Yesterday’s Wall Street Journal had two articles side-by-side discussing trends in spinal surgery and gynecology that I found interesting. The articles raise issues that spinal surgeons and Ob/Gyns should be aware of and could lead to more medical malpractice claims and Colorado Medical Board complaints.
The first article — Concerns Rise About Rate of Spinal Stenosis Surgery – WSJ.com — discusses rise in complex spinal surgery over the past eight years. The article points out that although spinal decompression surgeries decreased from 2002 through 2007, surgeries combining decompression with fixation or other procedures increased more than 15-fold during that time. As a result the complication rates have more than doubled. The author of a JAMA study cited in the WSJ article attributes the rise in complex procedures to financial motives (the complex surgery typically costs almost 400% more than simpler procedures) and marketing by device manufacturers. The increase in multi-procedure surgeries may signal a shift toward riskier, more expensive procedures. When complications occur, a neurosurgeon who performs a riskier, more complex surgery may have a find themselves not only defending HOW the surgery was performed, but also defending WHY the procedure was performed.
Meanwhile, Ob/Gyns appear to be moving the other direction — less treatment — but also potentially more regulatory and liability issues. The companion article — Questioning Need for Routine Pelvic Exam – WSJ.com — discusses the evolving standards regarding the recommended frequency for pelvic exams in asymptomatic women. The cited study indicates that pelvic exams in healthy, asymptomatic women may be of no use and may deter women from regular visits to their gynecologist. Although the ascribed motive is different than that for the complex spinal surgery, not performing a pelvic exam may end up resulting in more issues for Ob/Gyns. If a routine pelvic exam would have detected a problem, and isn’t performed …, well we know where that goes. So in this case, if something goes wrong, a gynecologist may find herself or himself defending why the examination WAS NOT performed. Thus, an Ob/Gyn may actually protect themselves by performing an otherwise non-indicated examination. I personally dislike the concept of defensive medicine, but that is, unfortunately, where we are.