Profit Motive Raised in Burst of Surgery on Elderly Patients

A surprising number of the elderly undergo surgery in the last year of their lives. A new study of Medicare recipients, published in the journal The Lancet, found that even among patients 80 years old, 35.3 percent had operations less than 12 months before they died.

That burst of late-in-life surgery is raising questions about whether doctors and hospitals are performing operations for their own profit or for the benefit of the patients.

As USA Today reports, a commentary accompanying the study pointed out that Medicare reimbursement rates for surgery are highly lucrative, suggesting that “surgeons and hospitals are often financially motivated to operate, regardless of the patient’s preferences or goals.”

But since the research looked only at patients who died, its findings are likely to be controversial. The results don’t indicate how many elderly patients benefited from the surgeries or evaluate in how many cases the decision to operate was appropriate, even if it wasn’t successful.

In addition, for the doctors, “There’s no way possible to know … if it’s the person’s last year of life,” said Jane Bolin, an associate professor of health policy and management at Texas A&M.

Dr. Ashish Jha, the lead author of the study and an associate professor of health policy at Harvard University, told The New York Times that doctors often avoid difficult conversations with dying patients. “As clinicians, we often end up focusing on something narrow and small that we think we can fix,” said Jha, a practicing general internist in Boston. “That leads us down the path of surgical intervention. But what the patient cares about is not going to get fixed.”

He cited an example from his own hospital involving a man dying of pancreatic cancer. “No one had talked to him about how close he was to death,” Jha said. “It’s the worst kind of conversation to have.”

Instead, doctors performed an endoscopy, a colonoscopy and abdominal surgery. “We did all of this because we were trying desperately to find something we could fix,” he said.

The man died of a complication from the surgery. “The tragedy is what we should have done for him but didn’t,” Jha said. “We should have given him time to have the conversation he wanted to have with his family. You can’t do that when you are in pain from surgery, groggy from anesthesia. We should have controlled his pain. We should have controlled his nausea.”

Instead, Dr. Jha said, “we sent him to the O.R.”

STUART SILVERSTEIN

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