On June 20, 2013, USA TODAY featured a special report titled: "Under the Knife 'for Nothing.'" This report is part of a series called, "When Health Care Makes You Sick."1 The article is filled with information that will certainly help consumers understand why they should question whether a surgical procedure is a good idea:
"Tens of thousands of times each year, patients are wheeled into the nation's operating rooms for surgery that isn't necessary, a USA TODAY review of government records and medical databases finds.
"Even more turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided, either because the medical facts don't warrant it or because there are non-surgical treatments that would better serve the patient.
"In fact, unnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures – not only stents, but also angioplasty and pacemaker implants – as well as many spinal surgeries. Knee replacements, hysterectomies, and cesarean sections are among the other surgical procedures performed more often than needed, according to a review of in-depth studies and data generated by both government and academic sources."
The article specifically names "spinal surgeries" as one of six procedures that are often unnecessary:
"About 10% of all spinal fusions paid for by Medicare in 2011 were not necessary, either because there was no medical basis for them or because doctors did not follow standards of care by exploring non-surgical treatments, according to a USA TODAY analysis of data from Medicare program audits. That translates to $157 million in improper payments, just for spinal surgeries in a single year."
"Another 2011 study, in the journal Surgical Neurology International, evaluated 274 patients with neck and back complaints over a one-year period: More than 17% had been told they needed surgery but had no neurological or radiographic findings that indicated an operation was necessary."2
Solutions to this problem are difficult. It takes some pretty outlandish behavior before a surgeon can be convicted of unnecessary surgeries. Money is obviously a motivating factor:
"Doctors' income can hinge largely on the number of surgeries they do – and the revenue those procedures generate. Those numbers also can determine whether doctors get privileges at certain hospitals or membership in top practices."
A sidebar to the article talks about what patients can do to protect themselves.3 These suggestions may appear obvious, but making the right choice could be a life-or-death decision.
Taking responsibility to find answers is the first step. Most patients are too shy to ask the hard questions regarding the surgical risks and alternative care. This is an area in which you, their doctor of chiropractic, can play an important role.
Encourage your patients to find out how they can manage their ailment without surgery. You can also do a little research and provide them with studies that identify the risks of adverse surgical events – like death or disability.
Finally, you should have a good working relationship with a neurologist who is willing to provide an honest second opinion. A second opinion can reduce some surgical procedures by as much as 20 percent.
The authors of the USA TODAY article interviewed Nancy Epstein, a neurosurgeon and chief of Neurosurgical Spine and Education at Winthrop University Hospital in Mineola, N.Y. She was one of the investigators in the Surgical Neurology International study noted above. Dr. Epstein is featured in the video on the USA TODAY website that accompanies the article. In the video, she says: "Over the course of a year I looked at patients with neck and back complaints coming in who were told they needed surgery and out of those, at least a third of them were scheduled for operations I didn't think they needed."
As a profession, chiropractic has always sought to eliminate the need for surgery. Now that the media is finally taking a hard look at the issue, you have the opportunity to educate your patients and teach them more about the importance of chiropractic care. The first step could be going to the USA TODAY website and printing out the article for your patients to read.
You can also provide important information to your patients about the risks of and alternatives to surgery. Working with your trusted neurologist, you can be a great source of second opinions that will be hard to argue with. You could be saving many patients from unnecessary surgery.
- Eisler P, Hansen B. "Doctors Perform Thousands of Unnecessary Surgeries." USA TODAY, June 20, 2013.
- Epstein NE, Hood DC. "Unnecessary" spinal surgery: a prospective 1-year study of one surgeon's experience. Surg Neurol Int, 2011;2:83.
- "Tips to Avoid Unnecessary Surgery: Advice for Patients Considering Surgery" (sidebar in Eisler and Hansen article)). USA TODAY.
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Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.