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'Informed Decision' May Irk Surgeons as It Cuts Costs, Improves Quality

Cheryl Clark, for HealthLeaders Media, August 16, 2012

National blindspot

Some surgeons themselves think this is an idea whose time has come.

"We have a major national blindspot, and that blindspot is unnecessary medical care, and there's a ton of it that goes on," says Martin Makary, MD, a gastroenterology surgeon and researcher at Johns Hopkins School of Medicine.

Makary is the author of an upcoming and extremely controversial book, Unaccountable, about dangerous practices that persist in a culture that is allowed to hide its mistakes. He tells me that preliminary results of his research project reveal that when asked, surgeons think the amount of unnecessary surgery that hospital culture chooses to ignore is huge, "in the ballpark of 10% to 20%."

These are the big drivers of cost, Makary says. " [They are] big ticket items, like coronary artery bypass graft surgeries, colectomies, hysterectomies, and back surgeries. They not only have the biggest price tags, but they also have the highest complication profiles of anything we do in healthcare."

The Dartmouth Atlas of Health Care presents another exhibit for the case that the problem of unnecessary procedures is significant. The Atlas, with its dramatic charts showing wide regional variation in volume of surgical procedures around the country, demonstrates little evidence that more surgeries are producing better outcomes.

Informed medical decision-making sessions, if done appropriately, Makary says, "can begin to address this problem that surgeons themselves are recognizing."

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9 comments on "'Informed Decision' May Irk Surgeons as It Cuts Costs"


Marshall Steele MD (8/20/2012 at 9:32 AM)
One of the biggest issues we have in medicine is that in my experience only 2% of surgeons collect and aggregate their patient rpeorted outcomes pre and post operatively. They can't accurately provide informed consent based on their own experiences? Our data base shows there is considerable variation amongst providers doing the same procedures. Quoting the literature is not the same as quoting your results. Until collecting and providing your own data to patients becomes part of the medical culture "second opinions" and "informed consent" will be less than accurate. Technology has made this much easier and affordable to accomplish.

M Makary (8/18/2012 at 7:32 PM)
Excellent article

Phillip (8/18/2012 at 12:00 PM)
The concept may be good but the process proposed is inherently flawed. In general, the Physician ordering a test (other than an x ray) should be a physician who is trained to interpret the test and trained to provide appropriate treatment options, either non-surgical or surgical. That physician is usually a specialist This "Informed Decision" process will not "irk" surgeons providing it does not add unnecessary bureaucracy which increases cost, and does not delay necessary treatment which is urgently needed in some cases. Informed patients are a surgeons ally not adversary.