I’ve recently observed cases where family and friends undertake serious medical interventions with not the best outcomes. These interventions seem well intentioned to rehab issues, but I now wonder if they sometimes are a money grab when potentially better health outcomes might exist. In fairness to the Doctors, we want instant and complete resolution to sometimes niggling health issues – many caused by our own lifestyles or basic aging.
Here are a few observations:
- My uncle had his prostate removed in his late 70’s, and successive complications from the surgery killed him after two years of miserable, bed-ridden life. The typical life expectancy for most prostate cancers is 10-15 years. In fact, some European health organizations eliminate prostate cancer screening after age 70 since studies show no longevity increase with surgical intervention.
- Another relative in her 70’s had major back surgery to cure mild back pain, which persists perhaps worse than before. This individual is sedentary and does not exercise, walk or stretch. No exercise or physical therapy regimes were recommended prior to surgery.
- A friend had a hip replacement in his 50’s to sustain his active sporting lifestyle. Eight years later, he has significant bone-loss damage and other chemical imbalance issues from metallosis poisoning. His prognosis is potentially continued deterioration of these systems.
- Three different acquaintances (60’s) had knee replacements that have not gone ideally – all are hobbling worse and a couple have had multiple surgeries. Two are overweight, and one of these two is relatively inactive. No weight loss or exercise regimes were progressed prior to surgery.
The American medical model seems to be to undertake every possible intervention. In the case of optional surgeries in particular, I just wonder if we sometimes are a defacto 529 Plan for the Doc’s children rather than getting the best outcome.
Do you have further examples where the medical process was not ideally implemented or downsides were not fully explained, or alternatively, do you feel I have it wrong with these examples? The more examples, the better – many of us will face sitting across from our medical professional and wondering whether we should proceed down an uncertain path.
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Interesting post! As a PA who has worked in family medicine for 20 years as well as emergency medicine for seven years, I can appreciate many of the comments. To answer your questions in the title of your post, no not all surgeries are necessary in my opinion. I also don’t agree that we have become “the college tuition bank for the Doc’s children.”
One thing that strikes me in these types of discussions is that many people think that medicine is an absolute. There is a reason why it is called “the practice of medicine.” Medical providers try and use the information that we have learned over many years of education and working with patients to help our patients. Unfortunately, there is no such thing yet of “absolute medicine” and 100% positive outcomes.
In all fairness, the main goal of everyone I know and have known in medicine the past 20+ years is to try and help people to the best of our ability. We all have sacrificed in one way or another to get trained in a profession to help people. I never took a class or clinical rotation in my training that taught me how to cut corners, harm people, or rip people off.
People that choose to practice in medicine invest many years and dollars for this training. In the case of physicians, they are required to complete four years of medical school. This is followed by many years of advanced training in whatever specialty they decide to work in. In the case of family medicine and internal medicine, this is usually three years of residency. General surgery or orthopedic surgery requires at least five years of residency. Neurosurgery usually requires 6 to 8 years after medical school.
Based on my experience with a variety of specialists over the years, they all deserve the income they receive based on their level of expertise and the sacrifices they have made to obtain that specialized training.
Someone mentioned in a post that they hated their nephrologist. I would recommend trying a different nephrologist perhaps in consultation with your primary care provider. While nephrologists may not have the best bedside manner, they are some of the smartest people that I have met in medicine.
While non-medical people usually graduate from an undergraduate program and start a career, medical professionals delay their career goals and incomes for many years in some cases. What is the main goal of the majority of these future healthcare providers? Help other people.
I have learned over the years working with patients that not all neck or back pain requires surgery. In addition, not all neck and back surgery cures neck or back pain. This is not due to most specialists doing unnecessary surgery in their professional opinions. The spine is a very complicated part of our anatomy.
It is mentioned in the original post and several other comments that “no weight loss or exercise regimes were progressed prior to surgery.” Do you know for a fact that this was not recommended by the surgeon and his team? Did these people follow all of the recommendations of their physical therapist after surgery?
