Should Doctors Police themselves?

After being in solo-practice as a physician, I have learned quite a few things. Some good and some bad. I have begun my practice from scratch without any experience in the business side of medicine and have learned by mostly trial and error. I have gotten some assistance from other close friends in the same profession, but mainly from my own mistakes on how to manage a medical practice. There is one thing that I have learned, that cannot be taught, politics. I’m not one who likes to “kiss others’ behinds” just to get ahead in life and I believe that if you are confident in yourself and have the solid medical training, that your practice will succeed. I also am not one who would put someone else down, just to get ahead of them. However, here are some examples that show we must begin to evaluate and take a stand.

Here are 3 examples of patients that I have recently seen for a second opinion, who have been provided poor medical care only for significant financial benefits:

Case #1: 17 year old female with pain in both feet who had surgery performed by a local podiatrist. This patient had a metal implants placed into both feet into her sub-talar joints (arthroeresis, a common procedure for correcting flat feet in children between ages of 8-12). In all the years of my training and schooling, I was taught that this procedure is mainly used for children between ages of 8-12, but can be used only in addition to other procedures such as achilles tendon lengthening, midfoot fusions (Hoke procedure), lateral midfoot fusions or osteotomies (Evans procedure), tendon repairs. In this particular case it was done as a single procedure and now this patient is only 6 months after her surgery and in more pain than before.

Case #2: 40 year old female that presents with toenail fungus. However, I noticed surgical scars on 8 different toes. After interviewing this patient, she states that a surgeon (same surgeon from case #1) performed procedures 8 different times in a 2 month time frame. Since 4 toes were surgically corrected per foot, that include fixing the toe on the first procedure with a metal pin followed by a 2nd procedure to remove the pin from the toe on a separate day. Why would a doctor make a patient go through the risks of 8 separate anesthesia events, and 8 seperate trips to the surgery center (owned and run by the same surgeon), and 8 different medical claims that could results in significant payments to the insurance company and the patient? These simple procedures could have been, in my surgical experience, performed in 2 different occasions not 8! Is this ethical? No. Is this something we should worry about? Yes. This is one reason why medical insurance premiums and our malpractice premiums are going up because of money hungry, non-trained, surgeons, who have learned how to manipulate the system until the system is empty.

Case #3: 83 year old female with painful ankles and feet and numbness. This lady had surgery performed just like in Case #1 and had metal implants placed into her sub talar joints of both feet. If you remember from case #1, these implants are only mainly indicated in children between ages of 8-12, but sometimes can be used in adults, only as an adjunctive procedure. In this case, the implants, were only used alone and after reviewing the Xrays, I noticed that the implants were not even close to the corrected position. The implants were so inappropriately placed by this surgeon, that the radiologist reading the xrays thought they were in the bone and not in the joint space. Secondly, this lady is now 83 years old and still has a flat feet and and additionally has numb, painful feet. What made this doctor deciede to do this kind of procedure on a 81 year old when the procedure is not indicated for that age group?

Do these doctor’s have the training to perform these type of procedures? Supposedly, these doctor’s have certification in foot and ankle surgery, but how did they get it? Is being certified enough to proof that we are good, ethical doctors? I don’t think so. I think, its time to start policing ourselves and put politics behind us. Take a stand and make our world of medicine better and safer. It will decrease our malpractice premiums, make our us and our patients happier and we will be able to sleep easier knowing that we did the right thing to help our patients and not just to put money in our pockets.