Surgery


What to know and do before surgery

What You Really Need to Do Before Surgery (Consumer Reports, October 2013) What you do before an operation can affect what happens after it
The Patient's Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized by Elizabeth Bailey. "A producer of music videos, Bailey was thrust into the role of patient advocate when her elderly father was systematically manhandled by one of New York’s great teaching hospitals. Bravo to her for turning that all too common misery to a constructive end."--Abigail Zuger, MD, New York Times book review
Your safer-surgery survival guide Consumer Reports' ratings of 2,463 U.S. hospitals can help you find the right one.
Hospital ratings by state (Consumer Reports)
ER Wait Watcher (Lena Groeger, Mike Tigas and Sisi Wei, ProPublica, 12-19-14) Use this tool to look up average ER wait times, as reported by hospitals to the federal government, as well as the time it takes to get there in current traffic, as reported by Google.
Going Under the Knife, With Eyes and Ears Wide Open (Jan Hoffman, Health, NY times, 3-25-17) More people are rejecting general anesthesia for procedures, prompting doctors to narrate their steps as they deal with alert patients asking questions. More surgery is being performed with the patient awake and looking on, for both financial and medical reasons.
But as surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. “For a thousand years, we talked about the operating theater,” said medical ethicist Dr. Mark Siegler,and author of a recent study on surgeon-patient communication during awake procedures, published in the American Journal of Surgery. “And for the first time, in recent years the patient has joined the cast.” "Choosing to watch your own surgery is one more manifestation of the patient autonomy movement, in which patients, pushing back against physician paternalism, are eager to involve themselves more deeply in their own medical treatment." But Dr. Alexander Langerman, "said that a patient’s decision to remain awake during an operation also reflects a growing suspicion, generally, of authority figures. 'The occasional scandals that emerge while patients are sedated continue to erode their trust in us.' But patients are also intrigued by what is being done to them while they are asleep. In choosing to stay awake, added Dr. Langerman, /​there’s a curiosity and desire to have control over your experience.”
Some Thyroid Cancer Patients Can Safely Delay Surgery (Liz Szabo, Kaiser Health News, 8-31-17)
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How to research your surgeon and hospital