Do you know how many times I recommend weight loss and exercise on a weekly basis? All I get in response is a glassy eyed stare from most patients. There needs to be a bit of self ownership by the patients and not just blame this on the surgeon or other healthcare providers.
Most patients that I see rave about the results of their knee or hip replacement. Unfortunately, in some cases when they have the second knee or hip replaced by the same surgeon, the recovery is not as smooth and takes longer. No one really knows why this occurs.
Are there mistakes made by medical providers? Yes. Are they intentional or just for the goal of making money in the majority of cases? No.
Do you know that the average cost of ob/gyn medical malpractice insurance can be $46,000 per year (https://griffitheharris.com/cost-of-medical-malpractice-insurance-by-state-and-specialty/)? In addition, neurosurgeons also pay steep annual premiums and nearly 19.1% face lawsuits annually. What happens when these specialists get tired of this and leave the profession?
Imagine sitting in an exam room one-on-one with an obese patient who is in tears about their knee pain. Imaging has revealed bone-on-bone arthritis. They have tried several knee injections with the goal of delaying surgery without any significant relief. They are requesting knee replacement because they are tired of the daily pain. What would you do?
My two cents…
This may be a variation on your question. How well do doctors communicate with us? I’ve hated my nephrologist since first meeting, but how does one select a specialist when it’s not a common problem. He said our goal is to keep my kidneys functioning until one hour after my death (he was unable to provide a date for that). We tried a certain stabilizing drug; he took discontinued it within weeks. Since then, five other doctors, in and out of nephrology have advised me to stay on that drug, and advised on a biopsy to more clearly understand the disease and its damage to date. I’ve followed their advice. I’m quite healthy except for the kidney disease, so I’m exploring transplant. Many of my consults are quite positive about that, but not my original nephrologist. Oh, did I mention he makes money from people being on dialysis?
Unsatisfactory medical encounters do happen and are regrettable. Still, I caution against concluding that such examples are evidence of widespread unethical or incompetent behavior.
I enjoyed practicing neurology and considered it a privilege to care for others. And now retired, and older, I have been learning what it is like to be a patient. In fact, I am now two days out from shoulder surgery as I type this.
You expressed uncertainty whether to proceed with the advice you might receive from a medical professional. Fair question. My suggestion is to do what you might when meeting with an attorney, financial advisor, or any professional. Be skeptical, but open minded, ask honest questions and share any concerns. And afterwards, if unsure, seek another opinion.
Find a primary care physician you trust, and seek his or her advice about treatment and specialty care. Word-of- mouth reviews from people you know can be helpful, but be skeptical and open minded about those reviews too!
I had knee replacement in 2015. Needed it because it was bone on bone after multiple surgeries from torn ACL and cartilage back in college. Doctor who did it was one of the best in Boston, and was the doctor who was flown overseas when a well known politician hurt his hip. He did a great job. I was very diligent with the PT, which was critical.
A year later I started Krav Maga, which has a lot of kicking. Did that for 4 years until covid hit. Now in my 70’s, I didn’t go back to Krav but 2 years ago started HIIT workouts at F45. The knee still is great. The only limitation is the bending, which may be at 120-130 degrees, which the doctor says is great.
Five or six years ago my shoulder started hurting from years of sports and exercise so my knee doctor referred me to a colleague of his who specialized in shoulders.
During a very brief meeting, he simply said he would suggest a shoulder replacement. No x-rays, nothing. I never went back.
I went to a different doctor a year ago and after x-ray and MRI, he said I have some tendinitis and a partially torn rotator cuff. He sent me to physical therapy, PT. He said no surgery needed unless rotator cuff is totally torn and painful. The shoulder is fine and there are certain exercises I stay away from, such as upright rows for example. So 2 well respected doctors with 2 different experiences. As in any industry, that is probably the case, whether in financial services, the law, etc.
