Opinion: You don't want a jack-of-all-trades surgeon

Story highlightsSurgeons who perform more of the same surgery have better outcomesStudy: Patients of high-volume surgeons have fewer complicationsBut some surgeons are just more skilled than others, Dr. Anthony Youn saysI once worked with a plastic surgeon, let's call him Dr. Saul, who performed cleft lip and palate repairs, face-lifts, breast reconstruction after mastectomy, and even complex repairs of tendons in the hands and fingers.

His practice wasn't very busy, so he performed some of these procedures only once every few months. While the breadth of Saul's practice was impressive, I couldn't get over the question:

How many different types of procedures can you trust one doctor to perform?

As a board-certified plastic surgeon like Dr. Saul, I'm fully trained in cosmetic surgery, hand surgery, burn surgery, cleft lip and palate surgery, reconstructive surgery, and microsurgery. But if your child has a cleft lip or your finger has been cut off, you probably don't want me as your doctor.

I'm not a jack-of-all-trades surgeon. And studies show you don't want one.

A 2007 study from the University of California, Los Angeles, examined 14,000 endocrine operations and analyzed the complication rates when categorizing surgeons based on the number they performed each year.

The group of surgeons with the lowest frequency (one to three per year) was responsible for 15% of all operations but 32% of all complications. This is contrasted with the group that operated with the highest frequency (100 or more per year); they were responsible for 15% of all operations but only 5% of the total complications.

A more recent study out of Tulane University looked at adrenalectomy surgery. Researchers separated surgeons into low-volume (one or less procedures per year), intermediate-volume (two to five per year), and high-volume (more than five per year) categories. The patients of low-volume surgeons were nearly twice as likely to develop a complication as patients of high-volume surgeons.

The critically acclaimed author and surgeon Dr. Atul Gawande wrote about this subject in his best-selling book "Complications." Gawande visited Shouldice Hospital, well-known for having the lowest recurrence rates for hernia.

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surgery in North America. He found that each surgeon performed the same surgery, the same way, 600 to 800 times per year.

This resulted in a recurrence rate of 1%, compared to 10% to 15% at most other institutions. At Shouldice Hospital, repetition breeds success.

But isn't there more to it than sheer numbers of surgeries performed?


Ask any surgical nurse and he or she will tell you that some surgeons are just more skilled than others.

A University of Michigan study recruited surgeons to analyze videos of other surgeons performing operations and judge them as being more or less skilled based on the quality of their movements during the procedure. They found that surgeons who were judged as being more skilled had better outcomes and fewer complications than surgeons who were determined as being less skilled.

So there's more to choosing a surgeon than simply the number of procedures he or she performs. Bedside manner, meticulousness, quality of training, technique and the surgical facility all play a part in the outcome you might have.

But, as a general guideline, it's probably best to consider a doctor who performs a large number of the operation you are considering. Ask your surgeon how many he or she has done before signing up for the procedure.

In surgery, you don't want a jack-of-all-trades, master-of-none.


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Can acupuncture be substituted as a form of anesthesia during surgeries?

From what I what is acupuncture what is acupuncture and how does it acupuncture treatments work and how does it work understand the acupuncture clinic yes, in certain cases it can.

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How to Optimize Keywords and SEO Titles

Avoid Keyword Stuffing

There is a lot of information on the dangers of keyword stuffing, which means over-use of your keyword or keywords in the Title, Description and in the text for the article. Google invokes a penalty for keyword stuffing, though the threshold keyword density is not exactly known. There are various tools for counting keyword use frequencies. Keyword Density is simply measured as the relative number of times your search term ( Keyword or Keyword phrase) occurs as a percentage of the seo services canada total number of words on a given page. The ideal Keyword Density is about 3%-6%, but the various search engines have different threshold levels before they apply penalties (nut they keep them secret). Reasonably high Higher Keyword Densities can help to boost a page rankings but don't overdo it.

