There's a dirty little secret when it comes to surgeons - most people don't have a clue as to who's really good and who's mediocre! There are no independent rating services, the work is actually covered up in most cases, and the doors to the inner chamber are off limits to all but a select few. Most doctors don't even know who is amongst the best.
This is a problem that I've thought about over my 18 years as a surgeon. I consider myself amongst the best, but I've noticed so does nearly every other surgeon. So, clearly an inflated ego is not the way to judge! How about bedside manner? Well, that actually has no bearing on surgical quality! During my five years of residency training, I was consistently criticized for my poor bedside manner. My mentors complimented my surgical skills but complained that I needed work on my interpersonal skills. (As it turns out, chronic fatigue was a better explanation of my grumpiness! When I started sleeping more like a normal human, I started interacting more like one! So, my apologies to all those affected during residency) There are lots of surgeons who excel at the bedside and struggle in the OR.
How about caring? Does a surgeon who cares operate better? I remember William Hurt playing the lead role in the 1991 film, The Doctor when he went to look for an ENT; he commented "I'd rather have a surgeon who cuts straight, and cares less." His attitude quickly changed as he became a throat cancer patient and experienced a taste of his own harsh bedside manner. From my point of view, it's critical that your surgeon care more for you than for his reputation, his calendar, or his wallet. These are the things you don't need to be in the OR to pick up on. Selfish people act selfishly, especially behind closed doors!
Honestly, honesty matters! A surgeon who struggles with the truth faces so many troubles. An honest surgeon spends a career examining his techniques and his results, always willing to change and adapt. An honest surgeon will send you to someone better - because they have the integrity to both realize it and to follow through with it. An honest surgeon acts the same whether or not anyone is watching. Surgical training is one of the toughest things a person can face and the temptations to take shortcuts loom everywhere. Integrity starts in medical school and shapes a career. If a surgeon is not honest in the exam room, why would you expect honesty in tougher situations? Look for integrity!
Ask tough questions. A surgeon's answers should help indicate how comfortable they are at their craft. Surgeons who can handle tough situations should be able to handle your tough questions! Patients who ask tough questions are usually well informed and care deeply about what's going on. So, don't back away from asking questions and never book a surgery with someone who can't explain your situation to you. You will live with the consequences of your decision, whether the outcome is good or bad. A good surgeon will be intellectually and emotionally invested in your outcome - so never book an operation with a surgeon who doesn't seem to care.
One of the few clues you have is the closure. I've never seen a surgeon make an excellent closure that didn't take the same attitude towards the work on the inside. While it's no guarantee, a surgeon who has meticulous closure technique usually works that way with the other parts of the operation as well. Sure, a dishonest surgeon could be sloppy on the inside and make it look good on the outside - but a surgeon with integrity will operate with consistency throughout.
Finally, get a second opinion. I tell patients all the time that an honest second opinion will make me look good if I'm doing my job right! A second opinion should reiterate the need for the surgery and the appropriateness of the decision making. Don't be afraid to ask only for an opinion - if a surgeon is told you're seeking only information then you're more likely to get just that. Feel free to focus on just the aspect you're concerned about - no need to go over the basics or the details that you're already comfortable with - focus on the areas of uncertainty and look for reassurance or a new direction. Finally, never apologize for wanting to be sure. It's your health on the line and you will live with the outcome long after the surgeon has moved on to the next case.