7.5 million unnecessary surgeries? Here's how we fix it.

There are 7.5 MILLION unnecessary medical and surgical procedures performed in the U.S. each year. Or another way of saying it, 60% of all surgeries performed are not needed.

Let that sink in.

Even worse, rather than reverse the problems they’re trying to fix, these procedures can often lead to greater health problems and even death.

For example, research suggests unnecessary back surgeries may lead to chronic pain and dependence on pain medication. Any surgery carries inherent risks of infection, bleeding, and complications from anesthesia. Perhaps most importantly, focusing on surgery can delay addressing the root cause of the problem. There might be underlying conditions that can be treated more effectively with non-surgical methods.

It’s clear - we don’t need more surgery. We need less.

But why are there so many unnecessary surgeries?

Well, there are a few reasons:

• Financial Incentives: The fee-for-service model in healthcare can incentivize more procedures. Money drives all the decisions that are made in healthcare, especially in the United States. That’s the reality.

• Defensive Medicine: Doctors may order unnecessary tests or procedures to avoid malpractice lawsuits, driving up costs. I call this a CYA mindset - Cover Your Ass. Sure, we should assume all doctors have their patients’ best interest in mind and are doing everything they can to help them. They’re also trying to keep their license and avoid going to court to battle a pissed off patient.

• Knowledge Chasm: Doctors largely controlling the flow of medical information can limit patient understanding of alternative options.

And in my opinion, this knowledge chasm is the biggest driver unnecessary surgeries, procedures, labs, tests, scans, etc. in healthcare.

Bridging the Knowledge Chasm

Right now in the U.S. we have a “Medical Monopoly.” It’s the historical belief that physicians, and not patients, should control all aspects of medical practice.

This monopoly exists for a couple reasons:

1. A silence by the patients receiving the care.

2. A profound gap in information.

Since the era of Hippocrates, doctors have largely controlled the flow of medical information. At the individual level, it might be that the data originates from the patient with a lab test or scan, but without the doctor, the patient is likely to find results hard to come by.

Maybe it’s because a physician is trying to “protect” a patient by not disclosing adverse, anxiety-provoking information. Either way, this is wrongful thinking.

Patients are not meant to be “protected”, they’re meant to be guided.

Patients CAN get information if they want it. It’s not hard to ask Dr. Google about symptoms and what they mean. However, no matter how much someone searches the Web, that’s general information about the population, NOT the individual. The quality of that information is also not assured.

Although we can close the information gap, the knowledge gap is much more important and much tougher to solve for.

Patients trust their doctors, more than anyone else in society actually.

So when a doctor prescribes an intervention, patients are going to take that recommendation as gospel. Combine that level of trust with the fact there’s a huge knowledge chasm of what patients know versus what doctors know, and it’s clear why there are so many unnecessary surgeries being performed.

If patients don’t know any better, how are they supposed to ask questions? It’s impossible to consider other alternatives if they don’t know they exist in the first place, right?

You see a similar example of this when taking your car to the mechanic. You may not know anything about cars, what’s wrong with it, or what it’s going to cost to fix it, so you just accept whatever the mechanic tells you. It may cost $50 or $500. You don’t know any different so you say “sure, let’s do it.”

Or, in an alternate scenario, you do a quick Google search to learn a little bit more about what’s going. You may call a spouse or close friend who knows a thing or two about cars to get their opinion. If you really wanna go the extra mile, you may go to YouTube and watch a couple videos on what the experts are recommending you should do.

Does this line up with the information being given to you by the mechanic?

Are the estimates online similar to what the mechanic says it’s going to cost?

Did you find out if you REALLY needed to get the thing replaced right now? Or can you hold off for another few thousand miles?

Here’s the point - you’re educating yourself, bridging the knowledge chasm, and becoming more “car literate.” As a result, you’re going to make a better, more informed decision about what to do with your car.

Health literacy, or the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions, is the key to reducing unnecessary medical procedures.

Studies have shown that patients with lower health literacy are more likely to undergo unnecessary surgeries. This is because strong health literacy empowers patients to ask informed questions, participate in decision-making, and advocate for themselves.

Equipping patients with knowledge is crucial. While challenges like access to information exist, promoting clear communication and providing patient-friendly resources can empower individuals to make informed choices about their health

This isn’t about challenging a doctor’s recommendation or being a difficult patient. It’s about being curious and engaged.