This is a fairly minor example on the relative scale, but I developed a foot problem in 2023. It became increasingly painful and was impeding my ability to exercise, so my primary care doctor sent me to an orthopedist. The choices he gave me were “cortisone or cut.” I’d researched the condition a bit and knew there were other alternatives (e.g., physical therapy, alcohol injections, etc.), but when I asked about those, he shrugged and said that’s not what he does.
As it happens, we have a good friend here in town who’s a retired orthopedic surgeon. He’d done the surgical procedure this condition indicates at least 20 times, but he strongly advised that I avoid the surgery if at all possible. Its success rate isn’t all that great, the surgery itself has a long recovery, and sometimes it makes things worse for people.
I got two cortisone shots from the orthopedic surgeon that didn’t help much, and so I switched my care to a podiatrist, which is probably where I should have gone in the first place. She had a range of possibilities we could explore, but the first thing she tried was an ultrasound-guided cortisone injection, which was a lot more effective than the “where does it hurt” approach of the orthopedist. Several injections later over a period of months, plus custom orthotics, and I’m doing much better. The foot pain isn’t entirely gone, and I still have to mind my footwear and ice and elevate it occasionally, but I’m now confident I’ll avoid surgery.
Good for you. I once avoided foot surgery (recommended by a podiatrist) by seeing a slightly unorthodox chiropractor who also provided orthotics.
You are spot on John.
I was having significant pain in my right hip and went to a recommended orthopedic. The doctor examined me and administered a steroid injection. He proceeded to give me a sales pitch for hip replacement which I thought was highly unprofessional.
Six years later the hip is doing fine thanks to PT and consistent exercises.
BTW, this same doctor botched the hip replacement of a friend who ultimately had a 2nd hip replacement by another doctor.
I have two personal examples to share with you:
My mother had a surgical gauze sponge left behind an abdominal surgery. When she went back to her surgeon and said that ‘My son (I am a veterinarian) thinks there’s a foreign body reaction at the surgical site’, he laughed. It took a second doctor to make an accurate diagnosis and correct the problem.
Second, my father’s diagnosis of adenocarcinoma of the ampulla (near the pancreas) was misdiagnosed as gall bladder disease, and by the time it was accurately diagnosed it had spread to local lymph nodes.
I believe the root cause of this problem is the insurance industry along with supporting roles by Medicare and Medicaid. Doctors are incentivized to ‘do something’, even if doing less or nothing is better for the patient. Until the economic incentives are changed to a system that rewards patient outcomes vs. surgeries/tests/procedures/scans performed, this situation will not change.
With respect to your first example, prostate cancer, the vast majority of doctors are now screening to pick up only aggressive tumors, having learned that most men over 75 die with prostate cancer, but not from prostate cancer.
“Doctors are incentivized to ‘do something’, even if doing less or nothing is better for the patient. “
Quite the contrary, they have an incentive to document, but not to act. Considering the shortage of medical professionals actively practicing, there is plenty of money to be made.
I’ve not responded before to any post, and I am an HD reader for years. I am a retired dermatologist, and I guess it falls to me to offer dissent. Are there bad apples in medicine? Sure, I met a few – very few – hackers in my 40 year career. The VAST majority of my colleagues were/are highly intelligent, exquisitely trained, reluctant to intervene capriciously, and dedicated to their profession and their patients. Reality: not every person is diagnosable. The very best surgeon can have a lousy result. You’re not talking about repairing a refrigerator. The human body consists of 30 trillion cells, each performing complex chemical reactions every second. Every one of the thirteen organ systems operates in concert with the others to achieve the highest level of function possible. I am unaware of any surgeon who factors in the financial gain before recommending a procedure – although I guess it’s possible. One is taught to make the most accurate decision based on the best available information, and then to make a recommendation to the patient – I liked to lay out options and if asked would offer an opinion, applying the “ if this was my family member what would I do” standard.
Lest we forget, death stalks us all. The highest standard of care applied to ideal patients in perfect circumstances will not prevent ultimate death. Believe me, physicians are trained to do the utmost to relieve suffering. It’s our “raison d’etre.”
