Is it financially compelling for doctors to do things that don’t help patients?

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Wow.  This article was fascinating to read and made a lot of sense.  As I would always say to a potential client when I would decline a case: “Just as you should always get a second opinion before getting an elective surgery, get a second opinion on this case.”

According to an Indiana orthopedist who has launch a moral campaign, he thinks financial conflicts of interest often drive physicians to perform worthless surgeries, and it is orthopedists who are the worst offenders.  He wants his colleagues to stop.

James Rickert, M.D., founded the Society for Patient Centered Orthopedic Surgery years ago opines that it is really hard for doctors to acknowledge this and change their ways.

A series of four reports from the Government Accountability Office support his opinion.  The reports document greater numbers of procedures referred by physicians who own providing businesses, compared to referrals from non-owners.

A lot of orthopedic surgeons “own part of the distributorships that sell the total hip or knee implants to the hospital, and they’ll make a ton of money on that. Or they own a piece of the imaging or the physical therapy center they send their patients to. They own a piece of the surgical center. They know if they’re not doing a lot of surgery, they may lose money on their overhead,” Rickert says.

Until Rickert got sick with cancer, he didn’t work hard to stop the surgical overuse that even he was doing.  According to Rickert, while being very sick, he had a chance to start thinking about patient-centered care expectations and how different that is from reality.

After conquering his cancer, he founded the society to appeal to surgeons’ consciences. So far, 14 fellow orthopedists have joined his effort.  Even though performing unnecessary surgeries is not arguably below the standard of care, is it the best course of action for some patients?

Rickert and some of his colleagues also criticize the American Academy of Orthopedic Surgeons’ Choosing Wisely list of five procedures doctors and patients should avoid. None on the academy’s current list is especially common or very important, Rickert says.   The AAOS did not immediately respond to a request for comment.

At the conference, Rickert and Rob Rutherford, MD, an orthopedic surgeon from Coeur d’Alene, ID, presented what they say is a more relevant list of procedures that are frequently performed, usually unnecessary, high cost, and sometimes harmful:

  1. Vertebroplasty    Cost: $10,000
  1. Clavicle fracture repair or “plating” in adolescents    Cost: $13,000
  1. Anterior Cruciate Ligament Tear Repair    Cost: $10,000
  1. Surgical Removal of Part of a Torn Meniscus    Cost: $6,000

He acknowledges that there are a lot of angry orthopedists who do not like what he is doing.  But, it isn’t stopping him.  He is convinced that he needs to show the doctors the data and studies that show this doesn’t work.

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