5 ms·

> Only a total sociopath would cut up people without any idea how to help them, and they would not stay in business (nor in town) long Surgeons needing to perf

> Only a total sociopath would cut up people without any idea how to help them, and they would not stay in business (nor in town) long Surgeons needing to perform number of procedures for their medical specialty, insurance related quotas, etc.? They'll cut you without talking to you in person. Good luck proving that and your complain and opinion will be powerless.

hef19898 4y ago
That is a pretty wild claim there. Care to elaborate?
- scyzoryk_xyz 4y ago
  When you're holding a hammer, everything is a nail. Surgeons will often have this bias, because they're seeking cases which fit their area of research. They're also often collecting data for the research. This helps advance their careers, makes them eligible for higher pay, advances them in the hierarchy, gives them many perks etc. Oh and obviously - successful research improves overall medical knowledge. Many surgeons will cut you without talking to you because they don't see the point. In fact, some surgeons believe staying focused on the bio-mechanical aspects of the work and not getting emotionally involved helps improve their outcomes. Others, of course think and do the exact opposite - but this also depends on the local culture. My own personal view is that for the patient talking to the surgeon is like talking to the chef of a restaurant - it doesn't change anything about what happens in the kitchen, and there is a whole team of people working in the kitchen anyways. As far as insurance and quotas - there are definitely others watching when you work anywhere as a surgeon. There might be pressure to use particular equipment that was purchased (DaVinci robots and disposable instruments are good examples). Or there might be pressure to do a procedure a particular way (to reduce insurance risk, even if surgeon would prefer to do it differently). In poorer countries there might be limitations around available equipment, or lower familiarity of the team with a procedure. All in all, I don't think any of this is something to get worked up about. Sure, there are inefficiencies and imperfections in every system, but surgery really was macabre until very recent times and it's amazing what these people can do. I know all this because I'm a PM in a company that makes surgical training devices and materials - I regularly talk to surgeons from around the world, I've visited OR's, conferences etc. Atul Gawande in his Checklist Manifesto compares the future of surgery to changes in construction. We used to have master builders who would deliver entire buildings start to finish. Now we have specialized contractors who hand off their work between each other. This is where surgery is going.
  - feet 4y ago
    Aren't most surgeries recommended after consult with a specialist physician? I don't think I've ever heard of someone just going to see a surgeon and getting surgery without that sort of due process With the exception of some plastic surgery I would assume
    - durnygbur 4y ago
      It's absolutely a case and the reason is money and desperation. Imagine there is no public healthcare (USA) or the public healthcare is completely dysfunctional (Poland, Romania). Then you pay for every encounter with every medical specialist, who is mostly interested in charging and dismissing the patient, resulting with the patient turning increasingly desperate and impatient.
    - hef19898 4y ago
      Well, some physicians are more likely to cut than others. Surgeons are more likely to do so, sure. The difference is prevalent when it comes to ortheopadics, knees and things. Surgeons in that field tend to prefer surgery, non-surgeons tend to be more conservative. As usual, neither is wrong. And neither is that kind of surgery done without consultation with the patient or due to "insurance quotas"...
    - scyzoryk_xyz 4y ago
      Oh yeah that one didn't even come across my mind. That's exactly right. Surgeons are used to a backlog of patients who show up with a history, records, paperwork etc.
Calavar 4y ago
Insurance related quota?
- durnygbur 4y ago
  So your profile is right - eg. gender, age, reported pains. The hospital has still 10 guaranteed procedures from the insurer for this year. The pieces fit together. Why bother investigating further, simply do the procedure and write-off the patient. eg. tonsillectomy, many other -ctomies.
  - Calavar 4y ago
    That's not how health insurance works - at least the US. Insurance companies reimburse either on a fee-for-service model, in which the hospital is paid for every procedure they do (with no cap); or bundle style model (capitation or diagnosis-related group), where the hospital is paid a flat fee, regardless of what procedures they might do. So while there are maximum quotas in the bundle style model, you actually make if you do fewer procedures, not if you do more. > Why bother investigating further, simply do the procedure and write-off the patient. eg. tonsillectomy, many other -ctomies. Because the insurance company will audit the medical chart and deny payment for the surgery if they deem the surgery to have been inappropriate. There is a huge incentive for them to do this - $500 dollars of audit time on their end could save them $10,000 or more if they end up denying payment. It actually much more profitable for the hospital to exactly the opposite of what you suggest - only do a surgery if they are 99% sure that the insurer will pay for it in full. This is one of the biggest sources of health care inequality in the US. Poor people are more likely to have cheap insurance that has a high rate of denying payment. Profitable hospitals don't want to risk nonpayment, so they will decline to do expensive surgeries on these patients and instead refer them to county hospitals or safety-net hospitals that operate at a loss and generally have poorer quality facilities and longer wait times.

