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

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.