I found a great deal of cynicism and skepticism in the posts. The CDC doesn’t list medical errors in the leading causes of death in the US. The US offers the best healthcare in the world, bar none. The excess mortality rates people sometimes cite that lower US ages at death are due entirely to drug overdoses and suicide. US healthcare is the envy of the world – how else to explain so many people coming here from overseas for care?
Can it be better? Always. Can it be done cheaper? Possibly. The dynamic that exists is people want the best possible diagnostic tests, and the best possible treatment, for no out of pocket cost, and so help me God I’ll sue you if you don’t deliver. You wonder why 2/3 of American physicians are burned out? Try pouring your blood, sweat, and tears into helping people, and then reading posts about how you are a money grubbing so and so who couldn’t care less about your pain.
my rant has ended. God’s blessings to anyone who reads this, and Happy Easter!
I have to disagree that the US has the best healthcare in the world, bar none. Not anymore. We have a lot of good positives compared to other developed countries, but we have shortcomings as well.
‘The US has a strong reputation for advanced medical technology and expertise.
The US has a large and highly trained pool of medical professionals.’
However:
‘The US healthcare system is significantly more expensive than those of other high-income countries, with high out-of-pocket costs and premiums high spending. The US lags behind other developed nations in key health outcomes, including life expectancy and rates of preventable and treatable deaths.
Also, I’m not sure your claim that mortality rates are due entirely to drugs and suicides is correct either.
‘It’s not entirely accurate to say that the lower US ages at death and the excess mortality rates are solely due to drug overdoses and suicide. While these are significant contributors, other factors like cardiovascular disease, cancer, and even increased rates of deaths from accidents, also play a role in the declining life expectancy.’
Another big problem in the US is the decline of general practitioners as well as the much longer wait times to schedule procedures.
i was looking for a general practitioner at the biggest and most respected hospital system here in the Boston area where I have other doctors, and the wait list is so long they no longer will add your name to the wait list.
I am a retired neurologist and I agree with you, Dr. Young.
Thank, well said, my daughter is in her 3rd year of med school and witnessing what she went though to get in and what they put students though has made me pretty defensive of Doctors now. She has sacrifice so much and will continue and her heart is purely motivated for wanting help people.
From what my daughter tells me, the main problem is medicine is based on the foundation of doing something to help the patient get better. The advent of modern technology has given medicine the ability to treat and prolong life far greater than we could image 50 years ago. Doctors are NOT trained to withhold treatment no matter the age of the patient. Of course wise Doctors will make wise decisions. BUT then the family gets involved and of course lawyers and bad outcomes can result.
You are the best defense against bad outcomes. Educate yourself. And for goodness sake, have a DNR and a health care power of Atty in the hands of the person who truly has your best interests and KNOWS what how you want to go out.
Sorry, my rant too.
Well stated Dr Young. What you did not say is that many of us are lousy patients. We do not take care of ourselves and expect doctors to give us a magic pill to make us better.
No doubt, yours is a challenging occupation.
Dr. Young, thank you for sharing your perspective. I think the physician burnout phenomenon you mentioned–along with the waning numbers of primary care physicians available–is a bigger concern for our health system.
John, like every profession, healthcare is populated by people. We both know that people come in all flavors, from the scrupulously ethical to the ones we hear have done some misdeeds, or just walked the line in-between.
Patients are not generic, either. They might share a diagnosis, but each case is unique. Each has a different set of causes and potential for healing. And the patient’s psychological makeup plays a big role in the outcome as well, especially for the orthopedic surgeries you cite in your examples.
I empathize with folks who don’t get the pain relief or restored function they expected. As a physical therapist, it’s one of the worst aspects of my job. I think most physicians feel the same. But seeing the majority who do get acceptable outcomes balances things psychologically for me.
I freely admit I probably have bias. But the poor outcomes might be more noticeable and memorable than the good ones. Maybe it’s like the occasional bad times in the market–most folks tend to feel them more than the “normal” good days. But in reality, life is a mix of good and bad.