Keyword Density can be boosted by using the keywords repeatedly in the Header tag, Body tag, Title tag, Comment tag, Anchor tag, Alt tag, Image tag, Paragraph Tag and Domain name.

The other general advice for titles is not to exceed using the identical keyword in the title more than twice.

How Google and other Search Engines Register and Rank your Keywords in the Title

It is not widely understood, but Google and other search engines register and rank EVERY individual keyword in you title and EVERY combination, including various orders and positions for the keywords. Although there is priority for phrases with the keywords in the order they are in the Title, and for words that appear first, Google will register all the keywords and phrases and derive a ranking for them.

Dilution of the Weight of the Keywords in the Title

Google also appears to regard long titles as more likely to be Sammy (especially very long titles). Longer titles may also appear keyword-stuffed. Research has shown that the first keyword in the title has the highest weight, the second keyword has somewhat less weight and so on. By adding more words you may dilute the weight applied to each of them. For targeting of two word searches and phrases it is important to keep keywords close to each other and in their 'natural' order. Try to match the likely order of the terms in the search phrase, to the order in the Title. The Autosuggestion tool is a good way to understand how much people search for the phrase you are targeting.

Can Using Multiple Keyword Phrases Multiply Your Traffic

If Google derives a rank for all the words in the title, surely by including two or three keywords, rather than one will be more likely to get more traffic. The traffic for each word should add up and multiply. Understanding when this is appropriate and when it is not is the crux of optimizing titles. As explained previously the weight or value of the keyword appears to fall rapidly as you move from the first word to the last. More keywords appears to dilute the weight given for each word. Also there is the important issues of relevance. You page may be penalised if the words you use are not highly relevant to the content of the page.

The key aspect is Competition - If the competition is High - Only use a single Phrase

If there is a lot of competition for a keyword then its is best to only use a single keyword of phrase. Stick to the Keyword Phrase you have found using the Google Keyword Research Tool for use in the title. You know the Statistic and competition for that exact phrase and it is unwise to fiddle with it. Various tools can be use to estimate competition for the phrase and the likely traffic. The Keyword Research tool shows how even minor changes in the phrase can dramatically affect the traffic and competition.

If the competition is high you have to maintain the strength of your page and title to compete. Adding extra phrases will dilute the weight applied to the keyword. You will be competing against pages that are likely to be strongly targeted on that keyword phrase as well. You could lose the battle if you don't have that singular, highly focused Title for the keyword.

If there is Moderate Competition Enrich Your Title with More Keywords

For moderate competition there are several ways you can go to use multiple keywords in the title.

Using Two or more Modifiers - The solution to not duplicating the keyword is to add one or two extra modifiers or action words. If you look at the competitive keyword phrases shown by the Google Keyword Tool you will often find that two phrases look promising that both contain the primary keyword or phrase.

[action word1 keyword] + [keyword action word2] = [action word 1 keyword action word2]

For example, lets say you are looking for a keyword title for an article about the health benefits of Green Tea, and you need a long-tail keyword narrowing the search. The obvious solution is:

Health Benefits of Green Tea Extracts

This provides a title for four phrases

Benefits of GreenHealth Benefits of Green TeaGreen Tea ExtractsHealth Benefits of Green Tea Extracts

Another example is a title about Professional Make-up Artists

Reviews of Professional Make-up Artists + Make-up Artist Portfolios = Reviews of Professional Make-up Artist Portfolios

which makes the title target four phrases in one:

Reviews of Professional Make-up ArtistsMake-up Artist PortfoliosProfessional make-up artist portfoliosReviews of Professional Make-up Artist Portfolios

In both cases this very simple tactic makes it possible to create a short concise title that is enriched by optimizing it for more than one key term and narrowing down your target audience. Perhaps your article is about creating portfolios and how to find and review make-up artists and this title targets these keywords. Of course, it is often hard to find word internet marketers combination similar to these and it emphasises that Title design is a real art. These examples also shows how use of action keywords and modifier phrases to target buyers who are ready to buy, which will fulfil the aim of your website.

