Articles Posted in Surgery

bugatti-300x118If big hospitals really want to keep surgeons happy and provide them with greater comfort during procedures, why not build giant, sanitary glass garages next to operating rooms and let docs park their Bentleys, Lamborghinis, and Bugattis there for ogling and maybe even to take a break under the vehicles’ hoods?

Okay, maybe we’re being a bit too snarky.  Yet that hyperbolic scenario just might be cheaper and more medically justifiable than the sustained embrace by specialists and profit-seeking institutions of fancy robotic surgical devices costing more than $1 million annually — and for which patients, ultimately, pay. Here’s what the New York Times reported of yet another published meta-analysis of dozens of studies on the devices and their outcomes found:

“Surgical procedures performed with the aid of a robot is sometimes marketed as the ‘best’ form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest … Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference.

davincirobot-300x176Hospitals finally are saying bull feathers to the leading maker of surgical robots that cost institutions millions of dollars annually to buy and maintain. New lawsuits against Intuitive Surgical dispute the company’s business practices, including the exclusivity it demands for its costly services and products.

But will the civil claims also crack open the door to bigger questions about daVinci robots and other such medical devices and whether they benefit patients or just add backbreaking costs to their hospital bills?

Intuitive has declined to comment on the suits filed against it in federal courts in California by the Franciscan and Kaleida health systems. The company has denied one aspect of the media reports about the suits — that it shut down its robots remotely in the middle of a patient’s operation, forcing a surgeon and his team to improvise and finish the procedure (without problems) using standard techniques.

Patients, politicians, and regulators may find it tough to believe, so they need sharp periodic reminders: While there are many terrific, dedicated doctors working today, there also are some truly terrible ones. And dealing with the harms of medical malpractice by the incompetent and abusive can require courage and vigilance.

  • Perhaps a new, streamed Hollywood serial — starring the likes of Alec Baldwin, Christian Slater, AnnaSophia Robb, and Joshua Jackson — can underscore for the public how grisly the results can be until a rare criminal prosecution derails the likes of Christopher Duntsch, a Dallas surgeon so grim he is nicknamed “Dr. Death?”

devicemakerdocpay-300x225Billions of dollars have flown from medical device makers to specialists performing back, spine, knee, and hip surgeries, with unsavory cash and practices also accompanying that fiscal tide.

Industry officials and doctors defend the sizable and growing payment program, saying it results in better medical hardware that ultimately benefits patients, the independent, nonpartisan Kaiser Health News service reported. Data show the bulk of payments from medical-device makers to doctors were for royalties and licensing of products and consulting on them.

But investigative reporters Fred Schulte and Elizabeth Lucas have found that the enriching bonanza concerns regulators, ethicists, and patient advocates:

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

cookmizzoudmv-150x150It’s long been routine, if often controversial, for operating rooms to welcome medical device sales people and surgical trainees to watch the work of surgeons and nurses. But now the University of Missouri health system may have reset the bar with its $16.2 million settlement with almost two dozen patients over questionable knee surgeries.

The contested procedures were performed in part by a veterinarian.

That vet, James Cook, is listed on the university’s web site as the William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery. The explanatory text online and a posted video has him describing how his chief role at the school focuses on research in people and animals in joint disorders. He says he is experimenting with techniques, notably in dogs, in which live materials can be used to replace problem joints.

kneelady-300x222With so many older Americans entering their later years in better shape than earlier generations and wanting to stay active, knee and hip replacements have become some of the most common surgeries performed in pre-pandemic times. The cost of this work, however, varies greatly. And surgeons may be promoting procedural variants to not only build business but also to increase their revenue for these operations.

Consumers, policy makers, regulators, and politicians may want to keep an eye on developments with patients’ knees and hips as indicators of what may occur in health care finances, especially if hospitals’ case loads return to something of a pre-pandemic norm and because taxpayers bear burdens from so many of the Medicare-covered procedures.

New data is emerging about hospital costs as the institutions, many of them overwhelmed now by the coronavirus pandemic, comply with Trump Administration price-disclosure regulations. These called for hospitals to post online their base costs (as earlier described in the hard-to-read charge master lists) for hundreds of common procedures and medical items, as well as previously secret prices for same, as negotiated with insurers.

javaid-300x169A Virginia criminal case, while focusing on claims of fraud against the federal government, also has exposed a long-running and nightmarish pattern of what prosecutors assert has been a Chesapeake gynecologist’s rampant mistreatment of his patients, many of them women of color and poor.

Dr. Javaid Perwaiz is on trial because authorities say he “manipulated records to cover crimes that enriched him but endangered pregnancies, sterilized women unnecessarily, and pressured them into needless procedures to finance his lavish lifestyle,” the Washington Post reported.

The newspaper’s articles, as well as the efforts by the FBI and federal prosecutors to develop the charges against the jailed specialist, raise disturbing questions about not only Virginia medical regulators but also the hospitals where the gynecologist practiced and colleagues who have described a “frenzied environment in which hospital staff struggled to keep pace with Perwaiz as he rushed from procedure to procedure.”

doc-300x169The Covid-19 pandemic continues to slam the practice of medicine, with patients’ infection fears and treatment delays putting at serious financial risk the providers of crucial medical services like primary care doctors and pediatricians.

At the same time, as is too often the case in U.S. medicine, the rich may be getting richer, as resuming care gives patients eye-opening information on the big money in orthopedic and plastic surgery and other cosmetic procedures.

The coronavirus’s economic shocks may most accelerate changes — not all of them happy for patients — for primary care physicians, who account for half the annual doctor visits annually in this country, the independent, nonpartisan Kaiser Health News service reported.

burkedbglobe-212x300A big Boston hospital has offered 13 million and one ways to try to make good with a former orthopedic surgeon who assailed the respected institution and colleagues for performing simultaneous operations in which doctors went from suite to suite, working for hours on multiple patients at once.

Massachusetts General Hospital insisted this practice was safe. Dr. Dennis Burke, a hip and knee specialist whose patients have included former Secretary of State John Kerry, disagreed. He told his bosses at the Harvard-affiliated hospital that simultaneous procedures put patients at risk, and, at minimum, they should be told that the surgeons they flocked to for surgery on them might pop in and out of their procedures.

Burke infuriated his bosses by taking his criticisms outside the hospital, including to investigative reporters for the Boston Globe. The newspaper dug into hospital surgeries, particularly in orthopedic cases where operations lasted for hours.

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