It’s a tough discussion, because in healthcare, the numbers always represent real people who are really suffering.
Very well said as usual Ed.
Always take a medically savvy person – a friend if possible – with you to appointments discussing serious issues. There is a psychological reason for this.
Informed consent is such a difficult idea. When your life is threatened with some very fatal medical problem are you really able to understand and internalize what you are told about what your life might be like should you elect to undergo the proposed treatment?
Seven years ago the spouse of a good friend underwent a double lung transplant. It was that or a pretty quick, certain death. Unfortunately, her life over these seven years has been hellish. The cost of her treatment has been in the millions, with her portion in the several hundred thousand dollar range. Because a transplant requires normal immune response to be suppressed, she has had many infections requiring hospitalizations, transfusions, scans, tests, and trips to see a doctor. She has not had a single “normal” day since the procedure. Just my opinion, but she doesn’t really have a life, even though she lives.
Another friend was diagnosed with advanced stage esophageal cancer. This is a very tough disease. He elected to be treated rather than do hospice. He did not live longer than forecast even after undergoing very drastic surgery. This surgery involved replacing his esophagus and half of his stomach with a piece of his small intestine. They also used some pieces of blood vessels from his leg in this procedure. This three simultaneous surgeries procedure really set him back. Afterward, he couldn’t eat normally. He had been a marathon runner, and very trim. He became emaciated, and when the cancer soon returned he died anyway.
When I think about these stories, I wonder about the physician’s Oath to “First do no harm”?
One of my daughter’s best friends, and a bridesmaid underwent a double lung transplant in 2012 due to cystic fibrosis. She obviously had very little time left if she did not undergo the procedure. Since the surgery she was married, then divorced, and has spent a fair amount of time both driving halfway across the country for care at the surgical facility, and in the hospital for complications. Are these all unfortunate events? Yes, but unfortunate events are part of everyone’s lives. She is glad to be alive, and is looking forward to her next transplant as her first replacement pair are failing.
We are biased toward giving too much weight to personal experiences and anecdotal evidence … I’m a big believer in 2nd and 3rd opinions and a lot of research
There are many anecdotal stories, and I have a few about myself and siblings. It is reasonable to assume things may not go well but sometimes outcomes are better than might be expected.
I’m going to relate some experiences for a couple of reasons. To paraphrase Nietzsche “That which does not destroy us makes us stronger”. In fact, it took me a few years to realize that any adversity I encountered in my life was an opportunity, presented choices and prepared me for those to come. I could and did enlist partners and networks of support. I decided it was okay to slow down when it seemed I couldn’t continue but that I would never, ever stop until my heart did. This approached has proved useful to me and to others.
When I was nearing the end of Radiation Therapy my Radiologist observed “You are made of stern stuff.” My tenacity became a means to joke with my GP and Oncologist. I’ve told my doctors that I will do everything practical to live some semblance of a normal life, acknowledging that there are serious restrictions. I appreciate their care and advice but ultimately, I am responsible for my wellbeing. Today I do realize I am hanging by a thread and the grace of God. The next setback, whatever it is, will likely be the final one or result in further, permanent loss of function.
In 2022 I discovered I was very ill, before consulting a doctor. It was determined that I had a very rare, inoperable cancer that had invaded the muscle wall of my bladder making surgery inadvisable. The type of tumor could have bled me to death if surgery was attempted. How serious? Even a biopsy carried extreme risk! The statistics for this type of cancer were a 15% survival; I was assessed to be lower. Shortly after diagnosis and beginning treatment it was suggested that I enter hospice.
I declined and after three years I’m still here. Treatment was difficult. The preferred chemotherapy drug wasn’t available (it was being rationed to younger patients) so I was given an alternate deemed to be less effective. A surprise to all, it was effective! I received two years of radiation treatment, chemotherapy and immunotherapy. Cancer has been one of several life-threatening events I’ve had.