Long-Tail Action Based Keyword Choices - Long tail titles using action words are generally more effective, as action-based queries usually attracts users that have already got their credit card out and are hungry to find what they want and to buy it. Targeting your audience will lose part of the potential audience but the ones you have filtered for will be more likely to buy.

The role of seo title optimization is to enrich the keywords in the title that potential buyers might use when conducting a search to target the group that is interested in your product or services.

The best strategy is to built a long-tail keyword title, not by using poorly selected action words as modifiers, but by researching the action words and phrases as well for maximum benefit.

Combining Competitive Keyword Phrases to Enrich the Title

The Google Keyword Research Tool may show two promising keyword phrases that essentially relate to the same topic. For example lets say you are marketing green tea extracts using their health benefits, particularly to help people trying to lose weight. The Google Keyword Research Tool shows three competitive phrases

green tea extractgreen tea health benefitsgreen tea health benefits for weight loss

These phrases can be combined in ways that retains the order of the words ( with green tea as the first phrase) but allows ALL these phrases to work in your title.

For example

Green Tea Extract : Health Benefits for Weight Loss

This ideal long-tail keyword is optimized for all three competitive phrases.

The Ideal Separator for two Phrases - What is the ideal separator when using multiple keyword phrases? It does not really matter. You can use a pipe (|), a colon (:) a dash (-) or a comma (,).However don't use the underscore ( _ ) as search engines don't recognise it as a separator. These characters have no ranking benefit, but they help make your title readable.

Dealing with Plurals and Synonyms

In some cases you may want to expand the keywords in the title to include plurals, synonyms and other expressions for your topic. For example "architect supply", "architectural supplies" and "technical drawing equipment" essentially deal with the same topic. You will need to craft the title to include these variants if you can.

For example: "Architectural supplies : Technical Drawing Equipment for Architects"

One of the potential dangers with targeting a single term in you title is that it creates a tendency for over-optimization, even when its not intended. You may use that single keyword everywhere on your page. It you include variants this is less likely to happen.

Don't Overdue It!

You need to be careful because adding more keywords can mean that each of them will have less and less impact. The more you try to stuff extra keywords into the less natural it is going to sound. For example, if you use the following title it will appear in the search results as

Cheap Coffee | Gourmet Coffee | Ground Gourmet Coffee

Google won't like it as it will be interpreted as keyword stuffing. Your potential customers won't like it because they will see it as unnatural and likley to provide useless promotional material

Much better would be:

Low Price Ground Gourmet Coffee and Fresh Roasted Bean Suppliers

Which version looks better in the search results? Which one is less likely to be seen as keyword stuffing and deception?

If you have a keyword 'Recycling Information How And Where To Recycle

What if you want to optimize an article for the keyword "Recycling Tips" as well ?

You could build a title such as

Recycling Information Recycling Tips How and Why Recycling is Better

But this is clearly keyword stuffing and Google will probably penalise it.

A better option is

Recycling Information Tips, Tricks and How to Recycle

You can see that your second keyword recycling tips is in the title, but with the keyword word information in between. This will be slightly less effective but Google will still list you page for the keyword Recycling Information Tips. If you look at the search results where the matching keywords are shown in 'bold', you will consultant seo notice that this often occurs even for pages that appear high up in the search results.

Final Thoughts

Building traffic is important, but its conversion rates that really matter.The keyword tail should not wag your dog (marketing strategy). Keep the focus on the major keyword and keep it at the front of your title.Use association and keyword matching to group keywords. Rank your potential phrases for search popularity, but make sure you can compete for them and cascade down by adding modifiers to build the ideal long-tail title that will work.Never forget that a human user will determine your conversion rates, not the search engines.Your titles must be readable and appealing.



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