How to Pick the Right Surgeon (Linda Marsa, AARP Bulletin, Sept 2017) Act as if your choice is life or death — because it often is. File this excellent batch of AARP articles and links in your home medical folder! Read the article to put these links in context:
---Federation of State Medical Boards (FSMB). Click on Consumer Resources to get to the free tool, “Learn About Your Physician.”
---Certification Matters (American Board of Medical Specialties)
---Pro Publica. Plug in your zip code and "and you’ll find a directory of local hospitals that perform eight common procedures, along with surgeons on staff who perform them, the number of procedures they’ve done and their complication rates."
---Surgeon Ratings (Consumers' Checkbook) Compares 5,000 surgeons' results for 12 types of surgery). Consumers' Checkbook also rates doctors, hospitals, and dentists.
Clear Health Costs Helps Consumers Determine if Medical Costs Will Be Just Expensive, or Really Expensive ( Robin D. Schatz, Fast Company, 11-27-13). "Startup Clear Health Costs aims to help consumers comparison shop for medical procedures—after all, why pay $3,500 for a vasectomy when you can get it for $450? The site also shows the Medicare reimbursement rates in a region as a benchmark to help guide consumers.
Clear Health Costs ("Your Source for Finding Health Care Prices"). See, for example, this Range of costs for cholesterol screening and this range of costs for CBC blood test.
Incremental progress seen in price transparency, but report may rate A+ among journalists (Joseph Burns, Covering Health, Association of Health Care Journalists, 7-28-16) There has been a bit of progress in states giving consumers the information they need to shop for care based on price, though 43 states earned a failing grade to meet even minimum standards. This year, three states earned an A: Colorado, Maine and New Hampshire. Oregon moved from an F to a B. Vermont and Virginia each got a C, and Arizona got a D. Vermont and Virginia each got a C, and Arizona got a D.
How Much Is That MRI, Really? Massachusetts Shines A Light (Martha Bebinger, WBUR and KHN, All Things Considered, 11-6-14) "There are no uniform prices; they vary from one insurer to the next. And you have to read the fine print on these sites to know what is and is not included in the dollar figure you'll see online."
Clear Health Costs: Cracking the Code Coverage. In April 2017, New Orleans PriceCheck, reporting on and crowdsourcing health prices with partners WVUE FOX 8 Live and NOLA.com/​The Times-Picayune, began saving its readers and listeners lots of money by comparing health care prices publicly. Says Jeanne Pinder, "We use shoe-leather journalism, data journalism and crowdsourcing to reveal the mysteries of pricing. The project is on fire, with hundreds of people sharing their stories, commenting, and sending in their EOB's [explanations of benefits]. The hospitals are extremely upset with us, and we have been able to save people hundreds of dollars-- and completely change the conversation in New Orleans about health care. Here's a page with their coverage collected together: https:/​/​clearhealthcosts.com/​new-orleans-partnership/​. Scroll down here for an earlier story about Clear Health Costs, and do watch The Healthcare Industry and the USSR Jeanne Pinder's wonderful talk (YouTube video, Ignite Health Foo 2013).
Medicare Provider Utilization and Payment Data . Under the Obama administration, soon after Steven Brill's article came out, in 2013, the Centers for Medicare & Medicaid Services (CMS) publicly posted inpatient prices for hospitals across the country, making public huge variations in cost for the 100 most common inpatient services, 30 common outpatient services, and all physician and other supplier procedures and services performed on 11 or more Medicare beneficiaries.
The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy (Uwe E. Reinhardt, Health Affairs, Jan. 2006, vol. 25, no. 1, pp. 57-69. Important article, covering many topics (How hospitals set their prices and how they are paid; Price discrimination by hospitals; Hospital pricing and consumer-directed health care; with invaluable links to other sources.) And the title sums it up: "Chaos behind a veil of secrecy!" "To move from the present, chaotic pricing system toward a more streamlined system that could support genuinely consumer-directed health care will be an awesome challenge. Yet without major changes in the present chaos, forcing sick and anxious people to shop around blindfolded for cost-effective care mocks the very idea of consumer-directed care....The bewildering and sometimes troublesome picture of contemporary U.S. hospital pricing is not entirely of hospitals’ own making. They are part of a wider system of health care financing whose administrative expense now ranks as a major cost component of U.S. health care (as much as 25 percent)."
Chargemaster (Wikipedia). Excellent links to articles on medical health care costs and billing. "In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital. The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital."
Defending Your Chargemaster (Elizabeth Gardner, Health Data Management, 2013, p. 27 ff.) Experts weigh in on the new rules of the game. See Gardner's "Reporter's Notebook" sidebar, for an overview of the effect of CMS (in May 2013) releasing data on charges for inpatient care. Yes, a hospital with more Medicaid patients may have to charge paying customers more than a hospital with few or no Medicaid patients, but hospitals may now have to change their approach to charges and pricing.
OpenNotes (evidence suggests that opening up clinicians' visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care) “Open notes create partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information.” See Patients and clinicians on the same page (Open Note videos)
Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences (Jeffrey Young, Chris Kirkham, Huffington Post, 5-8-13) Hospital price disparities made public
In Health Care, A Good Price (Or Any Price) Is Hard To Find (Jenny Gold, Reporter's Notebook, KHN, 9-14-17) A recent story about why Northern California is the most expensive place in the country to have a baby began as a tip from an obstetrician. Dr. Sarah Azad told me that insurers were paying her just a third of what they pay doctors employed by large hospital systems in her town of Mountain View, Calif. "As it turns out, the vast majority of contracts between doctors or hospitals and insurance companies are subject to a gag clause, which prohibits either party from disclosing negotiated rates. That means it’s almost impossible for consumers, researchers or journalists to find actual, accurate numbers, despite the fact that cost differentials among doctors can be so stark...
“ It’s no accident that data on physician costs are so hard to find. Its inaccessibility allows hospitals to keep raising their prices. It’s simply not in their interest for the public to know how much they’re charging. And insurers don’t want other doctors or hospitals to see the high prices they’ve agreed to pay, for fear they would demand the same....In the end, all of us — through our insurance premiums and our taxes — pay a price for non-transparency."
Unaccountable: What Hospitals Won't Tell You And How Transparency Can Revolutionize Health Care (listen online to interview on Diane Rehm show, WAMU, with Dr. Marty Makary, surgeon at Johns Hopkins and author of Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
Revealing a Health Care Secret: The Price (Tina Rosenberg, Fixes, Opinionator, NY Times, 7-31-13) A new health care approach: Don't hide the price. "Why are health care costs so high? ...only sellers, and not buyers, know the price. If prices are secret, patients can’t comparison shop. There is no way to push prices down, or force providers to compete on price. Price secrecy hides the need for reform. “Getting prices out in the open is crucial to bringing prices down,” said Katherine Hempstead, senior program officer at the Robert Wood Johnson Foundation."
Elusive Goal: A Transparent Price List For Health Care (Eric Whitney, Morning Edition, Shots, NPR, 2-19-14) Actual prices for a colonoscopy are hard to find and vary greatly from one clinic to another. Colorado is one of eleven states that are starting to make public a lot of health care prices. Since doctors and hospitals generally don't tell people how much services cost beforehand, the best way to figure out the price is to get receipts from the parties that pay the bills: insurance companies, Medicaid and Medicare, mostly. But "claims data is dirty" and takes lots of scrubbing before it can be presented in consumer-friendly formats.

