Everybody’s Got A Hand in the Healthcare Till

Yesterday afternoon I witnessed firsthand the maneuvering that some physicians will resort to in an effort to increase their revenue, even though it results in greater costs to patients. The issue was over providing anesthesia for a surgical procedure that can be performed in the office setting, a surgical procedure that does not necessarily require an anesthesiologist’s presence. The anesthesiologist’s pitch to my employing physician involved hyping one particular type of device that enables the physician to finish the procedure very quickly, in about eight minutes. However, using this particular device results in more pain for the patient, thus requiring deep IV sedation administered by an anesthesiologist. The anesthesiologist has a cozy working relationship with the vendor of the aforementioned device. In fact, they basically go around to physician offices as a team assisting with these procedures.

The issue is that there’s another device on the market that was designed specifically for the office setting. It does not cause significant pain, thus obviating the need for anesthesia. It does, however, take thirty minutes to complete. A representative for this device was also present yesterday afternoon, but she could barely get a word in edgewise with the anesthesiologist’s blowhard antics about how “risky” this procedure is without anesthesia personnel present, irrespective of the device used, and how much easier it is to do the procedure with anesthesia. Well, yeah, it’s always “easier” dealing with an unconscious patient. You just move him or her around like a piece of meat. You don’t have to listen to complaints or answer any pesky questions. Basically, you don’t have to interact in a meaningful way. It’s a very paternalistic and disempowering approach to healthcare, and it’s common among physicians.

I could tell my employer was convinced by the anesthesiologist’s charming promises of more money for all parties involved, less time, and compliant (i.e., gorked-out-of-their mind) patients. He quickly dismissed the representative for the alternative device by asking her to leave the brochure and studies for his review. He’s a big fan of quick procedures with patients so sedated they’re practically comatose. I’ve had problems with this since the beginning, and I no longer assist with procedures.

I don’t agree with sedating patients unless it’s absolutely necessary, and I certainly don’t advocate deep IV sedation or general anesthesia for a procedure that can be performed just as well without it, albeit in a lengthier timeframe. I think there are too many risks involved with anesthesia to consider it so lightly, and it’s no consolation to me, despite the anesthesiologist’s enthusiasm, that she’s right there to help if a patient stops breathing or drops their blood pressure. Keep in mind, we’re still in an office setting, and just like everyone else outside the hospital, we have to dial 911. And, no, I don’t advocate having patients gnaw on a leather strap when they undergo procedures, but there are far less risky and less costly oral and local medications that can be administered for simple surgical procedures.

Speaking of costs, the anesthesiologist casually mentioned that her hourly rate is $700-800. Oh, and there’s a one hour minimum charge per patient. So, now, not only are we dealing with unwarranted anesthesia (since the procedure can be performed just as safely with the alternative device), but we’ve added a new outrageous layer of costs for the patient to assume. Of course, insurance will pay the anesthesia charge, at least until they wise up to the fact that there’s an alternative method that doesn’t require it. But, patients will still be responsible for unmet deductibles and co-insurance for charges that weren’t absolutely necessary.

It’s a real shame that this procedure and many others across medical specialties are described to uninformed patients by entrusted physicians as “better” because they take less time, and anesthesia means “You won’t feel a thing!” The truth is that there are limited healthcare funds available, and the main players are quite creative when it comes to squeezing all they can out of every single encounter. I’m not saying that care is being compromised on a wide scale, but I do think it’s overdone in a way that is potentially harmful to patients’ health and pocketbooks all in the name of provider profit. Patients really need to do their own research and ask probing questions about any strongly suggested treatments because chances are, they’re getting a sales pitch that favors the physician's bottom line.