Saturday, June 22, 2013

Is surgery the right treatment now? The right question to ask.

USA Today recently pointed out that many surgeries that are performed are 'unnecessary'.

A quote from the article: "unnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures — not only stents, but also angioplasty and pacemaker implants — as well as many spinal surgeries. Knee replacements, hysterectomies, and cesarean sections are among the other surgical procedures performed more often than needed, according to a review of in-depth studies and data generated by both government and academic sources.

Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims."

The article is appropriately unsettling. 

The challenge is that while in some cases, for example a fracture with bone protruding from the skin, the need for surgery is clear. In other cases the indications for surgery are relative: back pain, knee pain, and early arthritis, for example. The situation is made more complex when MRI's are obtained of a bothersome shoulder and show findings that may be present in most adults, such as 'partial cuff tear' or labral fraying'. 

To help patients consider the timing of surgery for a progressive condition, such as arthritis, we have provided a relevant post.

While surgeons are dedicated to helping their patients, there is no question that surgeons have a conflict of interest: surgeons get paid more for doing a surgery than for referring the patient to someone more qualified to perform it or for putting the patient on an exercise program. Conflicts of interest are substantially more concerning when the surgeon is a paid by a company to advocate the use of their products or if they receive royalties for the use of the product.

We suggest that patients considering surgery ask the following questions of their surgeon:

1 What is my diagnosis?
2 What is the name of the surgery you propose?
3 Do you have any financial relationships with the companies making the products that will be used?
4 Is their any rush in doing this surgery, or is it elective?
5 What are the alternatives to this surgery?
6 How many of these surgeries have you personally performed?
7 Are you fellowship trained to perform this operation?
8 What complications have you and others experienced with this procedure?
9 What are the usual results of this operation in your hands?
10 What is the likelihood that I will have lingering pain, limitations or disability?
11 What special care, rehabilitation will I require for the period after surgery?
12 How long is it likely to be before I can return home, return to work, return to my recreational activities?
13 Do you consider me a good candidate for this surgery in your hands?
14 If I wanted to get a second opinion, will you provide me with all my records to take to another surgeon?

We suggest patients take this 'check list' to their surgeon for the preoperative discussion. 

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.