Earlier this year my father had surgery for prostate cancer. His biopsy had been done at another hospital, but with a son who is a urologist, I felt the least I could do was have the operation done at the hospital where I work. Being a urologist at the same hospital, I thought I would also be better placed to stay by his side through his treatment. Once the hospital was decided, the next question remained: which of my colleagues would I ask to take care of my father?
At first I thought I was in a relatively fortunate position. I was a professor in the same department of the same hospital, and I knew what the operation involved. My situation seemed different from that of a family member who does not even know whom to ask. But when I actually started looking, the information I really wanted was hard to reach — outcomes that matter but are hard to find, such as how much incontinence or change in sexual function to expect after surgery, and how often the cancer comes back. Working alongside someone every day did not mean I knew those things in any detail.
What I learned by asking around was mostly about the features of each surgeon's operation: that one used a particular approach, with these advantages and drawbacks; that one operated quickly; that another paid particular attention to a certain step. It helped with the choice, but it did not fully explain the outcomes I wanted to know. To judge how much each of those features would affect my father's recovery and the rest of his life, there were still gaps.
There is a reason the data are missing. Surgeons have no obligation to publish their results, and there is not much to gain from doing so. So the numbers that reach the outside are mostly the presentable ones, and sensitive figures such as recurrence or positive margin rates are sometimes shown only in part. Even when numbers are available, they are hard to compare as they stand, because the same measure means different things depending on which patients a surgeon mostly operates on. It is only natural that a surgeon who takes on more advanced disease has a higher positive margin rate.
If it was like this for me, a professor in the same department of the same hospital, I wondered what it must be like for a family member who is not a clinician. I could at least understand what I was told and think about what else to ask. Even so, I did not feel I had enough to make the choice. For someone to whom the disease and the operation are unfamiliar, simply sorting out which information matters would be hard. Meeting several doctors and comparing their explanations would not, on its own, let them set actual treatment results side by side. In the end they would decide by putting together the impression they formed in clinic, recommendations from people around them, other patients' experiences, and a few features of the operation they had heard about.
That is how I, too, entrusted my father to one surgeon. It was not a decision made after every question had been answered. I weighed the pros and cons as best I could, gave weight to what mattered most to me, and accepted the parts I could not fully verify and the parts I had to give up. Whichever way I chose, the advantages of the other options would remain. Choosing a doctor after confirming every condition I wanted, and being completely satisfied, was not possible even for me.
What, then, did I ultimately want to choose on? Thinking back, it was whether this doctor was someone I could trust. Skill matters most, of course. I wanted to leave my father with someone who understood the field deeply, had the techniques it required, and had refined their judgement through experience. On top of that, I hoped for someone with enough conviction to stand behind their judgement, and who knew where that conviction ended. Above all, I think I wanted to see whether, in making important decisions, this person would take seriously the body and the life entrusted to them, and whether they were honest and responsible as a human being.
That kind of trust is hard to confirm in one short consultation. You can only guess at it, little by little, from the attitude that comes through while they explain, the way they answer questions, how they treat patients. The reputation you have heard over the years feeds into that judgement too. Reputation alone cannot tell you everything about a person, but it can be a clue to the time you did not see for yourself. Putting together skill and knowledge, the seasoning that comes with experience, and an impression of what kind of person they are, I think we end up trusting someone with our body even without being able to know enough.
Once my thinking reached that point, the question came back to me. Am I that kind of doctor for my patients? I found myself asking whether I am academically well enough prepared in my field, whether I keep refining the skills my operations require, and whether my judgement is deepening as my experience grows. I also asked whether, on busy days and tired days, the way I treat patients matches the values I say are important, and whether my convictions rest on enough evidence. A worry that began with wanting to find a good doctor for my father turned into a look at what I myself need to have.
The parents sitting in front of me are making the same judgement. While listening to me explain, they are working out whether they can trust this person with their child, and matching what they heard before coming to hospital against the doctor in front of them. But in a short clinic visit it is hard to convey fully what I consider important, on what basis I make treatment decisions, and what I am careful about. Parents, too, need time to organise their questions and take in an explanation, and sometimes what they wanted to ask only occurs to them after they have left the room.
So I came to think there needs to be a channel through which I can explain a little more deeply, outside the clinic — a space where people can read calmly about a condition and its treatment, and also see what evidence and deliberation lie behind the doctor recommending that treatment. That is part of why I write here. A few pieces of writing cannot prove skill or character, but I think they can at least show a little more fully what I know and what I do not, and what I consider important when I make a judgement.
Just as I hoped, when I was choosing my father's surgeon, to find someone I could trust, the parents who come to my clinic now must feel the same. I mean to think about what that trust requires, and to look at how I treat people even as I refine the knowledge and skills of my field. I hope that I, too, am gradually becoming the kind of doctor I went looking for on behalf of my family.