How surgeons' duties surround the entire invasive process, and therefore make them something closer to specialists.
Jeffrey Indes, MD
The role of a vascular surgeon is not one only limited to the operating room. In an interview with MD Magazine®, Jeffrey Indes, MD, director of residency and a vascular surgery fellow, site director of Jack D. Weiler Hospital, and professor at Albert Einstein College of Medicine, Montefiore Medical Center, detailed how a vascular surgeon is a specialist whose duties begin in the preoperative phase, continue through the postoperative phase, and call for collaboration with a patients' entire team of care providers.
On defining the modern vascular surgeon
Indes: Basically, a vascular surgeon is different in the fact that we deal with such a broad spectrum of vascular patients, and we deal with patients at all stages of the process. Some like to refer to ourselves as vascular specialists, because there’s a lot more to it than the surgery part. There’s a lot of medicine involved in managed disease processes, non-operatively, such as exercise, ultrasounds and surveillance, screening.
And in addition to internal medicine, there’s lot of radiology involved—we have to conduct ultrasounds, angiograms, and we perform minimally invasive procedures in addition to open surgeries. It’s a very broad spectrum specialty, and I like to refer to us as specialists.
I’ve experienced that elsewhere, and actually, the society of vascular surgery has made some strides to identify vascular surgeons as specialists for these very reasons. We do a lot of non-operative management for the patient as a whole.
On the preoperative and postoperative role
Indes: We follow these patients for significant amounts of time. However, here at Montefiore, it’s much more of an active role because of the diversity of the patient population and disease patterns, and just the sheer volume of patients. I do it a lot more and to a higher degree than other places I’ve been.
Before the procedure, we identify patients at risk for vascular disease and we screen them with visits and ultrasounds, and then we follow them if they don’t meet surgical criteria at regular intervals at office visits. We manage them from a medical standpoint and follow them with‚ if needed, ultrasound studies.
Afterward, in addition to postoperative stuff, we follow them to make sure they don’t have additional or recurrent disease. We do that with the help of imaging modality, if the physical examination suggests we’re needed.
On relationships with patients
Indes: We really need to know our patients as well as their regular doctor because many are with us for the rest of their life. These patients can be very prone to additional and recurrent disease. Being a vascular specialist you deal with it in all parts the body (with the exception of the brain and heart) so some patients develop it in different vascular beds.
We develop long-term relationships with them. We get to know them much better to a functional capacity so we can better understand the treatment that would be best for them. We can tailor the treatment for the patient. I think having a relationship and knowing the patient makes that a better decision making process, rather than just seeing them and not knowing them.
You see them at regular intervals, our clinics tend to be packed, and we rely on EMR and a good multidisciplinary team approach so they don’t get lost to follow-up—that we’re on top and keeping in touch with them. We have our office staff and nurses help us keep in continual contact with them.
As vascular specialists, we do cross-management with other subspecialties. So we maintain a good working relationship at our institution—maintaining that relationship and sharing patients with them helps when we overlap. It gives us more help to deal with the volume of our patients.