The best outcomes in healthcare and wellness come from a collaboractive approach and when there’s an alliance between provider and patient. A two-way street of exchanging information, listening to one another, and agreeing on a plan.

If this were to happen more frequently between doctors and patients, these unnecessary medical procedures would decrease. I don’t think that’s arguable to be honest.

Too often people go to the doctor’s office and are left with advice and prescriptions that are out of alignment with what they’re looking for. “Rest, take some meds, consider surgery, stop exercising” would all be examples of advice that can leave someone who’s active feeling helpless and frustrated.

Preparing For Doctor’s Visits

Patients should be in the driver’s seat of the visit, which ultimately will result in a clear understanding and agreement between both parties. Patients should be empowered to play active role in their healthcare by clearly identifying their goals for the visit and understanding their role as a participant in the process. By doing their own research, patients can come to the appointment with ideas, thoughts, and opinions and work with their healthcare provider to agree on the best course of action. 

Some key questions to consider when preparing for a doctor's visit include: 

• What other options do I have?

• What would happen if I elect to do nothing?

• Where can I get another opinion?

• What does "X" diagnosis mean exactly?

• What are the potential side effects or setbacks I can anticipate from following electing for this procedure/ taking this medication?

• How long will this prevent me from doing the activities I love?

By considering these questions, patients can be better prepared to have a productive and meaningful conversation with their healthcare provider.

Proposal

Do your own research and come with ideas, thoughts, and opinions around what you believe is the best course of action. Then, you and your healthcare provider can come to an agreement.

Some examples of doing your own research and coming to the doctor's visit with ideas, thoughts, and opinions include:

• Researching different treatment options for a specific condition and discussing the pros and cons of each option with your healthcare provider.

• Reviewing success rates and side effects of a specific medication and discussing whether it is the right choice for you.

• Learning about alternative or non-invasive treatments and discussing whether they may be a good fit for your condition and lifestyle.

• Reading up on the latest research and guidelines for your condition and discussing any updates or new information with your healthcare provider.

• Keeping track of your symptoms, pain levels, and daily activities, and discussing any patterns or changes with your healthcare provider.

• Considering your personal preferences, such as recovery time and potential side effects, when discussing treatment options.

• Considering your long-term health goals and discussing how different treatment options may impact those goals.

• Learning about the insurance coverage for certain treatments and discussing how it could impact the course of treatment chosen.

By doing your own research and having ideas, thoughts, and opinions, you can better participate in the decision-making process with your healthcare provider and make a more informed decision about your treatment and better ensure you’re not agreeing to something you don’t really need.

Questions

What to Ask When...

Considering a certain treatment.

• What are the risks and benefits associated with each treatment option?

• How has this condition been treated in the past?

• Are there any non-invasive or alternative treatment options available?

• What is the success rate for this treatment?

• Will this treatment require follow-up appointments or monitoring?

• How will this treatment affect my daily activities?

• Are there any lifestyle changes that can be made to improve or manage my condition?

• Is there any literature or resources that I can read to learn more about my condition and treatment options?

• How will my insurance cover this treatment?

• Will this treatment have any long-term effects on my overall health and well-being?

What to Ask When...

Recommendation: Joint Replacement

Your own health is your biggest priority, use this checklist to ask honest and

clarifying questions to your medical professional to help create a care plan

you believe in

• Do you think I should try conservative care first?

• Are they any lifestyle factors I can change to help with the symptoms I'm feeling?

• Is it possible I have had these imaging results for a long time and not experienced symptoms until now?

• Will strength training help me improve my quality of life and/or potentially avoid surgery altogether?

• What would post-op recovery look like over the next 1-2 years?

What to Ask When...

Assessment: Degenerative Disk//Arthritis//DJD//”Bone on Bone”

Your own health is your biggest priority, use this checklist to ask honest and

clarifying questions to your medical professional to help create a care plan

you believe in

• Is this a normal part of the aging process?

• Is it possible I have had these imaging results for a long time and haven't experienced symptoms

• Will strength training help me improve my quality of life?

• Are they any lifestyle factors I can change to help with the symptoms I'm feeling?

• What foods do you recommend I eat more of or less of?