David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



Welcome to Dr. Nelson's
Choosing a Doctor Page

You are here because you have a hand problem and don't know which way to go! You need to decide if Dr. Nelson is the right hand surgeon for you.

This discussion presumes that you have a hand problem and that you live in the Marin County, California, area. Dr. Nelson only treats hand problems. If you have a general orthopedic problem, call the office at 415-925-0501, and the staff will direct you to a general orthopedist in your area that Dr. Nelson knows and trusts, and would send his own family to. If you do not live in this area and need to find a hand surgeon, go to ASSH.org, and look in the upper right hand corner for the link that says Find a Hand Surgeon.

Choosing a hand surgeon can be confusing. It need not be, please read on..

What is a hand surgeon? Click here to find out!

Your hand is important: you use it every day. Choosing the right doctor for your hand is also very important. There is no one right way to choose a doctor, but here are some things you should consider.

1. Choose a doctor who is Board Certified in Hand Surgery, not something else

The first thing to consider is the doctor's academic qualifications: is he or she Board Certified in Hand Surgery? The highest certification that a doctor can have in hand surgery is called the Certificate of Added Qualifications in Hand Surgery. A hand surgeon who has such a certification will list it in their yellow pages ad or their website; if it is not listed there, they are not Board Certified in Hand Surgery. You deserve to be seen by a Board Certified hand surgeon, not someone only with Board Certification in something else, such as only plastic surgery or only orthopedic surgery, as they have limited training in hand surgery, even if they claim to be a "hand surgeon."

Dr. Nelson has Board Certification in both Orthopedic Surgery and in Hand Surgery. You can review all of his qualifications here. Dr. Nelson is the only Board Certified Hand Surgeon who maintains a full-time office in Marin. He has been full-time in Marin since 1993.


2 How much time will the doctor spend with you?

An interesting and insightful question when you are selecting a doctor is to ask the receptionist how much time they allot for a new patient visit or for a routine follow up visit. 85% of doctors in the United States spend an average of less than 25 minutes, according to a nationwide survey of 15,000 physicians in 2011. 20% spend less than 12 minutes with each patient.

Time Spent with patients

In the San Francisco Bay Area, the majority of hand surgeons see 40 to 50 patients a day; some see 60.

In Dr. Nelson's office, the standard appointment for a new patient is 30 minutes. If the patient has been referred by another doctor or has seen another doctor, the standard appointment is 45 minutes; if they have had surgery or have been seen by more than one doctor, the standard appointment is 60 minutes. We do not have any return appointments for less than 15 minutes. Dr. Nelson never schedules more than 16 patients a day, to guarantee that you have enough time with him.


3. Who provides the care that you receive?

Most physicians now employ "physician extenders" that provide most of the care that you receive. On some office visits, you may not even see the doctor! Most doctors have Physician Assistants or Nurse Practitioners that see you instead of the doctor, an xray tech that does the xray, a cast tech that applies or removes the casts. Offices do this to save money.

In Dr. Nelson's office, there are no staff other than the front desk staff. Dr. Nelson sees 100% of the patients on every single visit. If you need xrays, he will personally position your hand so that you get the optimum xray. If you need a cast, he will personally place and remove every cast so that it fits perfectly.


4. How long will you have to wait in the doctor's office?

Is your time important? Are you often in a rush? If so, an interesting and insightful question when you are selecting a doctor is to ask the receptionist what the average wait is for the doctor. If they don't know, it means that they haven't studied this part of their practice and you might wonder if they consider your time to be important. If they say the average wait is an hour or more, you know that they don't respect their patients or consider their time important.

We think that your time is just as important as ours. We have kept track of the time patients wait in our office for more than 10 years, and the average wait time is less than 15 minutes. 5% of patients get seen prior to the time of their appointment. We never over book (schedule more patients than there are time slots available).


5. Practice Type

Does the doctor do only hand surgery, or is hand surgery something they only do occasionally or in addition to other types of surgery? You can usually find this out by asking the office receptionist. Another good way to find out how important hand surgery is to the doctor is to look at their yellow pages ad or their website: if they have a small ad in hand surgery, but a very large ad in another specialty, such as plastic surgery, you can probably guess which area of medicine is more important to them. If their website emphasizes cosmetic face or breast surgery, you can guess what is important to them. It is not your hand.

Dr. Nelson limits his practice to only hand surgery, and he does hand surgery full-time. This is documented here on the website, as well as on his stationery and his business card. His ad only appears under hand surgery (actually, the yellow pages has "Hand Surgery" under "Surgery, Hand") and orthopedics (his original board certification); both specify that he limits his practice to hand surgery. He does not do general orthopedics, plastic surgery, or general surgery.


6. Is the doctor in your plan?

You probably want to stay within your insurance plan, since it will be more expensive to see a doctor outside of your plan. However, depending on how serious your problem is, or how important your hand is to your work or recreation, you may consider seeing someone outside your plan, at least for an initial consultation. (See Section 7 below for important information.)

Dr. Nelson participates in a variety of health plans; click here for a list. If your insurance plan is not accepted, call the office to get an estimate of how much it might cost to go out of plan.


7. Does the doctor within your plan have any financial incentives to limit your treatment?

Many patients don't realize that many plans pay financial incentives to their participating doctors to limit the treatment that they offer to their patients, such as restricting referrals only to same-plan doctors. This is the "managed" part of "managed care." There are other, more subtle ways that managed care may affect your hand problem. For important information on this, read Financial Incentives: The Hard Facts for Patients.

Dr. Nelson does not participate in any plans that pay financial incentives to limit patient care.


8. How long will you have to wait to get an appointment?

Many patients are finding that they cannot get a timely appointment, even for an urgent matter such as a fracture.

Our office policy is that any patient with a new fracture that is not in a splint or cast will be seen in the office the next day we are in, whether or not there is an appointment opening. Rather than over book the schedule, Dr. Nelson will either come in early, skip lunch, or stay late. Obviously, emergencies cannot be scheduled or be put off until it conveniently fits into the doctor's schedule, and it would not be appropriate to make other patients wait unless it was absolutely necessary. Fractures that have already been placed in a splint may need to have the swelling decrease before it is safe to place them in a cast, and should wait a few days to be seen.


9. Does the doctor have a special skill or interest in your problem?

The field of hand surgery is so broad that not all doctors have the same level of skill or interest in all hand problems. Dr. Nelson has a special interest in distal radius fractures, wrist pain, wrist kinematics, and post-operative pain management. (See his Resume to see his research and talks on these topics.) For example, Dr. Nelson has written many articles on distal radius fractures, including the one on the website of the American Academy of Orthopedic Surgery (see it here). Dr. Nelson has a wide experience in standard hand problems such as fractures, carpal tunnel syndrome, trigger finger, and Duputyren's. However, Dr. Nelson is quite frank is stating that he is not an expert on burns, skin grafts, congenital anomalies, or brachial plexus, and refers patients with these problems to other hand surgeons who are specialists in these fields. Be sure that your hand surgeon has a special skill and interest in your hand problem.


10. Where does the doctor practice? Will they be there when you need them?

Many doctors have more than one office, and some come to Marin only a half day a week. If you need to seem them on another day, or if you have an emergency and need to see them right away, you will have to travel outside of Marin, typically to San Francisco, to see them.

Dr. Nelson's ONLY office is in Marin and he is available full-time to see you.

We hope that these suggestions will help you in deciding if you would like to make an appointment with our office. Call if you have any questions. Our number is 415-925-0501.