Spare Us the Cutter

When I was a fourth-year med student, one of my favorite things was to wake up on an noncall Sunday, read the newspaper(s) and blogs, and find something to write about.

Fast forward a few years: I've got a boatload of assignments I should be tackling, I'm working a shift tonight... and yet.

CNN's got a list of Five Operations You Don't Want (hat tip: Clinical Cases). They are: Hysterectomy, episiotomy, angioplasty, Nissen fundoplication, and lower back surgery.

The article is written by an ex-patient who talked with "25 experts involved in various aspects of surgery and surgical care" and reviewed some data from the government and think tanks. It's well-referenced, and provides many disadvantages and alternatives for each procedure. But, while I know that writers don't often pick their headlines, but in this case "want" is the wrong word -- I've never really seen a patient "want" one of these procedures (with the possibly exception of episiotomy and lower back surgery, and then, only because of extreme pain possibly clouding their judgment).

The only surgery patients seem to really want (besides cosmetic) is gastric bypass surgery. I'm really surprised it's not on the list -- probably because surgeons know better than to perform gastic bypass unless absolutely necessary.

Still, patients often mention it to me in the ED -- regardless of the reason they came in. I could be suturing a laceration, when an obese patient could ask me out-of-the-blue for a referral. Or an asthmatic with shortness of breath will wonder aloud if gastric bypass will prevent future exacerbations.

I don't really know how to view these situations. I'm not an expert on this procedure, but these patients often have limited access to health information. So I try to address some misconceptions and steer them in the right direction.

Gastric bypass carries a 30 day mortality between 0.3% - 1.9%, which ought to prompt some reflection. Common sequelae include iron and calcium deficiency, ulcers, hernias, infection, and the dumping syndrome. Plus -- this seems to gets patient's attention -- they become more sensitive to alcohol, often unpleasantly so.

Everyone gets a referral to a primary care doctor for more information -- though I don't know how many follow up. I do think CNN and the media would do readers a service with more reporting on the risks of gastric bypass.

In the meantime, the above CNN article would be a good deal more helpful to lay readers if it were simply titled "Five Operations You May Not Need." And if the author is thinking of starting a series, I'd be interested in reading something like, "Five Operations You May Someday Need, But Really Don't Want".