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Another article about what should be happening, but is not
Over the short time that I’ve been following this field I’ve seen several earnest efforts to address the serious problems with hernia repair. Dr. Heniford, Dr. Ramshaw, etc. They make a good effort but then, apparently, typically, realize the futility of fighting the huge corporations, I assume. They fade away and disappear.
Maybe Dr. Prabhu will have more luck, or fortitude, or just be more skilled at forcing through the obliviously right things that should be done.
It’s amusing, in a sickening way, how they always talk about how “it’s time” to do these things, unaware that similar efforts were proposed decades ago.
I hope she has better results. Somebody, eventually, must do the math on the actual cost of these poor repair methods. The true cost to society, not just the balance sheet results, with the cost transferred to the insurance/healthcare system. Human cost, not just workforce effectiveness.
Exceprt –
“We need to begin by acknowledging that we truly know very little about the treatment of hernias. Furthermore, we need to acknowledge the legitimacy of peer-reviewed publication, and to critically appraise the idea that crowdsourcing anecdotes through social media groups can result in meaningful change or reasonable surgical care of patients. Beyond that, we need to hold ourselves accountable for contributing to our profession. This is particularly important given that we benefit (indeed, make our livelihood) from the suffering of others.”
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This discussion was modified 3 years, 7 months ago by
Good intentions.
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This discussion was modified 3 years, 7 months ago by
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3 Replies
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To address @deeoeraclea, ultrasound or other imaging is used to diagnose an inguinal hernia when examination is non-diagnostic.
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One thing, and one thing only, will affect change here: an evolution of how a “successful” surgical outcome is defined. Right now, “success” means no recurrence, meaning this is THE outcome surgeons are incentivized (and no, not just economically) to achieve and therefore that residency programs are incentivized to teach.
If consensus was reached that there should be more allowance for recurrence, with less allowance for chronic pain, you’d see the repair methods change. If zero recurrence were still the goal, but low-to-no pain was an equal goal, you’d see changes in how carefully surgeons are taught.
But, as I’ve said before and will say again: People respond to incentives, and the criteria on which they are judged at the end of the day matter. As long as those remain unchanged, so too will this situation.
This has way more to do with learned behavior and resistance to change than anything drug/device companies could ever do (they’ll always find something else to sell to surgeons, since that is their incentive).
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I can’t even begin to compute the total cost of my mesh-based hernia repair. In addition to the (1st) operation, there were a bevy of ultrasounds, MRIs, follow-up appointments, visits to pain-management clinics all to figure out the source of my pain (hint…in was the mesh). There was also the mesh-removal operation and the personal mental and physical cost to me to deal with chronic pain.
The total cost of my non-mesh hernia repair: one operation.
As a side note, I don’t understand why we are even using ultrasounds to identify hernias. A physical exam has a lower false positive and a lower false negative rate.
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