One thing I’ve learned is one must be an advocate for oneself. I’ve also approached my treatments as a partnership. I relocated to get the best care with as little stress as possible for my spouse. I have four specialist doctors. My GP is with one medical group while my specialists are with a different hospital with a cancer treatment focus. I consult with both groups, post data and photos to the team on their online portals and I am frank in my discussions. For important treatments I get at least two opinions. Then I discuss my decision with the doctors and when appropriate with my spouse, whom I attempt to shield from most of the worst. At times I go a different way from the doctors after I convince them. At times I modify my position and acquiesce to their recommendations. There have been some eyeball to eyeball standoffs which were resolved.
Here’s one example of my health challenges: I have nephrostomy tubes “for life”, now going three years. Either that, or I can undergo a cystectomy. I’ve experienced a myriad of problems with my nephrostomy tubes. A cystectomy also has risks as I’d have the 5-hour surgery, a long convalescence and still have plastic external parts.
There is daily care and procedures I perform on the tubes and replace dressings (wound care) every couple of weeks. Doctors recommend I have the tubes replaced on a regular basis. How regular? I’ve been told as frequently as every two months, and I also have information indicating two or three times a year.
There are risks associated with replacement, and I’ve experienced a serious pseudomonas infection with sepsis as well as kidney damage. I have made the decision to delay replacement for 6 months or more if no issues appear. This reduces the frequency of procedure related risks, ideally to only twice a year. My decision also carries risks. My next procedure is scheduled for April 24 at 7 months. I do get regular blood tests, now monthly unless I’m travelling.
Here’s another example. It is usual to install a “port” for administering blood and drugs intravenously. Chemo in particular can be caustic and can damage the circulatory system. I began without a port. The chemo and blood were administered via the veins in my arm; I’d been getting regular blood infusions. My hemoglobin (Hgb) level was as low as 3.6 and a high of 7.0. Normal is 13.0 g/dL. It is currently 10.7.
At 3.6 I was amazingly able to think clearly, function, walk and talk. The doctors did not want to wait to install a port. Hgb was below 8.0 so blood was administered immediately prior to each chemo session.
When the port was installed in my right shoulder within three days I experienced severe swelling and pain going all the way down my arm. I took photos and sent to my doctors. After discussing with doctors I was admitted to the hospital and it was recommended that the port be immediately removed. A new one would be installed in my left shoulder. I discussed further with their infectious experts. I had a slight fever. I declined to approve removal until the outcome of cultures testing for infection were complete, about 72 hours. Reluctantly the surgeon who installed the port agreed to wait. Meanwhile a variety of other tests for infection and EKG occurred. Everything from Covid to Chlamydia and in between. Without treatment the swelling and pain diminished in about 24 hours. After three days there was no pain and little swelling. All of the tests including the culture came out negative for infection.I met with the infectious team and thanked them all for their thoroughness and excellent work. A final test using ultrasound indicated only a small hematoma, which would be naturally absorbed. After five days I was released with the original port intact, which I still have and used continuously for two years. What had caused this? Most likely an attempt by my body to reject the port.
I’ve had other medical experiences including at age 8 a severe foot infection of which there were two most likely outcomes: amputation or fatal blood infection. That foot was not removed. At age 12 a freak accident while playing baseball of all things crushed my right elbow, destroying it and severing the nerves in that arm. I had paralysis from the elbow down, no feeling and no movement. It was predicted I’d have limited mobility at the elbow and an uncertain future for that hand. At the age of 17 although there was a lack of feeling in that hand I was sufficiently proficient to land a job as a draftsman for a consulting engineering firm. Anyone who has had this job knows it requires excellent motor skills, steadiness and strength to print and draw on vellum or mylar for 8 hours a day, or longer. I was proficient and three years later I was an “Electrical Designer I” on a nuclear generating project and one of a two man engineering team responsible for oversight of the controls design on the first computerized fossil fuel generating plant constructed in the U.S. Even today I have a lack of feeling in some parts of that hand, occasional severe elbow pain, etc. I avoid any medications as they mask the pain and may prevent my detecting a serious condition.
