Unnecessary Medical Procedures: Understanding the Risks, Ways to Avoid & When to Seek Accountability

When patients put their care in the hands of a surgeon an immense amount of trust is transferred. If recommendations don't follow clinical guidelines, if personal incentives outweigh and ethical duty of care, medical malpractice can result if care delivered isn't necessary and causes harm to patients.

In the complex world of healthcare, patients place immense trust in medical professionals to recommend treatments that are both necessary and beneficial.

However, it is estimated that over five million surgeries or procedures are performed each year without clear medical justification, leading to physical harm, emotional distress, and financial burdens on patients and families and ultimately medical malpractice. It drives heatlhcare costs, impacts access and consumes resources otherwise better used. When alternatives are not adequately explored or communicated, everyone loses.

This type of medical malpractice can take the form of a surgeon specializing in knee surgeries recommending surgery for a patient's MCL tear that can be properly healed with rest, ice, compression, elevation and physical therapy. 

This type of unnecessary medical interventions may not be readily recognized. It however not only compromises patient well-being but also raise serious ethical and legal concerns.

This article explores the common types of unnecessary procedures, cases, prevention measures and programs, what patients and families can do to avoid being a victim and resources available to support this type of medical negligence.

The Prevalence of Unnecessary Procedures

Unnecessary medical procedures are more common than many realize. Studies have indicated that a significant percentage of certain surgeries, such as spinal fusions, knee arthroscopies, and cesarean sections, may be performed without clear medical necessity.

The National for Health Statistics https://www.cdc.gov/nchs/fastats/inpatient-surgery.htm estimates there are roughly 50 million surgeries annually. Of which as much as 10 percent or perhaps five million surgeries may be unnecessary. This impact access to services, drives up healthcare costs and has negative impacts on those harmed.

Factors contributing to this issue include:

• Financial Incentives: In fee-for-service models, providers are compensated based on the volume of services rendered, potentially encouraging more procedures.

• Defensive Medicine: Fear of litigation may lead physicians to order additional tests or procedures as a precaution.

• Lack of Standardized Guidelines: In some cases, the absence of clear clinical guidelines can result in varied interpretations of treatment necessity.

  
  

For each reason above, established treatment guidelines should be adopted and frequently reviewed so care is provided to the highest standard of care regardless of the independent physician judgement. Guidelines should be adopted by healthcare providers to guide best practice.

Real-World Cases Highlighting the Issue

Several high-profile cases have brought attention to the consequences of unnecessary medical procedures:

1. Unwarranted Spinal Surgeries: A 35-year-old man underwent multiple spinal surgeries for a condition that did not warrant such interventions. The procedures resulted in severe complications, including paralysis, leading to a $1.5 million settlement.

2. Heart Bypass on a Healthy Patient: A woman received an emergency heart bypass surgery despite having no significant cardiac issues. The unnecessary procedure led to a $1 million settlement.

3. Gynecological Surgeries Without Consent: Over 40 women filed a class-action lawsuit against a physician for performing unnecessary and non-consensual gynecological surgeries, including hysterectomies, while they were detained at a facility.

4. Misinterpreted Genetic Tests Leading to Unnecessary Surgeries: A woman underwent a double mastectomy and hysterectomy based on misinterpreted genetic tests indicating a high cancer risk. She later discovered the tests were negative, leading to a lawsuit seeking accountability for the unnecessary procedures.

   
   

Understanding the Impact

The ramifications of unnecessary medical procedures are profound:

• Physical Harm: Patients may suffer from complications, infections, or long-term disabilities resulting from unwarranted surgeries.

• Emotional and Psychological Distress: The trauma of undergoing unnecessary procedures can lead to anxiety, depression, and a loss of trust in the medical system.

• Financial Burden: Patients often face significant medical bills for procedures that were not needed, leading to financial strain.

  
  

Preventative Measures Built Into The Healthcare System

To combat the prevalence of unnecessary procedures, several initiatives and best practices have been implemented:

• Choosing Wisely Campaign: Launched by the American Board of Internal Medicine (ABIM) Foundation, this initiative encourages conversations between clinicians and patients about unnecessary tests and procedures, promoting evidence-based decision-making.

• Value-Based Care Models: Transitioning from fee-for-service to value-based care emphasizes patient outcomes over the volume of services, reducing incentives for unnecessary procedures.

• Shared Decision-Making: Engaging patients in discussions about their treatment options ensures that care aligns with their values and preferences.

• Clinical Guidelines and Protocols: Establishing standardized treatment protocols helps in determining the necessity of procedures based on evidence and best practices.

• Decision Support Tools Integration into EHRs: Integrating decision support tools into Electronic Health Records help guideline clinical judgement toward established practice guidelines that follow evidence-based care.

• Care Coordination: Involving more health team members is a great way to ensure you have a diverse treatment team providing feedback to decrease the likelihood a single intervention is being prioritized over other viable options.

What patients and families can do to avoid being a victim of unnecessary procedures.

