Experience matters. Look for a provider with years of experience helping patients with venous disease. A recent article in the Journal of Vascular Surgery emphasized the importance of having teams dedicated exclusively to helping patients with varicose veins. There has been an explosion in the number of physicians providing venous services. Some providers have added varicose vein procedures as a natural extension of their practice, while others may have less obvious intentions. This lesson is designed to help you find the right provider, and to know what questions to ask.
How long have you been treating varicose veins?
This question is all about experience. There are different skill sets for different procedures. If you had to choose between providers with two days of observation in a seminar vs. an accomplished specialist with years of experience, it is only natural to pick the experienced provider. Does the physician have a practice exclusive to venous problems, or is venous disease a small portion of the larger primary focus? Venous anatomy and pathology is complex, and there is no substitute for experience and dedication in this field of medicine. It reasons that the more knowledgeable and dedicated a provider is, the greater skill he/she possesses to manage varicose vein concerns.
What training do you have?
Some providers have attended a weekend seminar and are now self proclaimed ‘vein specialists’. The reality is that there is only one fellowship in Phlebology, and no formal curriculum in vascular surgery or interventional radiology. This means that some physicians have attended seminars and then searched for quality preceptors to spend further clinical time as they gain knowledge in venous disease. Regardless of the path to phlebology, providers should have credentials shared on the office walls to include medical school diplomas, board certifications, and ultrasound credentials if performing diagnostic services in the office. Strengthen beliefs and confidence with the provider by asking questions about how they became interested in Phlebology and what efforts did they pursue to find quality training.
What are your complication rates?
In a perfect world, complication rates of providers would be public record. The reality is that we are far from that yet complications exist from any venous procedure and this question is perfectly appropriate. If the provider offers a candid discussion about his/her experience, that should say something about the provider. A provider who shies away from answering this question should raise a red flag.
What types of services do you offer?
Be wary of providers who only offer one treatment option. Thousands of patients have received thermal ablation for the great saphenous vein, but their physician offered no treatment options for the painful veins at the surface. Is that because the provider only had knowledge to perform thermal ablation? Look for a provider who is skilled with a variety of treatment options and who is committed to meeting your objectives.
Will my insurance cover your treatments?
Insurance companies have medical necessity policies and therapeutic guidelines. If treatment is rendered and medical necessity is not met, the patient is stuck with the bill. If medical necessity is established, but a procedure is performed that did not fall within the plans guidelines, the patient is stuck with the bill. To avoid financial surprises, it requires dedication of the practice to help patients in need with this administrative task. A sign of an accomplished vein practice is one that can not only meet the medical expectations of freedom of pain and swelling, but also avoid financial surprises.
Who will be performing the procedures?
There are risks associated with any treatment for varicose veins. Although the standard of care in most communities requires physicians to perform laser, surgical, and image guided procedures, some nurse practitioners and physician assistants have begun performing invasive procedures in states that permit this activity. Ask the questions and be aware that the person performing a potentially limb threatening procedure may not have a license to practice medicine and may not be able to manage a complication if one were to arise.
Varicose and spider veins represent a common medical condition affecting over 20% of adult Americans. Search for the best and share your expectations, and do not be afraid to seek a second opinion. Vein treatments are not without potentially devastating complications. If the provider cannot meet your expectations, ask if the provider is experienced enough to meet your needs or if your goals are set to high.
