The surgeon isn't part of the process.
Instead, patients would learn from experts—perhaps hired by the health system or the payers—whether they meet indications for the procedure or whether there are feasible alternatives.
They'd see data on complication and infection rates, track records and experience levels for the hospital and/or the surgeon, adverse events of required medications, post-procedure functional limitations, challenges to recovery, and rates of repeat surgery.
They would learn about the likelihood of the procedure actually accomplishing what is expected, even if all goes perfectly. And patients who have undergone the procedure would explain what happened to them.
Some healthcare systems will bridle at this idea. Specialists insist they never operate on a patient who is unlikely to benefit. And family doctors may not want to be bothered with more bureaucratic steps in a referral process they have to do more to vet.
But consider just a few recent headlines to see the paving of the large runway that may enable this plane to take off.
• A New York Times story last week revealed some 1,200 patients underwent unnecessary invasive cardiology procedures in one South Central Florida hospital, and many other facilities in the large HCA chain are under federal investigation.
• A Grand Rapids surgeon's study in September's Journal of Clinical Oncologysays far too many patients undergo unnecessary surgery to remove tumors in patients with advanced colon cancer when chemotherapy and a drug have a better success rate.
• A report in the New England Journal of Medicine found many women with breast cancer are unnecessarily undergoing a second surgery to remove more tissue for wider margins.