Articles Posted in Surgery

choosing-wisely@2x-300x197Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos  go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

heart-300x190Hospitals and heart doctors may need to rethink their common test to determine if their patients have suffered a heart attack, and whether a newer alternative open-heart procedure carries with it more risks than benefits.

Health News Review, a health information watchdog site, has raised interesting questions as to why mainstream media outlets haven’t paid much attention to the recommendation by the High Value Practice Academic Alliance (HVPAA), a blue-chip group of medical scientists and institutions (including Johns Hopkins), for the phase out of the creatine kinase-myocardial band. CK-MB is the “go-to blood test doctors used to determine if a patient’s heart muscle had been damaged by a heart attack (or myocardial infarction).”

To the tune of $400 million or so annually, doctors turn to CK-MB tests millions of times each year to distinguish, along with patient symptoms and EKGs, if the person before them has suffered a heart attack, HVPAA members write in the medical journal JAMA Internal Medicine.

knees-300x81Although grandma and grandpa and even older ancestors before them didn’t live as long nor usually as well as many of us do, they still can provide valuable insights into how modern Americans can avoid painful debilitation that now leads to some of the most commonly performed surgeries on seniors.

Want to avoid an inconvenient, costly knee or hip replacement?

Keep your weight down and keep moving—two steps that researchers say may have helped reduce the prevalence of the joint rheumatoid arthritis (RA) that pushes tens of thousands of baby boomers each year to seek medical treatment, up to and including knee and hip procedures that cost taxpayers billions of dollars through the Medicare and Medicaid health programs.

kidguns-300x168We love our kids dearly, and most of us would do most anything for them. So why can’t folks with sway get it together to make some straight-forward, common sense changes that would significantly benefit young people? Here are three suggestions, based on recent reports:

  1. Congress should make clear that it not only supports but it will fund public health research into gun violence, which is killing kids at unacceptable rates.
  2. Hospitals and surgeons should make public and transparent their surgical volume and outcome data on procedures performed on youngsters.

Knee-300x166Hip and knee replacements, especially among seniors, have become so prevalent that almost 7 million Americans by 2010 had undergone the surgeries. With the cost to Medicare of knee replacements running between $16,500 and $33,000, and with roughly half of the procedures’ expense occurring post-operatively, there’s some good news for patients on saving money—and staying safer too.

Patients may want to get themselves out of the hospital and stay out of in-patient rehab centers in favor of well-planned, careful recuperation at home, studies show. The research focused on single adults living alone, and whether they fared better over the short- and long-term by rehabbing from total knee and hip replacements at skilled nursing facilities or at home, particularly if their home care was well considered and followed through.

They did at least as well and were happier recuperating at home, researchers found, adding that they also may have been safer: That’s because a third of patients in rehab facilities suffered adverse events in their care, a rate comparable to unacceptably high hospital harms and those in skilled nursing facilities.

Prostate-e1492269148971-483x1024A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms:  The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual  screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes healthnewsreview.org.

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

vasectomy-300x170In a health fad that has spread to include sports radio in Washington, D.C., some sports fans apparently have decided that March is the perfect time to undergo a vasectomy. The relatively simple surgical procedure, which urologists can perform in their offices, can result in minor discomfort. But advocates say men can offset this by scheduling the work so they can recuperate by becoming couch potatoes and watching the wall-to-wall basketball games that lead to the crowning of the NCAA national championship team.

An unnamed Warrenton, Va., fan recently won a “pre-operative assessment and consultation, the vasectomy procedure, and aftercare, including a semen analysis in two to three months,” from the DC CBS radio affiliate after going on air to explain that:

I’ve tried for a boy 4 times; having my 4th child in July. I’m 38 years old and was actually in the market for a procedure after our 3rd was born; the last one being a surprise. Thought it was an omen; it’s not. 4th girl due in July. I am the only male (including our female dog) in a household full of estrogen drama. A buddy of mine, my neighbor, has three girls, same ages as mine and is having a 4th a month before my 4th is due….his is a boy. I’m happy for him…really.

obamacare-cartoon-2-a-300x240As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the legislation’s repeal-and-replace proponents — despite seven years and several dozen U.S. House votes  to roll back the ACA — have yet to detail how 20 million Americans who have gotten health insurance under Obamacare will be covered in the days ahead.

Opponents also haven’t explained how they may change the far reach of the ACA, including how the law and the Obama administration have reshaped, and often, improved American health care, for example, by changing entrenched payment practices and forcing greater accountability.

The New York Times, in reviewing the presidential legacy, has reported on what it terms the transformational aspects of Obamacare that also may sustain, no matter the partisan attacks on the attempt to provide broader health insurance coverage. In brief, the paper says Obamacare forced health care in this country to become more data-driven and evidence-based, as well as refocused on patients and their needs. Although some of the major drivers of these reforms, including hefty spending for electronic health records, haven’t hit the high marks advocates hoped for, progress has occurred.

breastIt’s described as an “aggressive, costly, morbid, and burdensome” surgery that often lacks “compelling evidence” that it contributes to patients’ “survival advantage.” So why are increasing numbers of women  deciding to have both their breasts removed when doctors detect early stage cancer in one breast?

New research, based on a questionnaire and follow-up with more than 2,400 women, recommends that surgeons be clearer and more direct about treatment options and outcomes with breast cancer patients. That’s because 17% of respondents said, incorrectly, that they think that removing the other healthy breast in a woman with cancer in one breast helps prevent the disease’s recurrence, while almost 40 percent said they didn’t know this procedure’s effects.

Researchers found that many women—including more than 40 percent of their respondents—with breast cancer contemplate the surgery known as contralateral prophylactic mastectomy (CPM), and that sufficient numbers of surgeons may not explain why it may be inappropriate for them. Their study has been published in the peer-reviewed Journal of the American Medical Association Surgery. As the Los Angeles Times reported:

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