Monday, February 4, 2008

Ready! Aim! Operate on my back please!

Working for a managed care company, I am observing the high number of spinal surgeries that take place in the market (and just think that, what a funder sees is only a fraction of what is actually happening in South Africa...)

South Africa is known to have a low threshold for doing spinal surgery. In the UK, you would have to go through a lot of conservative therapy and years of waiting... AND have severe disease in order to get an op. Here, we see many neurosurgeons going in to do fusions or disc replacements sometimes without severe disease, sometimes even without conservative treatment!

Is this due to the patients who put so much pressure on surgeons to do something about their pain? Sometimes I think these people fit into their own subset, and should be defined by psychiatry for a new personality disorder. We get a constant stream of calls - all exactly the same personality types - fighting tooth 'n nail to get a surgery for disease that is very mild on their MRI.

OR. Is it due to monetary greed on the part of certain local surgeons (believe me... when we're looking at funding requests, we see large subsets from the SAME neurosurgeons, and the SAME areas of the country). Sniff sniff. I smell a pattern.

Back surgery is dangerous... not necessarily curative, and often leads to repeat surgeries. Yet in South Africa, it's itchy trigger fingers all round. I think South Africa (neurosurgeons, medical schools and possibly funders) need to have a serious look at the indications for doing back surgery.

Or before long, we'll set a precedent that could rather have been controlled by Celebrex.

(PS. The surgeons in this picture were ripped straight off the Internet and have NOTHING to do with this article! If you're a back surgeon, send All Scrubbed Up your picture... We'll post your picture up with dollar signs. For free.)

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Rosi said...

I seriously think that the only reason is money.

In other different types of medicine the patients expirience a lot of pain either but there is no rush to do a surgery in those medical aspects.
Money makes some people rob banks, others do unopropreat medical treatments ignoring what is best for the patient.

cardiogirl said...

I believe there *is* a personality disorder for what you described. It's called hypochondria. I am amazed at people and what they will do to have surgery.

My sister falls into this category.

She basically bullied her doctor into giving her a hysterectomy because she was over dealing with the *beginnings* of menopause.

I have always wanted to see her medical chart because I guarantee there is some kind of short hand notation, known only to the doctor and his staff, indicated that she is a "high-maintenance" patient.

Thanks for turning me onto this site, Andy.

A laugh a minute said...

Your comments are great!