Q. Other stories tell of more dire consequences.
A. A patient was given a double knee replacement without a thorough checkup prior to the surgery. A thorough physical would have shown that he didn't have pain in his knees, which might have indicated arthritis. Instead, the pain was in his legs and was caused by peripheral vascular disease [a circulatory problem that often involves narrowing of the arteries]. Knee replacement surgery put him at risk and offered no benefit. Three days after the operation he died of a massive heart attack.
Q. In the book, you say the volume of certain surgeries is incredibly out of control.
A. Ovariectomies for one. About 50 percent of the 600,000 women who have a hysterectomy each year also have healthy ovaries removed. Even after menopause, ovaries continue to dispense hormones that keep heart disease and osteoporosis in check. A study in the journal of the American College of Obstetricians and Gynecologists found that women who had the procedure and had no risk factors for ovarian cancer were more likely to die prematurely from heart disease and osteoporosis-related hip fractures.
Q. What else?
A. A study by the Harvard School of Public Health and the Rand Corporation concluded that one-third of people who were told they needed heart bypass surgery did not need it. In addition, 17 percent of patients who had the surgery did not have severe enough heart disease to warrant surgery. The problem was that the angiograms were read incorrectly. If the 17 percent figure were applied to the number of bypass surgeries performed annually in the U.S., 42,500 surgeries may be unnecessary.
CT scans, back surgery, carotid surgery to prevent strokes, and Pap smears are also overordered and overperformed.
Q. In your experience, what is the top violation of the patient-physician trust?
A. People expect health care professionals to act in the patient's best interest. A survey by the American College of Physician Executives of their members found that 80 percent of respondents were very or moderately concerned about their physician colleagues overtreating patients to boost their income. When the bottom line supersedes the patient's interest, that is a profound violation of trust.
Q. For example?
A. In one case, Ron Spurgeon, a millwright from Redding, Calif., had coronary bypass surgery at Redding Medical Center after a diagnosis of a severe blockage. The year that Mr. Spurgeon had his bypass surgery, the medical center had the highest rate of heart bypass surgery in the nation. The center was later investigated by the FBI. That's when Ron learned that he was among more than 700 patients who had had unnecessary heart procedures. The center and the doctors paid nearly $500 million in fines and penalties; however, no criminal charges were ever brought against the center, its administrators or its physicians.
Q. Was no oversight in place?
A. Physicians are supposed to monitor the care their colleagues provide to patients. In this instance, the system of peer review completely failed at all levels — the hospital, the state medical board, as well as Medicare. The case came to light only when a patient blew the whistle and contacted the FBI.
Q. What is the medical profession doing to police overuse?
A. Very little. In November 2008, the National Quality Forum, a Washington-based group comprising physicians, nurses, consumers and other stakeholders, identified tests and procedures that are overused. This was an important step forward. But very few meaningful steps have been taken to stop the spiral of overuse. In fact, it is an epidemic and is likely to continue. The best advice I can give: Caveat emptor.