Wednesday, March 12, 2014

Oops! What do you Mean She was not Pregnant?

There was a story reported in mid-December of a 37 year old Brazilian who underwent an emergency cesarean section in Brazil. The only problem was that she was not pregnant. She reported to the hospital complaining of pain and told doctors she was 41 weeks along. Relying on complaints of nausea, and the visual perception of enlarged abdomen, the physicians concluded she was pregnant. As they could not hear the baby's heartbeat, they concluded the child was in distress and elected to perform surgery.

What is wrong with this picture? First, admittedly there are no details provided as to how sophisticated the facility at which this occurred. Possibly surgery was the only tool at their disposal when they could not find a heartbeat. The urgency may not have afforded much time for reflection or investigation, regardless of the facility's resources. However, it is a headline that grabs attention and leads back to questions about surgery.

According to MSN "tens of thousands of patients annually submit to costly operations that could be avoided." This assertion emanates from a USA Today article resulting from a review of government records and medical databases. They concluded that "10% to 20% of all surgeries in some specialties" may be unnecessary.
Among USA Today's conclusions were angioplasty, pacemaker, spinal fusion, and colonoscopies. The article concluded that "70% of hysterectomies were inappropriately recommended, often because doctors didn't attempt treatment with non-surgical procedures." The authors broke these procedures "into three groups: the immoral, the incompetent and the indifferent."

A New York Times investigation cited by The Washington Post concluded that unnecessary procedures are performed. They suggest that "doctors may have performed unnecessary procedures because there was a financial incentive to do so." Because physicians are "paid for each service they provide," the more procedures, the higher the salary. They conclude that 78% of health plans pay the physician on a "fee-for-service model" that is consistent with the maxim of more procedures equating to more income.

The USA Today article recommends that patients should question surgical recommendations, ask for non-surgical options, and seek a second opinion. It is ultimately the patient who deals with the trauma of surgery, and the rehabilitation and recovery that follows. It is therefore ultimately the patient that should ask these questions about recommended treatments. Whether the doctor is inclined to surgery by habit, comfort level, or incentives, it is the patient's ultimate responsibility to look out for her or his best interests, ask questions, and make sound decisions.

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