Barron, James. "Unnecessary Surgery," New York Times Magazine, 16 April 1989), pp. 25ff.

 

Barron, James. "Unnecessary Surgery," New York Times Magazine, 16 April 1989), pp. 25ff.

This reporter makes no bones about identifying unnecessary surgical procedures. They are:
Caesarean section, hysterectomy, coronary bypass, prostate surgery, tonsillectomy, pacemaker
implant and carotid-artery surgery. How many of these procedures are performed unnecessarily?
The best guesses are that from 1/5 to 1/2 of all surgery done may have been unnecessary.

There are several sources identified as contributing to the abuse. For one thing, there are just too
many surgeons trying to make a living. They intrude surgically when other methods would do
just as well. Barron identifies government as the source of surgeon oversupply, suggesting that
government's 1960 efforts to overcome the physician shortage produced too many surgeons.
(That is an oversimplification of the problem. There is no physician oversupply; there is simply a
poor distribution of practitioners. Why so many physicians picked surgery as a specialty is also a
question which needs to be asked.)

There are guesstimates here that up to 50 per cent of C-sections may be unnecessary. (I find that
figure low.)

In general, Barron reports much the same sort of thing that Payor reported recently concerning
cross-cultural studies of medical care: "Where a person lives can affect the chances of being
operated on unnecessarily. For example, according to a 1985 report by the Senate Special
Committee on Aging, hysterectomies are performed 80 per cent more often in the South than in
the Northeast. Within the state of Massachusetts, the rate of hernia repair surgery varies by as
much as 380 per cent, while pacemaker surgery varies by as much as 1,250 per cent." (p. 45)

Also identified as a cause of unnecessary surgery: insurance practices (whereby less dramatic
procedures are not reimbursed at all or are reimbursed at a lower level); the fear of malpractice
suits (dramatic surgery lessens the risk of being accused); the lack of serious study of the
problem (invites lawyers to create a problem); the speed and simplicity of surgery as perceived
by the patient (patient-demand for a quick fix); hospitals which are hurting financially (and often
promote surgery as a way of making up for losses). All of this should be terrifying!