At age 23 I fell off a tower and plummeted 60 feet to the ground. It was a Friday evening. My left leg had dislocated while climbing an industrial ladder. The pain caused a blackout for a fraction of a second, of sufficient duration for me to lose my handhold. As I fell backwards I stretched outward to spread the force of landing. I bounced. I crawled to my car, tied my belt to the ankle and using my other foot pushed off, stretching my dislocated leg back into position. I then wrapped the belt at the knee to hold it and with great difficulty drove my stick shift automobile. The clutch was a painful experience. I iced the knee and applied a compression bandage. A doctor gave me ibuprofen for the pain. On Monday I was at work at 7:00am as usual and I wore that bandage intermittently for several months. I continue to wear a flexible knee brace when I do certain activities.
I’ve led a life with lots of walking and outdoor activities, including regular outdoor work, canoeing and backpacking which were very strenuous. I have reduced my exercise regimen to a stationary bicycle and walking each day. I eat everything but avoid sugar and empty calories, emphasizing protein and vegetables. I do everything “in moderation”. I hadn’t had my cholesterol checked recently, so my GP suggested that be done last week. It is 113. During my cancer treatment among other things I had an acute kidney injury. It is likely some of what I have experienced is because of chemotherapy, etc. My doctors attribute my resilience to my long term lifestyle and mental approach.
I have chronic kidney disease and low kidney function. My systolic blood pressure is about 140, which can further damage my 1-1/4 functioning kidneys. I’ll probably be placed on a medication to reduce further damage to the kidneys. At present my medications are multi-vitamins and a prescribed iron supplement.
Sorry for the long-windedness.
Related to this, there’s a book (doctor written) titled “Overdiagnosed”.
Learn about NNT, number needed to treat for a single person to receive benefit. Or how scanning machines (CT, MRI) can find something wrong with anyone.
Just read that CTs contribute to cancer is radiation is too high
Oh there are plenty of wasteful tests, and procedures don’t go well for everyone. But when things go well quality of life can be greatly improved. When I met with the surgeon before my prostatectomy, he told me we would achieve two things. One was to get rid of the cancer, and two was to have me peeing like a kid again. I may not know if the cancer will ever return, but it sure is nice not having to pee in morse code any longer.
One minor editing note: It’s prostate, not prostrate.
Deleted, Mike Haynes beat me to it!
Thanks Kristine – fixed.
Although your prostate can render you prostrate!
I agree that many surgeries can be avoided. The old financial adage “don’t just do something – stand there” can apply to medicine as well as finance. Patience and educating ones self prior to proceeding with any surgical endeavor is necessary. I would caution against the notion that surgeons are out to maximize profit from your care. Money does not make up for the pain experienced by both the patient and surgeon when things go wrong. It also is important for the surgeon to be compensated for his work. A system that rewards you for NOT providing care has dangers all its own.
You raise a real issue. I consider health care a bit like financial advice; buyer beware. I’ve seen examples of cases where people have gotten procedures done they probably shouldn’t have, and also cases where people put off procedures they should have gotten done earlier. In some cases it appears clearly profit motivated, but in other cases it’s complicated and hard to know what’s really the best path forward. So 2nd and 3rd opinions are generally good ideas. For myself as I’ve dealt with my own serious illness, it comes down to trying to educate myself as much as possible while actively seeking out the best medical advice I could find. In the end, even when doing one’s best to make good decisions there’s still an element of luck involved. While the goal is a good outcome, I at least want to feel I made the best decision I could with the data available at the time. Said another way, I want no regrets.
John – I do not agree with your assessment. As the recipient of both a knee replacement five years ago, at 67, and a hip replacement three years ago, I can report how extremely happy I am with the results. In both cases, the pain I experienced prior to surgery was debilitating and limiting. I explained to my surgeon and physical therapist before surgery my activity level and desire to return to the same level.
