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There is an absolutely fantastic quote relevant to this in An Astronaut's Guide to Life by Chris Hadfield (a fantastic book). Unfortunately, I don't have the bo

There is an absolutely fantastic quote relevant to this in An Astronaut's Guide to Life by Chris Hadfield (a fantastic book). Unfortunately, I don't have the book handy and cannot do it proper justice, but the part I refer to involves dozens of years after a childhood appendectomy when Hadfield was beginning his "real" astronaut career. After experiencing severe abdominal pain at the surgical site, he was sent to a panel of surgeons for guidance. Going into surgery at this time would've been catastrophic to his career, as after a surgery one cannot fly into space for some extended period of time. At this point in his career Hadfield was relatively green, and there was a plethora of new astronauts as talented as he was just waiting to take his spot. Going into surgery at this point would have relegated him to a successful career at mission control, but not in space. To the best of my recollection, his physician's opinion was he didn't need a full surgery to investigate this abdominal pain. However, the panel of surgeons universally, unequivocally recommended the gastrointestinal surgery. He states infinitely more eloquently than I can how applicable "uf you only have a hammer, everything looks like a nail" in regards to the surgical panel. I recall he decided against the recommendations of the surgeon panel, and decided his abdominals wouldn't suddenly tear apart with potentially fatal results while orbiting earth in the ISS. It turns out he guessed right, and had one of the most prolific careers of any astronaut of the last few decades. While this anecdote may make it seem like I am some anti-surgeon, anti-surgery person, let me state that I have had one surgery (besides wisdom teeth, which "doesn't count" as it's so common). It was an orthopedic reconstructive ulnar collateral (thumb) surgery, and my repaired thumb is honestly almost indistinguishable from my left thumb. And in this case it was clear surgery was needed, but after reading Hadfield's book and the parent article here it was astounding how the surgeons were literally unable to see any mode of treatment which didn't involve surgery. I think just like overprescription of antibiotics, we as a society should look at the overprescription of surgeries for medical issues which can be treated without surgical intervention.

rscho 6y ago
> it was astounding how the surgeons were literally unable to see any mode of treatment which didn't involve surgery. Current medical practice is the definition of "when all you have is a hammer, everything looks like a nail", so no surprise here. This a result of hyperspecialization which most of the time is good (capable hands) but sometimes not so good (rigid mind).
Peradine 6y ago
The problem with that anecdote is that its all with the benefit of hindsight. Certainly, in this instance, non-operative management was appropriate. But the more important question is what on average happens to the entire 'population' of people presenting with Hadfield's symptoms and signs if they're managed operatively and non-operatively. If we imagine a disease where non-operative management leads to a 50% mortality rate within a year. If we take 100 people with this disease and manage them non-operatively, at the end of a year we'll have 50 people saying how pleased they are to have avoided surgery and complaining about the aggressiveness of surgeons, and we'll have 50 dead people. That's why the diagnosis and management of disease must be informed by high quality clinical studies, rather than anecdotes.
- oarabbus_ 6y ago
  While your general point about anecdoes makes sense, your point about the 100 people and 50 dead is completely incorrect. and ironically that example is a made up anecdote, at least Hadfield is a real example. It's well documented across many studies that a staggering number of surgeries are unnecessary. https://www.usatoday.com/story/news/nation/2013/06/18/unnecessary-surgery-usa-today-investigation/2435009/ https://www.usatoday.com/story/news/nation/2013/06/18/unnece... key highlights: "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" "An estimated 7.5 million unnecessary medical and surgical procedures are performed annually with the number of unnecessary hospital stays around 8.9 million a year. One study determined that almost 29% were not necessary (Health In The 21st Century by Fransisco Contreras MD, page 212)" "A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices" Anecdotes are great for illustrating a point and making an emotional connection which is why I brought up the story from Astronaut's Guide. But there's absolutely no doubt that a significant and unacceptable number of surgeries are unnecessary.

rscho 6y ago

> it was astounding how the surgeons were literally unable to see any mode of treatment which didn't involve surgery. Current medical practice is the definition of "when all you have is a hammer, everything looks like a nail", so no surprise here. This a result of hyperspecialization which most of the time is good (capable hands) but sometimes not so good (rigid mind).

Peradine 6y ago

The problem with that anecdote is that its all with the benefit of hindsight. Certainly, in this instance, non-operative management was appropriate. But the more important question is what on average happens to the entire 'population' of people presenting with Hadfield's symptoms and signs if they're managed operatively and non-operatively. If we imagine a disease where non-operative management leads to a 50% mortality rate within a year. If we take 100 people with this disease and manage them non-operatively, at the end of a year we'll have 50 people saying how pleased they are to have avoided surgery and complaining about the aggressiveness of surgeons, and we'll have 50 dead people. That's why the diagnosis and management of disease must be informed by high quality clinical studies, rather than anecdotes.

oarabbus_ 6y ago
While your general point about anecdoes makes sense, your point about the 100 people and 50 dead is completely incorrect. and ironically that example is a made up anecdote, at least Hadfield is a real example. It's well documented across many studies that a staggering number of surgeries are unnecessary. https://www.usatoday.com/story/news/nation/2013/06/18/unnecessary-surgery-usa-today-investigation/2435009/ https://www.usatoday.com/story/news/nation/2013/06/18/unnece... key highlights: "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" "An estimated 7.5 million unnecessary medical and surgical procedures are performed annually with the number of unnecessary hospital stays around 8.9 million a year. One study determined that almost 29% were not necessary (Health In The 21st Century by Fransisco Contreras MD, page 212)" "A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices" Anecdotes are great for illustrating a point and making an emotional connection which is why I brought up the story from Astronaut's Guide. But there's absolutely no doubt that a significant and unacceptable number of surgeries are unnecessary.