FIND MORE ON THE SUBJECT OF PRICE TRANSPARENCY HERE:
Decoding Health Care Prices
Orphan Prices: The Good, the Bad, and the Greedy
Understanding the Issues Health Reform Should Address
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How to help children deal with surgery

Preparing Your Child for Surgery (KidsHealth)
Doctors get creative to distract tech-savvy kids before surgery (Jenny Gold, Kaiser Health News, 7-12-16). They called it BERT, short for Bedside Entertainment Theater. It looks high-tech, but the whole thing costs about $900 to build. Here's the video that goes with that story: Distraction (video, Heidi de Marco, KHN). Pre-surgery anxiety is dangerous for kids. One hospital is solving the problem without meds.
The day of surgery for your child (Medline Plus)
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Brain surgery

The Terrible Beauty of Brain Surgery (Karl Ove Knausgaard, NY Times, 12-30-15)
Preparing for neurosurgery (UCLA Neurosurgery, video, English or Spanish)
Care and recovery after brain surgery (Johns Hopkins Medicine)
About brain tumors (Johns Hopkins)
Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh. What is it like to be a brain surgeon? How does it feel to hold someone’s life in your hands, to cut into the stuff that creates thought, feeling and reason? How do you live with the consequences of performing a potentially lifesaving operation when it all goes wrong? Leading neurosurgeon Henry Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets and the moments of black humor that characterize a brain surgeon’s life. See also Admissions: A Life in Brain Surgery
Anatomy of Error (Joshua Rothman, New Yorker, 5-18-15) A review of Dr. Marsh's book Do No Harm: Stories of Life, Death, and Brain Surgery, a review that in itself explains a few things also.
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Heart surgery

Open heart surgery, explained at MedlinePlus.
The Open Heart Companion: Preparation and Guidance for Open-Heart Surgery Recovery by Maggie Lichtenberg
Organ and tissue transplants. See also Donating your body or body parts
Recovering From Heart Surgery (For Heart Bypass, Heart Valve Surgery and other Open Heart Surgery Patients) (DVD, RecoverRite)
Heart surgery (overview, Texas Heart Institute)
Minimally invasive heart bypass surgery (Medline Plus)
What Is Coronary Artery Bypass Grafting? (National Heart, Lung, and Blood Institute, NHLBI)
Cut to the Heart (PBS series on radical but promising new form of heart surgery)
• Nova has useful material online: Map of the Human Heart (images showing bloods flow path through the heart), Troubled Hearts (images, PBS, Nova)
DNA Links Deadly Germs, Tainted Heart Surgery Devices To German Factory (JoNel Aleccia, KHN News, 7-12-17) Heater-cooler devices made at the LivaNova PLC plant in Munich, Germany, were contaminated during production. Researchers also found that some hospital water systems and Maquet heater-coolers were contaminated, raising concerns about local contamination.
Treating a Sick Heart (PBS, Nova)
Narrating and imaging an aortic dissection (Edward Tufte)
Surgical corrective procedures for congenital heart disease (LearningRadiology)
The Richer You Are, the Better You May Do After Heart Surgery (Nicholas Bakalar, Well, NY Times, 10-20-15) They have found a relationship between income and survival, but that doesn't mean there is a causal effect.
More than half a million heart surgery patients at risk of deadly infection (Lena H. Sun, Washington Post, 10-13-16) "More than half a million patients who had open-heart surgery in the United States since 2012 could be at risk for a deadly bacterial infection linked to a device used during their operations, federal health officials said....The device in question is a piece of medical equipment known as a heater-cooler unit, an essential part of life-saving surgeries because they help keep a patient’s organs and circulating blood at a specific temperature during the operation....About 60 percent of these procedures use the German-made model that has been linked to the infections."
Heart Surgery, Unplugged (Jerome Groopman, New Yorker, 1-11-99). Making the coronary bypass safer, cheaper, and easier
Top-scoring hospitals for heart surgery in USA (Consumer Reports, June 2014)
Best Hospitals for Cardiology & Heart Surgery (U.S. News & World Report)
Mortality rates after surgery for congenital heart defects in children and surgeons' performance (J. Stark et al., Lancet, 18 March 2000.
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Hip and knee replacement surgery