Especially for the knee replacement, recovery is not a walk in the park. I started with PT at home two days after surgery and worked for many weeks to regain leg strength. Even now, five years after surgery, when I go to the YMCA for core strength and stretching exercises, many of the tasks I have on repeat are exercises the PT prescribed during recovery.
There’s no question that the result of some procedures do not alleviate all symptoms, but I think you’re painting with too broad a brush. Later today I plan a 15-mile bike ride, where I’ll push myself just like I did ten years ago.
I guess I have been lucky. I am 77, which I believe is prime time for unnecessary procedures.
This week i saw my ophthalmologist fully expecting to start the cataract surgery process. He talked me out of it for now. I got a somewhat stronger prescription for my glasses.
I am considered at moderate risk for colon cancer and my general practitioner urged me to get a colonoscopy. I went to the guy who would do the procedure and we agreed to wait another year at least. In that case I was pretty aggressive in questioning the need.
Maybe both doctors did not have yacht payment due.
colon cancer is a painful, ugly way to go out. just saying. I’m 65 and going for my 5 year which I hate, but thankful a day of unpleasantness can save my life.
If you are at moderate risk for colon cancer have you considered using Cologuard? It’s non-invasive.
That is an excellent suggestion
the example I thought of was my grandma. She had heart surgery in her late 70s. She did not do rehab. Within a couple of years she had a debilitating stroke and spent many years in a Medicaid nursing home b/c her heart was fine. It was so sad. Chris
Great post, John. For several years I endured paralyzing pain from Bi-lateral
sciatica issues caused by back injury. Surgery was recommended by two different orthopedic doctors.
Treated by a variety of medical specialists and hospital stays, finally found an excellent physical therapist who was actually a Sports Specialist. His treatment plan for me was successful, following the McKenzie method for back pain. Still recurs in milder form when I overdo myself but escaped surgery. Grateful.
As a retired orthopedic Physical Therapist I can tell you that the McKenzie treatment program was one of the two best new treatment techniques I learned in thirty years of continuing education courses.
Ironically McKenzie discovered the treatment method purely by accident in 1956. Here is the story per McKenzie by his institute’s website, the patient came in complaining of, “pain to the right of the low back, extending into the buttock and thigh to the knee, had undergone treatment for three weeks without improvement. He could bend forwards, but could not bend backwards. I told him to undress and lie face down on the treatment table, the end of which had been raised for a previous patient. Without adjusting the table, and unnoticed by any of the clinical staff, he lay face down with his back overstretched for some five minutes. After some time, when I entered the room I was aghast to find him lying in what at that time was considered to be a most damaging position. On enquiring as to his welfare, I was astounded to hear him say that this was the best he had been in three weeks. All pain had disappeared from his leg. Furthermore, the pain in the back had moved from the right side to the centre. In addition, his restricted range of extension had markedly improved. After standing upright, the patient remained improved with no recurrence of leg pain.”
Thanks for the rousing endorsement, David and for enlightened Physical Therapists like you and Ed Marsh.
Physicians when surveyed say 20% of all health care is unnecessary. A similar stat often allies to surgeries. 25% is wasteful.
Medical errors are the third leading cause of death in the US.
More is not always better in health care. As I said before, the more facilities available, the more they must be used to be funded.
But mention a better organized, managed, coordinated universal system and see what happens.
Statistically, doctors use the health care system less than the average person…reminds me of insider trading.
Amen!
This is what happens when you have a fee-for-service model, over-loaded with specialists rather than generalists, gerontologists and family practitioners. It’s not only major surgeries – I believe this is the only country where a colonoscopy is first-line screening for low risk patients.
I have avoided both major and minor surgery by getting a second opinion. I would not agree to major surgery without doing so – and possibly getting a third.
Katy Butler’s “The Art of Dying Well” recommends avoiding much medical intervention as you get older and frailer, but I suspect it is good advice at any age in this country.
You are correct, we are the only country that screens low risk patients with colonoscopy, which is a mini-industry of its own. We have a relatively high rate of colon cancer due to our poor diet, specifically too little fiber and too much animal protein.