4 ms·

There's actually a really good law review article about this that I encourage you to read: https://scholarship.law.cornell.edu/cgi/viewcontent.cgi?article=1467

There's actually a really good law review article about this that I encourage you to read: https://scholarship.law.cornell.edu/cgi/viewcontent.cgi?article=1467&context=cjlpp https://scholarship.law.cornell.edu/cgi/viewcontent.cgi?arti... It basically boils down to surgical training/procedural variance across geographic regions that make it hard to extrapolate some conclusions without multi centered trials, surgeon hubris, and self-regulation through way of surgical societies sponsoring trials and publishing guidelines. I think many also overestimate the FDAs ability to regulate "useless" medicine, so doctors that prescribe medicine also have the same problems surgeons do. The article goes over more of this as well, but there's some regulation just not by a federal agency (unless you count CMS compensation/approval). Maybe we'll eventually have a group that specifically monitors surgical procedures. Finally, I think it's fairly telling that the majority of these "useless" surgeries are elective procedures (disclosure, if it matters: I'll be entering a surgical field that almost exclusively only performs elective procedures)

JMTQp8lwXL 6y ago
Does this mean that, as a consumer, if I need a specialized procedure I should be looking into regional variations, as there could be a material difference in outcomes?
- jhart99 6y ago
  Absolutely. If you have a disease which is uncommon or need a surgery which is uncommon, consider traveling to a center specializing in treatment. For example, while a doctor at a regional center might have a 100 breast cancer patients in a year, other cancers have only 10 patients in the whole US per year. That regional center doctor is only likely to see a single patient with that disease in his life. In that case, I would seek out those who study that disease.
- phkahler 6y ago
  As a consumer it would be nice to review a surgeon's track record in some way. Short of that - as a start - I'd say nobody should be charged for surgery if they die during the procedure. Then only the most skilled will take the riskiest cases.
  - Engineering-MD 6y ago
    This already happens in some select specialties (such as cardiothoracics) within the UK. In the UK, patients don’t directly pay for their care, but the effect of this case has (anecdotally) been that surgeons are more likely to refuse to operate riskier cases to avoid impacting on their outcomes score.
- rscho 6y ago
  Yes. You should go somewhere they do a lot of the particular surgery you are interested in.
- dredmorbius 6y ago
  As others have noted yes, very often with dramatic differences by facility directly traceable to head surgeons within departments. Multiple facilities sharing a common head surgeon, or the same facility after the arrival or departure of a surgeon being strongly detectable in outcomes data, from what I've heard.
- athriren 6y ago
  this is the most important thing you can do for planned (not emergency) operations. check volume and pt outcomes.

JMTQp8lwXL 6y ago

Does this mean that, as a consumer, if I need a specialized procedure I should be looking into regional variations, as there could be a material difference in outcomes?

jhart99 6y ago
Absolutely. If you have a disease which is uncommon or need a surgery which is uncommon, consider traveling to a center specializing in treatment. For example, while a doctor at a regional center might have a 100 breast cancer patients in a year, other cancers have only 10 patients in the whole US per year. That regional center doctor is only likely to see a single patient with that disease in his life. In that case, I would seek out those who study that disease.
phkahler 6y ago
As a consumer it would be nice to review a surgeon's track record in some way. Short of that - as a start - I'd say nobody should be charged for surgery if they die during the procedure. Then only the most skilled will take the riskiest cases.
- Engineering-MD 6y ago
  This already happens in some select specialties (such as cardiothoracics) within the UK. In the UK, patients don’t directly pay for their care, but the effect of this case has (anecdotally) been that surgeons are more likely to refuse to operate riskier cases to avoid impacting on their outcomes score.
rscho 6y ago
Yes. You should go somewhere they do a lot of the particular surgery you are interested in.
dredmorbius 6y ago
As others have noted yes, very often with dramatic differences by facility directly traceable to head surgeons within departments. Multiple facilities sharing a common head surgeon, or the same facility after the arrival or departure of a surgeon being strongly detectable in outcomes data, from what I've heard.
athriren 6y ago
this is the most important thing you can do for planned (not emergency) operations. check volume and pt outcomes.