Healthcare Matters

Remarkably, many of us still won’t seek a second opinion prior to committing to a significant medical procedure. C’est la vie. Regardless of whether you’re the type who always checks twice, pay attention to the following: If you find yourself a candidate for one of the following three procedures, get a second, if not a third opinion. Far too many of these procedures are performed; they are money-makers for the hospitals and surgeons who perform them; and patient outcomes for treating these conditions are questionable at best.

Complex Spinal Fusion –Not much of shocker here. If you’ve got back problems, you’re a target. Spinal fusions are popular procedures for treating spinal stenosis. But there is little consensus on how best to relieve pain from stenosis, so doctors tend to develop their own preferences. Their top treatment choice increasingly seems to be fusion. Complex fusion procedures have increased 1,400% for the 5 year study period (2002-2007). Those who underwent complex fusion were nearly three times more likely to suffer life-threatening complications than those who underwent less invasive surgery. “Previous studies have also found that most fusion patients experience no more relief from their chronic back pain than those who had physical and behavioral therapy.” “Probably less than 5 percent of all back pain requires surgery,” says Arnold Weil, M.D., clinical assistant professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.

Hysterectomy for Uterine Fibroids –How should you react when learning that each year approximately 600,000 American women have hysterectomies, and studies show that the vast majority are unnecessary? A hysterectomy is critical when the patient has cancer (which is the case for about 10 percent of those women). Women who undergo a hysterectomy have a 60 percent increased risk of incontinence by age 60, a University of California, San Francisco study found. A hysterectomy that includes removal of the ovaries — an oophorectomy — throws the patient into instant menopause. These patients also face a higher risk of heart disease and lung cancer, says William Parker, M.D., author of A Gynecologist’s Second Opinion and lead investigator of a 2009 study on the long-term health consequences of hysterectomy.

Stents for Stable Angina — If a patient is having a heart attack, a stent can be a lifesaver. But for heart disease patients with stable angina — chest pain brought on by exertion or stress — a stent is not better at preventing a heart attack or prolonging survival than lifestyle changes such as exercising and taking statins to lower cholesterol, according to a landmark 2007 Department of Veterans Affairs study. Surgeons frequently insert the stents during heart-catheterization procedures to evaluate patients’ blood vessels, says Lee Lucas, Ph.D., an epidemiologist at Maine Medical Center Research Institute, who argues that the catheterization should be done first as a diagnostic test, and stenting done later, if necessary. “This should be a two-stage procedure, but patients never get to leave the cath lab to think about it,” says Lucas.

Source: AARP publications do a nice job compiling this kind of information. When reading it, you find yourself wondering why payors don’t more aggressively insist on a second opinion, even if the patient won’t.

—Tom Finn