Friday, 17 December 2010


Surgeons’ Decisions and the Financial and Human Costs of Medical Care

A good piece by an anesthesiologist in the NEJM today. What I found interesting was the fact that there used to be a chapter on surgical judgement
and on when not to operate in the 1960 edition of a major surgical textbook. The chapter had disappeared by 1972. As surgical and anaesthetic techniques improved, the scope for surgical intervention was extended to sicker and older patients. Now the emphasis on cost containment in a world that is broke and on patient reported outcomes is beginning to apply the brakes on that hubristic approach. It is however that kind of approach that frequently plays an important part in the advancement of medicine. With much greater scrutiny on doctors' performance, that kind of approach has now become increasingly socially and some might say morally unacceptable.