Quote:
Originally Posted by blueash
Gracie, you are misunderstanding the issue. Here it is :
All these patients saw a surgeon. But whether the surgeon was going to make more money by operating seemed to influence the recommendation. The fee for service doctors are paid by the insurance company for doing surgery. Paid a lot more for an hour of operating than an hour of office time. The salaried doctors are paid by a corporation for being there and are paid the same whether they operate or do not operate, they get a paycheck.
Yes, we agree some people need surgery. The question is whether the only factor in the choice is what the patient needs not what the surgeon gains.
Edit: By the way, you are a medical consumer and a tax payer, so this very much concerns you and everyone else.
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Thank you for your reply. I'm not sure why you chose to be argumentative rather than informative, but yes, I should have read the article. You gave a pretty good synopsis, but I would hardly call raising legitimate methodology questions "pontificating"
Now that I read the article, there are still problems with it:
It remains a retrospective study, with all the inherent problems of such studies. The large number of patients is not unusual, since all you have to do is find a bunch of old charts. The Ca++ channel blocker study that led to a horrible conclusion was also retrospective and included thousands of patients. Retrospective studies are also more subject to researcher bias since you are not collecting data in real time but rather interpreting old data. Above all, retrospective studies are not double blinded.
The next problem is that all surgery was performed by MILITARY surgeons. There's an old saying that goes "there's a right way to do things, a wrong way to do things, and the army way to do things". The article does not spell out "the army way" Are the criteria by which a military vascular surgeon decides upon carotid endarterectomy different than civilian?
Next, military surgeons are indeed on straight "salary". In the real world, that is not the usual case---an employed surgeon usually gets a salary guarantee PLUS a productivity bonus, so I wonder if the odds ratio would be less with civilian employed surgeons.
If you look at the odds ratios in the data, it is about 1.6 for fee for service surgeons, certainly implying that financial gain may be a significant factor. But the odds ratio for smokers, regardless of payment model, was 1.9. Therefore, I could us their data and title an article "Vascular surgeons are far more likely to "punish" a smoker by "putting them under the knife" and my conclusion would be even more statistically valid. Do you think that is really the case? And if not, why is "Tahiti" more valid? The odds ratio for symptomatic patients was about 9. Yet progression to CVA is nowhere near 9x as great for symptomatic patients, so why is that? Perhaps the patient with symptoms is more eager to have something done?
Lastly, are there surgeons motivated by money? Of course there are. There are dermatologists and radiologists and internists with that motivation. There are also lawyers, plumbers and used car salesmen as well. I just don't think that money is the MAIN motivation for the MAJORITY of surgeons. I just didn't want a person with a legitimate need for surgical intervention to reject that treatment because he became convinced that the surgeon is just trying to make money.