Medicare opens new push on hip, knee replacement in effort to follow patients more closely, head off complications (Ricardo Alonso-Zaldivar, AP, in Wash Post, 3-31-16) The idea is to follow patients more closely to smooth their recovery and head off unwanted complications that increase costs.
After Knee or Hip Replacement, No Place Like Home (Jane E. Brody, Personal Health, NY Times, 4-24-17) "It may surprise many to learn that, even if joint replacement patients live alone, the overwhelming majority recover equally well and may experience fewer complications if they go home directly from the hospital and get outpatient rehabilitation instead of spending days or weeks in a costly rehab facility....[In one study, S]ix months after their surgery, there was no difference in mobility, pain, function or quality of life between those who got inpatient rehab and either of the two groups that got outpatient rehab....Costs aside, patients who go home directly may be less likely to experience what doctors call “adverse events” – complications like infections, blood clots or worse." "I can also underscore the general futility of some popular efforts to postpone needed joint replacements, including injections of hyaluronic acid and corticosteroids, braces, shoe inserts and opioid painkillers like OxyContin and fentanyl, none of which are recommended by the American Academy of Orthopaedic Surgeons....(The academy guidelines strongly recommend only three of the eight preoperative treatments studied — physical therapy, nonsteroidal anti-inflammatory drugs and the painkiller tramadol.)"

Knee replacement surgery
An Inside Look at Knee Replacement Surgery (video, WebMD). You can see what happens during surgery.
Recovery Timeline for TKR: Rehabilitation Stages and Physical Therapy (Healthline)
Total Knee Replacement Surgery - Hospital and Home (YouTube. This video follows a Spokane orthopedic knee surgery patient through the total knee replacement surgery and recovery process at Sacred Heart Medical Center.)
What I wish I knew about total knee replacement (video, Dame Judi Dench with Jonathan Monk) Would she have done anything differently? She would have done it sooner. It's not going to get better. It's only going to get worse. A good pep talk.
A New Set of Knees Comes at a Price: A Whole Lot of Pain (Jane E. Brody, Health, NY Times, 2-8-05). Total knee replacement may be more painful if your doctor prescribes the minimal dose of opioids, which many do (which interferes with rehabilitation), and if your insurance doesn't cover the amount of rehabilitation you need, you may have to pay out of pocket for it.
3 Years Later, Knees Made for Dancing (Jane E. Brody, NY Times, Health, 6-3-08)
Jane Brody's New Knees (Tara Parker-Pope, Well, NY Times, 6-3-08)
What Do You Want to Know About Total Knee Replacement? (Samuel Greenguard, HealthLine, 4-30-12) This will take you to a whole set of Q&A pieces about knee surgery (and alternatives).
Understanding Knee Replacement Costs: What's On the Bill? (Samuel Greengard, HealthLine, 2-23-15)
Alternatives to Knee Replacement Surgery (Samuel Greengard, HealthLine, 7-19-17)
Hospitals And Surgery Centers Play Tug-Of-War Over America’s Ailing Knees (Christina Jewett, Kaiser Health News) What felt to Kirschenbaum like a bold experiment may soon become far more standard. Medicare, which spends several billions of dollars a year on knee replacements for its beneficiaries — generally Americans 65 and over — is contemplating whether it will help pay for knee replacement surgeries outside the hospital, either in free-standing surgery centers or outpatient facilities. The issue is sowing deep discord in the medical world, and the debate is as much about money as medicine. Some physicians are concerned that moving the surgeries out of hospitals will land vulnerable patients in the emergency room with uncontrolled pain, blood clots or other complications. Even if a policy change is made, Medicare would still pay for patients to get traditional inpatient surgery. But with the agency also paying for the bulk of outpatient procedures, there would be a huge shift in money — out of hospitals and into surgery centers. Perhaps of equal concern to patients are the financial consequences, because even though less care is given, outpatient procedures require higher out-of-pocket costs for patients. Medicare covers inpatient hospital stays, aside from a $1,288 deductible.
Runner's Knee (WebMD)
Regular exercise, healthy diet may help reduce knee pain for overweight adults with diabetes (News-Medical.net, 7-24-15)
The sound of a knee cracking amplified is the actual worst sound ever (Science Alert, 5-31-16) A team from Georgia Institute of Technology has been investigating ways that will allow them to tell a healthy knee from a bad 'crunchy' knee, without having to open it up or run a bunch of X-rays and scans.
Joint Pain Alliance on Facebook posts links to news and articles about knee pain and alternatives to knee replacement surgery.
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HIP REPLACEMENT SURGERY
What I Wish We Had Known About Hip Replacements Before My Husband’s Surgery (Judy Kirkwood, Third Age, June 2016)
A New Hip, A New Dance (Judith Sachs, 10-11-14)
Total hip arthroplasty. (J S Siopack and H E Jergesen, Western Journal of Medicine, March 1995, on PubMed Central)
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Memoirs and reflections of surgeons and about surgery


Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande
Better: A Surgeon's Notes on Performance by Atul Gawande
The Checklist Manifesto: How to Get Things Right by Atul Gawande "Gawande gives a vivid, punchy exposition of an intriguing idea: that by-the-book routine trumps individual prowess. That humblest of quality-control devices, the checklist, is the key to taming a high-tech economy."--Publishers Weekly. In riveting stories, he reveals what checklists can do, what they can’t, and how they could bring about striking improvements in a variety of fields, from medicine and disaster recovery to professions and businesses of all kinds.
Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh.
Admissions: A Life in Brain Surgery by Henry Marsh• Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh. What is it like to be a brain surgeon? How does it feel to hold someone’s life in your hands, to cut into the stuff that creates thought, feeling and reason? How do you live with the consequences of performing a potentially lifesaving operation when it all goes wrong? Leading neurosurgeon Henry Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets and the moments of black humor that characterize a brain surgeon’s life. See also Admissions: A Life in Brain Surgery
Anatomy of Error (Joshua Rothman, New Yorker, 5-18-15) A review of Dr. Marsh's book Do No Harm: Stories of Life, Death, and Brain Surgery, a review that in itself explains a few things also.
When the Air Hits Your Brain: Tales from Neurosurgery (2008) by Frank T. Vertosick Jr.
Heart Matters: A Memoir of a Female Heart Surgeon by Kathy Magliato (2011)
Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors by Paul A. Ruggieri (2012) From NY Times review: "Dr. Ruggieri, by his own description, is a regular Joe Scalpel: An average student, he graduated debt-ridden in the middle of his medical school class, weathered a grueling old-style residency program, and now works as in private practice at a community hospital....Ask for your surgeon’s complication rate before your procedure, Dr. Ruggieri suggests — you will have to assume the answer is truthful. And if you want to know what really happened while you were asleep, track down the operative report (although even that document may not reflect all the potholes on the trip)....He offers up the requisite anecdotes featuring hapless people impaled by various pointy objects (including the horn of an annoyed rhinoceros), but he is at his best describing his own worst moments, muttering under his breath to a recalcitrant section of intestine, his right eye twitching in anxiety, wondering why he didn’t go for that M.B.A. instead."
The Patient's Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized by Elizabeth Bailey. "A producer of music videos, she was thrust into the role of patient advocate when her elderly father was systematically manhandled by one of New York’s great teaching hospitals. Bravo to her for turning that all too common misery to a constructive end."--Abigail Zuger, MD, New York Times book review.
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High costs, adverse events, bad practices, other problems with surgery
And a few solutions


