Is the Best Treatment No Treatment?
The roundtable sent out a reference to an article about how doctors treat themselves when they are faced with end-of-life decisions. Often, what a doctor chooses for himself is not what he would choose for a patient. The majority choose to forego intensive treatments that have a marginal chance of success. Their time is spent with friends and family, avoiding the medical system as much as possible. However, when their patients face similar illness, doctors frequently recommend medical treatment.
Unnecessary Spine Fusion
A similar phenomenon occurs in spine surgery. I know of only two spine surgeons in my 25-year career who have undergone a spine fusion for LBP. One was an older surgeon who did pretty well. The other committed suicide two years after the operation. I don’t know how much of his ongoing pain contributed to his emotional state.
No One Wants a Spine Fusion
Whenever I give a lecture to a group of physicians, I usually ask the question “how much lower back pain would you have to experience before undergoing a spine fusion?” I have never seen a single physician ever raise a hand. This includes surgeons who routinely perform fusions.
Surgeons Don’t Want What They’re Selling
There was a survey done through one of our national spine societies a few years ago asking surgeons about the use of an artificial cervical disc. Although 75% percent would recommend it for their patients, only nine percent would have one performed on themselves.
I gave a lecture, “Low Back Surgery—The State of the Union.” I covered what we knew about outcomes for specific surgeries versus what surgeries are currently being done. There is almost a complete disconnect between the two. The upshot is that Surgical Results are Overly Optimistic. We need to stop performing surgeries that we know are undesirable.