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Physicians Have Fewer Surgeries

© David S. Sobel MD

The following is one in an ongoing series of columns entitled Mind Body Health by David S. Sobel MD. View all columns in series
Your decision about whether or not to have non-emergency surgery will be influenced by your expectations and understanding as well as the desires and biases of your surgeon. What patient can resist an enthusiastic surgeon? Apparently, the answer is other physicians.

When faced with a surgical decision, who better to be than a physician? You would be among the best informed consumers. You would be well aware of the risks, benefits, and alternatives to the proposed procedure. And, according to the results of a new study, you would be less likely to have surgery at all.

Researchers compared surgical rates for physicians, lawyers, and their families to the general public in a large population in Switzerland. They looked at rates for the surgical removal of tonsils, gallbladder, uterus, hemorrhoids, appendix as well as repair of hernias and D&C (dilatation and curettage of the uterus).

For all of the operations except appendectomy, the general public went under the knife much more frequently than physicians or their families. For example, if you don't have a physician in the family you are 50% more likely to have had a tonsillectomy, hysterectomy, or hernia repair and 80% more likely to undergo removal of hemorrhoids or gall bladder. If you want to avoid surgery, it also helps to have a lawyer in the family. Their surgical rates were almost identical to physicians!

These differences don't seem to be due to financial barriers since all patients were covered by the public insurance programs and even the poorest had access to needed surgical services. Nor does it appear to be differences in how sick the general public was compared to physicians and lawyers. While some disease rates do vary by level of income and occupation, there is little evidence of variation in the specific types of disease for which these surgical procedures are indicated.

It appears that the more informed you are, the less likely you are to ask for or agree to elective surgery. Lawyers seem to have a special immunity to surgery. Lawyers may be more likely to challenge the surgeon's authority and have greater potential for causing legal problems. Physicians may tend to be more cautious and prudent about recommending elective surgery to these "risky" patients.

We don't know for sure the optimal rate of these surgical procedures that yields the best overall outcomes for patients. Nor do we know whether the reversal of financial incentives from fee-for-service to prepaid, managed care will lead us closer to optimal surgical rates. Nevertheless, we suspect that more operations are performed than are needed and that we would all do well to more closely follow the example of the most informed consumer, the physician-patient.

For More Information:
Sobel D, Ornstein R: Preparing for Surgery, Mind/Body Health Newsletter, Volume V, Number 2, 1996.

Domenighetti G, et al: Revisiting the most informed consumer of surgical services: The physician-patient. International Journal of Technology Assessment in Health Care 1993;9(4):505-513.

Domenighetti G, Casabianca A: Rate of hysterectomy is lower among female doctors and lawyers' wives. British Medical Journal 1997 May 10;314(7091):1417.


Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

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About The Author
David S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the national initiative in Self-Care and Shared Decision-Making for Kaiser Permanente. He is coauthor of Living a Healthy Life with Chronic......more
 
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