Why One California County Went Surgery Shopping (Chad Terhune, Kaiser Health News, 9-1-17) "Fed up with wildly different price tags for routine operations, some private employers are steering patients they insure to top-performing providers who offer bargain prices. Santa Barbara County, with about 4,000 employees, is among a handful of public entities to join them. The county has saved nearly 50 percent on four surgery cases since starting its out-of-town program last year, officials said. The program is voluntary for covered employees. At a Scripps Health hospital in the San Diego area, the county paid $61,600 for a spinal fusion surgery that would have cost more than twice as much locally.
"Typically, employers are seeking deals through “bundled payments” — in which one fixed price covers tests, physician fees and hospital charges. And if complications arise, providers are on the hook financially. Medicare began experimenting with this method during the Obama administration. Even as more employers and insurers embrace bundled payments, the Trump administration is applying the brakes.
"Santa Barbara officials try to persuade workers and their family members to participate in its program by waiving copays and deductibles. The county pays about $2,700 in travel costs and still comes out way ahead.
Double-Booked: When Surgeons Operate On Two Patients At Once (Sandra G. Boodman, Kaiser Health News, 7-12-17) The controversial practice has been standard in many teaching hospitals for decades, its safety and ethics largely unquestioned and its existence unknown to those most affected: people undergoing surgery. But over the past two years, the issue of overlapping surgery — in which a doctor operates on two patients in different rooms during the same time period — has ignited an impassioned debate in the medical community...
Known as “running two rooms” — or double-booked, simultaneous or concurrent surgery — the practice occurs in teaching hospitals where senior attending surgeons delegate trainees — usually residents or fellows — to perform parts of one surgery while the attending surgeon works on a second patient in another operating room. Sometimes senior surgeons aren’t even in the OR and are seeing patients elsewhere.
Critics of the practice, who include some surgeons and patient-safety advocates, say that double-booking adds unnecessary risk, erodes trust and primarily enriches specialists. Surgery, they say, is not piecework and cannot be scheduled like trains: Unexpected complications are not uncommon. Indiana orthopedic surgeon James Rickert regards double-booking as a form of bait-and-switch. “The only reason it has continued is that patients are asleep,” said Rickert, president of the Society for Patient-Centered Orthopedics, a doctor group." [Do read the whole article!]
Stop Knee Pain! 8 steps you can take to avoid surgery (Richard Laliberte, AARP Magazine, Feb/​March 2017)
4 Surgeries to Avoid (Karen Cheney, AARP Magazine, Aug. 2014) four operations are often overperformed. Some are moneymakers for doctors and hospitals; others are expedient and still others seem to work, at least in the short term. But evidence shows that all have questionable long-term outcomes for treating certain conditions, and some may even cause harm. Consider these alternatives. Providing stents for heart disease patients with stable angina, spinal fusion for spinal stenosis, any type of back surgery, and hysterectomy for quality-of-life concerns, such as heavy bleeding or pain caused by uterine fibroids,
The lap band for weight loss is a tale of medicine gone wrong (Julia Belluz, Vox, 5-25-17) The lap band for weight loss is a tale of medicine gone wrong. How the lap band works — and how it fails. It doesn’t lead to weight loss and often requires more surgery. Other weight loss surgeries are more effective, but doctors will still keep doing the lap band.
For Surgeons, Talking About Adverse Events Can Be Difficult: Study (Zhai Yun Tan, Kaiser Health News, 7-20-16) Medical mistakes often happen. National guidelines call for doctors to provide full disclosure about adverse events, and studies have shown that those discussions benefit patients. But new research finds that the act of disclosure, combined with stress from the procedure gone wrong, can be an anxious experience for some doctors — and more training is needed to help them engage in these difficult conversations. “For a long time in the field, people thought that the primary reason that physicians have trouble reporting adverse events is that they were worried about being sued, but there are other barriers that are more important,” said Gallagher, one of the authors of the study. “This paper helps highlight how embarrassing and upsetting these events are for clinicians … (and) makes it difficult for the physician to admit to the patient, ‘Here is exactly what happened.’”...
"They found that about 90 percent of the surveys showed that doctors said they had disclosed the event to patients or their families within 24 hours, expressed concern for the patient’s welfare, explained why the event happened, expressed regret and discussed with patients steps to treat subsequent problems. But only about half showed the doctors discussed whether the event was preventable and a third reported they talked about how it could be avoided in the future. Just over half apologized to the patient.
The study also reported that those surgeons who find an event very or extremely serious and who had difficulty discussing that event are more likely to suffer anxiety over the experience. That was also true of surgeons who feared negative reaction from patients, an impact on their reputations, bad publicity or a malpractice suit."
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