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Old 01-03-2013, 11:40 AM   #24
LuckyR's Avatar
Join Date: Jun 2006
Location: The Great NW
Posts: 6,392

Originally Posted by ollinger View Post
Don't know how much time LackeyR spends in medical staff lounges, but I'm in one every day and talk to surgeons about this all the time. Two points stand out in my mind. One is that surgeons are generally not eager to operate on people with disk issues unless they feel it will be helpful. But the other vital point is that people with chronic and severe back pain are a desperate lot who suffer constantly and not infrequently become suicidal over their plight, not to mention addicted and abusive of opiates. The question posed about whether a surgeon should or would operate if he sees a 40% chance of benefit is naive; for comparison sake, should an oncologist administer chemo if he sees a 30% chance of cure? Most would say "of course" if the alternative is death. People with severe chronic debilitating back pain often feel the same way; they see their affliction as a death sentence and will beg surgeons to operate even if there is a less than even chance of benefit. Even in the non managed care setting, which still exists to some extent, people usually have to shop around to find a surgeon who will operate.

A couple of things: Only the most naive would not acknowledge that compensation is a real life incentive. By stating that, I am not accusing the vast majority of surgeons (or anyone else for that matter) of practicing Bad Medicine or fraud (though, again only the most naive would not agree that there is such a thing as medical fraud, rare but real). Rather I am refering to the well established phenomenon of unconsciuous bias (hence the reason for double blinding in legitimate research). If there was no such thing as compensation bias, there would be no difference in care between insured and uninsured patients, yet there is.

True there are other biases: fear of litigation, fear of poor patient satisfaction etc that may skew clinicians in the opposite direction than that of conpensation bias, but that doesn't mean that compensation bias does not exist.

As to the strawman of oncologists doing chemo when the alternative is death, that I believe qualifies as the very lowest hanging of all fruit, hence it's use as your alternative example. Can't you address the more controversial example I posed: do you operate purely for pain relief, (not to save a life) with a procedure that has a moderately high risk of complications if it only has a 60% chance of working? Of course there is no "right" answer, that's why I used it to point out the nuances in Real Life medicine, which is much more complicated than this thread.

You ponder how much time I speak to surgeons, I do speak to some between my cases.
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