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