hef19898 4y ago

That is a pretty wild claim there. Care to elaborate?

scyzoryk_xyz 4y ago
When you're holding a hammer, everything is a nail. Surgeons will often have this bias, because they're seeking cases which fit their area of research. They're also often collecting data for the research. This helps advance their careers, makes them eligible for higher pay, advances them in the hierarchy, gives them many perks etc. Oh and obviously - successful research improves overall medical knowledge. Many surgeons will cut you without talking to you because they don't see the point. In fact, some surgeons believe staying focused on the bio-mechanical aspects of the work and not getting emotionally involved helps improve their outcomes. Others, of course think and do the exact opposite - but this also depends on the local culture. My own personal view is that for the patient talking to the surgeon is like talking to the chef of a restaurant - it doesn't change anything about what happens in the kitchen, and there is a whole team of people working in the kitchen anyways. As far as insurance and quotas - there are definitely others watching when you work anywhere as a surgeon. There might be pressure to use particular equipment that was purchased (DaVinci robots and disposable instruments are good examples). Or there might be pressure to do a procedure a particular way (to reduce insurance risk, even if surgeon would prefer to do it differently). In poorer countries there might be limitations around available equipment, or lower familiarity of the team with a procedure. All in all, I don't think any of this is something to get worked up about. Sure, there are inefficiencies and imperfections in every system, but surgery really was macabre until very recent times and it's amazing what these people can do. I know all this because I'm a PM in a company that makes surgical training devices and materials - I regularly talk to surgeons from around the world, I've visited OR's, conferences etc. Atul Gawande in his Checklist Manifesto compares the future of surgery to changes in construction. We used to have master builders who would deliver entire buildings start to finish. Now we have specialized contractors who hand off their work between each other. This is where surgery is going.
- feet 4y ago
  Aren't most surgeries recommended after consult with a specialist physician? I don't think I've ever heard of someone just going to see a surgeon and getting surgery without that sort of due process With the exception of some plastic surgery I would assume
  - durnygbur 4y ago
    It's absolutely a case and the reason is money and desperation. Imagine there is no public healthcare (USA) or the public healthcare is completely dysfunctional (Poland, Romania). Then you pay for every encounter with every medical specialist, who is mostly interested in charging and dismissing the patient, resulting with the patient turning increasingly desperate and impatient.
  - hef19898 4y ago
    Well, some physicians are more likely to cut than others. Surgeons are more likely to do so, sure. The difference is prevalent when it comes to ortheopadics, knees and things. Surgeons in that field tend to prefer surgery, non-surgeons tend to be more conservative. As usual, neither is wrong. And neither is that kind of surgery done without consultation with the patient or due to "insurance quotas"...
  - scyzoryk_xyz 4y ago
    Oh yeah that one didn't even come across my mind. That's exactly right. Surgeons are used to a backlog of patients who show up with a history, records, paperwork etc.

Calavar 4y ago

Insurance related quota?

durnygbur 4y ago
So your profile is right - eg. gender, age, reported pains. The hospital has still 10 guaranteed procedures from the insurer for this year. The pieces fit together. Why bother investigating further, simply do the procedure and write-off the patient. eg. tonsillectomy, many other -ctomies.
- Calavar 4y ago
  That's not how health insurance works - at least the US. Insurance companies reimburse either on a fee-for-service model, in which the hospital is paid for every procedure they do (with no cap); or bundle style model (capitation or diagnosis-related group), where the hospital is paid a flat fee, regardless of what procedures they might do. So while there are maximum quotas in the bundle style model, you actually make if you do fewer procedures, not if you do more. > Why bother investigating further, simply do the procedure and write-off the patient. eg. tonsillectomy, many other -ctomies. Because the insurance company will audit the medical chart and deny payment for the surgery if they deem the surgery to have been inappropriate. There is a huge incentive for them to do this - $500 dollars of audit time on their end could save them $10,000 or more if they end up denying payment. It actually much more profitable for the hospital to exactly the opposite of what you suggest - only do a surgery if they are 99% sure that the insurer will pay for it in full. This is one of the biggest sources of health care inequality in the US. Poor people are more likely to have cheap insurance that has a high rate of denying payment. Profitable hospitals don't want to risk nonpayment, so they will decline to do expensive surgeries on these patients and instead refer them to county hospitals or safety-net hospitals that operate at a loss and generally have poorer quality facilities and longer wait times.