Unnecessary Surgery

In discussions about the cost of health care, health care reform, and doing the right thing for patients, we often bring up "unnecessary surgeries and interventions." Some people, including me, feel that we occasionally do too much, that we send too many tests, do too many things to people, and ultimately hurt them and or society. But I'm not writing about that today. After being on call this weekend, I have realized that another group of unnecessary surgeries stem from things that should not have happened. A teenager comes in after being stabbed multiple times. A motorcycle crash leaves someone blind. A person with depression tries to hang himself. For many of us, these are the patients we go into medicine to save. They have an acute injury and with intensive care, we can get them to walk out of the hospital. Those in emergency medicine and trauma find these situations immensely satisfying.

I can see that. However, there is a part of me that wishes these patients never came in in the first place. It is a public safety measure to decrease the amount of gang violence, motorcyclists without helmets, drivers without seatbelts. Each of these accidents dramatically changes that patient's life and costs the health care system an incredible amount. After surgery, these patients go to the intensive care unit and may stay in the hospital for days; even when they are discharged, they may have long-lasting effects of their injuries that lead to disability, chronic pain, and possibly poorer quality of life. Seeing this has helped me understand why public health includes such mundane issues such as traffic accidents, suicides, and weapons at home.