Tuesday, February 10, 2009

Green eggs and surgery

With office surgery suddenly being the rage in my speciality, I have had to ask myself whether I will begin to do procedures currently done at an outpatient center in one of my exam rooms. Many reasons are cited by my colleagues for this change in practice. I believe I have heard most of them so here is the list:

"It is more convenient for the patient." (Some of these doctors practice in a fifteen story office building with basement garage parking. The surgery center is a single floor with a drive through for picking up the post operative patients.)

"Patients are more comfortable at their doctor's office where they are familiar with the staff." (But these doctors hire a company to come into their office one day per week to accomplish these procedures and when was the last time you were 'comfortable' in any doctor's office?)

"It will cost the patient less." (The co-payment if the patient has insurance is the same. The surgeon charges the same. The people who own the traveling surgery center bill also.)

Last but certainly not least is the one true reason that I suspect physicians are now doing office surgery: "I am making three times as much money doing the same procedure." For some reason, probably that insurance companies have not caught up to the billing procedures, the reimbursement for an in-office procedure is much higher. About three times as much in fact as the reimbursement for the same procedure in a surgery center.

Yes, endometrial ablations are being done in doctors offices to lessen or stop menstrual periods so that the surgeon can receive as much as three times what they could for doing the same procedure at an outpatient surgery center.

I had this exchange with a company representative for one of devices used:

LDM: "Well, I don't think I am ready to do these procedures in the office. What if I wanted to try your product at the surgery center?

Rep: "No problem! I have the equipment in the trunk of my car. Here's my card. Just call me and I will bring it over."

Thinking about this sparked the following in my mind:

The rep, let's call him Sam, is ready to help

"Where would you, could you do this?" I hear him yelp.

"It is all about patient safety can't you see.

"I took that oath saying primum non nocere*"

"But everyone is doing it this way," cries Sam with glee.

"That's what I told my mother but still she never let me."

Would I, could I do surgery anywhere?

Only if patient safety is optimal there!

*Latin for "first do no harm" in the Hippocratic oath
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