Questionable care

A doctor in Michigan was last week fined US$775,000 for ordering surgeries that were unnecessary. In one case, he removed a woman’s uterus, cervix and both ovaries because of a threat of cancer, even though no cancer was present.

He is hardly alone in his malpractice. Even in 2020, when many hospitals were refusing non-urgent surgeries, more than 100,000 unnecessary and potentially harmful procedures were performed on older patients in the USA, according to anaylsis from health think-tank the Lown Institute.

“You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures,” said Vikas Saini, MD, president of the Lown Institute. “The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”

From spinal fusion, to heart stents, knee arthroscopes, to root canal work, surgery with questionable benefits is routinely performed all around the world. Surgery of any kind carries risk. As American clinicians, Stahel, Vanderheiden and Kim noted in 2017, “it is significantly safer to board a commercial airplane, a spacecraft, or a nuclear submarine, than to be admitted to a US hospital”. Every year, more than 1 million patients die during or immediately after surgery.

But doctors and patients alike usually believe they are acting in the best interest of the patient. Social and cultural pressures come to bear on decisions; doctors are only human after all. Their pre-existing biases may push them into surgery where it is not strictly necessary.

So while clinicians call for more patient education and shared decision making, social scientists are examining the context of the decision making, showing that people — doctors, patients and their carers — are more than a collection of body parts.

REALITY CHECK

More than 100,000 unnecessary and potentially harmful procedures were performed on older patients in the USA between March and December 2020, according to the Lown Institute.

Medical errors are the 3rd leading cause of death in the United States.

As far back as 1976, the American Medical Association called for a congressional hearing on unnecessary surgery, claiming that there were “2.4 million unnecessary operations performed on Americans at a cost of $3.9 billion and that 11,900 patients had died from unneeded operations”

Unsafe surgery causes complications in up to 25 percent of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery.

BIG IDEAS

Quote attributable to Brian D. Earp, University of Oxford
“Non-trans-identifying children in the United States and elsewhere are routinely subjected to medically unnecessary surgeries affecting their healthy sexual anatomy — without opposition from conservative lawmakers.”

Quote attributable to Alison Downham Moore, Western Sydney University, Fouzieyha Towghi, Australian National University, or Tinashe Dune, Western Sydney University
“Hysterectomies have disproportionately impacted the most disadvantaged women and have frequently been concentrated in populations that are already marginalised on the basis of race, ethnicity, age, criminality, disability, gender deviation, lower class, caste or poverty.”