that, if a surgeon does not know his own results, s/he cannot give the patient informed consent. Therefore, each surgeon must have a handle on their outcomes. Our results for fistulas were last examined in 2009 – we refer to those statistics to help patients make their decisions, and to create realistic expectations. Another effort is underway to examine our outcomes in the 2009-2011 cadre – I expect them to be better than our results in 2009. (links to “2012-2013 MVA Newsletter”, “2011 MVA Newsletter”, “2010 MVA Newsletter”, “Results on Fistulas”), our local presentations, and at national meetings.
We have looked at our results to address many important questions in vascular access. Our conclusions and results have been presented at local, regional, and national meetings.
Download: Results presented at the Society for Vascular Surgery, Boston, 2014 (297.4 KiB, 469 hits)