LiveLongAgeWell

When doctors talk to each other about the reason a patient needs surgery, they use the term “indication”. So one doctor might say to another: “What was the indication for that guy you just ‘did’ (operated on)?”  Because to put a patient through an operation, or even a minor procedure, a surgeon should have the patient’s best interest as the primary concern, and the collective benefits of surgery or procedure should outweigh the sum of the risks. Any operation needs at least one valid “indication”, one medically justifiable reason to put the patient through the pain, expense, inconvenience, and risks of a procedure.

So the joke goes something like this: two surgeons are talking about a patient who they think had an unnecessary operation by some other surgeon and the first surgeon says to the second: “What do you think the indication was for that guy’s surgery?”…second surgeon: “Probably the patient had a Blue Cross card and a heartbeat!” (A Blue Cross card means he had good insurance.) In effect, the surgery was done more for the doctor’s financial profit than to benefit the patient. Sadly, this happens. Moreover, it’s often difficult for the patient to know he had unnecessary surgery, particularly if the doctor came across as very knowledgeable and was personable.

When I was about ten years old, it seems like nearly every kid—myself included—had their tonsils out, and the indication often was: good insurance and a heart beat. Many of us probably didn’t need our tonsils out, but it was the custom, and parents rarely complained.

Years later when I myself was doing tonsillectomies on other children, I took the procedure very seriously. Occasionally I would have a parent come in with their child and—perhaps because they remembered back to their own childhood—they would say: “My daughter has had a few tonsils infections and I want you to take out her tonsils”. In many of these cases, their child didn’t really need a tonsillectomy (it wasn’t “indicated”). They hadn’t had enough problems to justify the risks, expense, discomfort, and pain of surgery. They were better off being managed medically; with other, more conservative measures.

I would tell the parent: “These days we have strict criteria about who gets their tonsils out, and I think we should try more conservative treatment before we even think about surgery.” Still, some parents would persist and say: “No, I really want her tonsils out. When I was a child, I had mine out, and I did fine.” At that point then I would either suggest they go for a second opinion or I would say: “You know, tonsil surgery has risks, and the biggest risk is severe bleeding. There’s even a risk of bleeding to death. Back when I was a kid they did about a million tonsillectomies a year in the U.S., and about a thousand of those kids died every year from bleeding. And you know what’s most sad? Most of those kids really didn’t need their tonsils out in the first place.”

On Monday’s post I’ll relate all this to back surgery.