Beneath the surface: Beneath the surface of unnecessary surgery: A case study on the limits of existing protections

Abstract

Unnecessary surgery has been a focus of health policy concern for decades. Such events are supposed to be prevented by the (a) self-policing of hospital medical staffs, (b) oversight of state medical boards, (c) third-party restrictions on payment, and (d) threat ofmalpractice lawsuits.While criticsmay point to failures ofwill on the part of those responsible for such policing, this case study points tomore fundamental problems. The case involved an extension of the diagnosis of Chiari malformation to justify surgery to help relieve symptoms of individuals previously identified as suffering from chronic pain or fatigue syndrome. It illustrates howstrenuous efforts to reducewhat other members of the medical profession perceived as unnecessary surgery were overcome by (a) uncertainty concerning appropriate diagnosis and treatment, (b) patient desperationdriven self-referrals unrestricted by professional oversight or geographic boundaries, (c) the ambition of a surgeon determined to practice as he or she desired, (d) a business-focused national hospital chain insulated from direct clinical accountability, and (e) the highly profitable nature of the surgery itself.