1. Seek a Second Opinion

Why it helps:Getting a second opinion from a qualified, unrelated medical professional can offer a fresh perspective, confirm the necessity of the procedure, or even present non-invasive alternatives. Many unnecessary surgeries are discovered through second opinions.

How to do it:

• Ask your primary care provider for a referral.

• Use hospital networks or health plan resources to find specialists.

• Contact local teaching hospitals, which often have specialists familiar with the latest evidence-based practices.

Reference:American College of Surgeons: Getting a Second Opinion https://www.facs.org/for-patients/patient-resources/second-opinion/

2. Ask Questions and Request Clarification

Why it helps:Understanding the rationale behind a procedure is crucial. Sometimes, patients consent to surgeries they don’t fully understand.

Questions to ask:

• Why is this procedure necessary?

• What are the alternatives?

• What happens if we wait or do nothing?

• How many of these procedures have you performed?

  
  

Tool:Use the Choosing Wisely Patient Questions to guide conversations with your doctor. https://www.choosingwisely.org/patient-resources/

3. Research Using Hospital Library Services

Why it helps:Many hospitals offer access to medical libraries and librarians trained to help patients find credible, peer-reviewed medical information. This can empower patients to learn more about their conditions and treatment options.

Action Steps:

• Contact your hospital's patient education or medical library department.

• Ask for evidence-based resources or clinical guidelines on your condition.

• Use resources like MedlinePlus or PubMed Health for trustworthy medical literature.

  
  

4. Participate in Shared Decision-Making

Why it helps:Shared decision-making involves patients and providers working together to make healthcare choices that consider both medical evidence and the patient's preferences and values.

Tools:

• Ask your provider if your hospital uses shared decision-making tools or decision aids.

• Use Healthwise Decision Aids or Mayo Clinic Shared Decision Making Tools if applicable.

  
  

5. Understand the Clinical Guidelines for Your Condition

Why it helps:Most professional medical societies publish guidelines for when surgeries or other treatments are appropriate. Understanding these guidelines helps you recognize if a procedure is consistent with best practices.

How to access:

• Visit sites like the National Guideline Clearinghouse (archived) or specialty-specific organizations (e.g., American Heart Association, American Academy of Orthopedic Surgeons).

• Ask your provider which guidelines they’re following.

  
  

6. Know About the “Choosing Wisely” Campaign

Why it helps:This initiative identifies commonly overused tests and procedures and promotes conversations to help avoid unnecessary care.

Resource:Choosing Wisely Recommendations https://www.choosingwisely.org/patient-resources/

7. Involve a Patient Advocate

Why it helps:Advocates can help you navigate the healthcare system, ask tough questions, and review your options with you. They can be especially helpful during times of stress or medical complexity.

Sources for advocates:

• Hospital patient advocacy services

• Independent advocates (search via NAHAC)

• Organizations like Patients Rising

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8. Review Your Medical Records

Why it helps:Errors in documentation or misinterpretations of symptoms can lead to inappropriate recommendations. Reviewing your records helps ensure accuracy and understanding.

Tool:Use your provider’s patient portal or request records under HIPAA. Services like EvaluCare can help interpret your records and offer a professional opinion.

9. Clarify Your Personal Goals of Care

Why it helps:What matters most to you? If maintaining independence or avoiding invasive care is your priority, that should shape your medical decisions. Sometimes a “standard” treatment may not be the right one for your lifestyle or values.

Ask your doctor:

• How will this surgery impact my quality of life?

• What does recovery look like?

• Is the benefit worth the risk, based on my health and goals?

  
  

10. Consider Cultural and Language Barriers

Why it helps:Language or cultural misunderstandings can lead to misinformed consent or failure to understand options.

What to do:

• Always ask for a medical interpreter if English isn’t your first language.

• Make sure written materials are available in your preferred language.

• Use culturally competent resources like EthnoMed or HealthReach

  
  

The Role of EvaluCare in Identifying Medical Malpractice

For patients and families who suspect they have been subjected to unnecessary medical procedures, seeking clarity and accountability is crucial. EvaluCare stands as a compassionate ally in this journey. Comprising a team of seasoned hospital executives, quality professionals, and medical experts, EvaluCare offers:

• Comprehensive Medical Record Reviews: Assessing the care received against established clinical standards and guidelines.

• Identification of Negligence: Determining if the procedures performed deviated from accepted medical practices, and practice guidelines.

• Guidance on Next Steps: Providing insights into potential direct settlement demands to referrals to attorneys for legal actions.

  
  

By leveraging their extensive experience in healthcare quality management, EvaluCare ensures that patients and families receive the support and information they need during challenging times. EvaluCare Medical Care Review Services

Conclusion

Unnecessary medical procedures not only jeopardize patient health but also erode trust in the healthcare system. To address this common issue we need a full court presson on awareness, preventive measures, and avenues for accountability to ensure we address this issue.

If you or a loved one have concerns about the necessity of medical treatments received, reaching out to organizations like EvaluCare can provide clarity and support in navigating the complexities of medical care and potential malpractice.

Learn more at www.EvaluCare.net or email info@EvaluCare.net