unnecessary surgery | Health Beat by Maggie Mahar

“The doctor was adamant: ‘This is America, not Sweden,’ he told me. ‘We operate.’”

Below, a physicians assistant (PA) recounts what happened when he was diagnosed with appendicitis.

Andrew T. Gray knew that he could not afford surgery. Ironically, he had just taken a new job as a PA but had not yet filled out all of the paperwork for insurance. Moreover, he had read about a randomized controlled trial done in Sweden suggesting that over 70% of patients did just as well taking antibiotics rather than going under the knife.

Gray’s story originally appeared in pulse- voices from the heart of medicine, a free online magazine that publishes riveting stories and poems written by health care providers as well as patients. All of the them are true, and both the writing and the editing is superb. If you’re not familiar with pulse, see this post where I describe how pulse was boron, quote reviews, and link to some of my favorite stories.

I urge everyone to consider subscribing to pulse’s free weekly e-mails. You will receive a story or poem at the end of each week that will brighten your Fridays.

At the end of Gray’s story, I have added a note on research done not only in Sweden, but in the UK, comparing the results when doctors recommend antibiotics before scheduling surgery for patients diagnosed with appendicitis.

Saving My Appendix

By Andrew T. Gray

How did this happen to me? I wondered, looking at him across the ER exam room. How could I, a healthcare provider, not have insurance?

I had woken up that morning with a mildly upset stomach. Nonetheless, I’d gone to my job (begun only six weeks earlier) as a physician assistant at a Beverly Hills HIV clinic. I’d seen patients until lunchtime, then attended a research meeting. The subject was a study of irritable bowel syndrome.

“I need to be in this study,” I joked to a coworker. “My IBS is acting up.”

I don’t have IBS, but I was indeed having crampy stomach pain. I continued to see patients until 3 pm, when the pain became steady: on a ten-point scale, I gave it a six. I left work early.

As I exited the building, my first thought was Freedom! I can get home early, relax, maybe take a nap…

Crawling into bed, however, I realized that my pain had coalesced in the right lower quadrant of my abdomen. Could it be appendicitis?

Panic flooded me. After six weeks at my new job, I now qualified for health insurance, but I’d neglected to fill out the necessary paperwork.

Only an hour after leaving the clinic, I returned. Almost hysterically, I completed and faxed in the insurance forms.
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Last week, when former President George W. Bush underwent stent surgery, the procedure was declared a great success. What is surprising is that not everyone in the mainstream media applauded.

From Bloomberg News “Former President George W. Bush’s decision to allow doctors to use a stent to clear a blocked heart artery, performed absent symptoms, is reviving a national debate on the best way to treat early cardiac concerns.

“The discussions have been ongoing since 2007, when the trial known as Courage first found that less costly drug therapy averted heart attacks, hospitalizations and deaths just as well as stents in patients with chest pain. The results were confirmed two years later in a second large trial.

“The debate has centered on both the cost of stenting, which can run as high as $50,000 at some hospitals, and its side effects, which can include excess bleeding, blood clots and, rarely, death. Opponents say the overuse of procedures like stenting for unproven benefit has helped keep U.S. medical care on pace to surpass $3.1 trillion next year, according to the U.S. Centers for Medicare and Medicaid Services.

“’This is really American medicine at its worst,’” said Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio . . . ‘It’s one of the reasons we spend so much on health care and we don’t get a lot for it. In this circumstance, the stent doesn’t prolong life, it doesn’t prevent heart attacks and it’s hard to make a patient who has no symptoms feel better’” . . .

“’Stents are lifesaving when patients are in the midst of a heart attack’ added Chet Rihal, an interventional cardiologist at the Mayo Clinic in Rochester, Minnesota . . . ‘They allow immediate and sustained blood flow that help a patient recover. For those who aren’t suffering a heart attack, the benefits are less clear . . . While stents may be used in patients with clear chest pain, there’s no evidence that they prevent future heart attacks.’ A review of eight studies published last year in JAMA Internal Medicine also found no differences.

“Two large-scale clinical trials completed within the last seven years have shown that drug therapy works just as well as stents in preventing cardiac complications. (The three major U.S. heart associations changed their guidelines in 2011 in an effort to reduce excess treatment. )

[This is important. The major U.S. heart associations have absolutely no vested interest in recommending fewer procedures. When they say “Do Less,” everyone should listen–mm. ]

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Category Archives: unnecessary surgery

Unnecessary Surgery? The Story of a Health Care Provider Who Finds Himself in the Hospital, Scheduled For an Operation He Doesn’t Want

Saving My Appendix

George W. Bush’s Recent Stent Surgery—Two Perspectives