by Kathleen Bartholomew

Tom Emerick is a man I respect immensely. He administered benefits for 1 million Wal-Mart employees and took that job very seriously. When you walked into Tom's benefit department, you couldn't miss the wall of thank you cards--all written by "almost patients." These patients are the ones who almost went under the knife to have a variety of surgeries from heart transplants to spinal fusions, but were "saved" by a conscientious benefits manager from the largest retailer on the planet--not by their doctor.

Granted, some cards are duplicates. One couple sends one every single year. You see, their doctor said this 40ish gentleman had to have a heart transplant immediately, or he would die. But the benefits manager insisted on a second opinion from the Mayo Clinic and put the couple on a plane despite the threats of a screaming physician. The result? He didn't need a total heart transplant. He needed one stent and was prescribed a single heart medication. An isolated event? No. Mayo found that 40 percent of recommended transplants were not necessary, and the ear, nose and throat surgeons themselves deemed 75 percent of all tubes placed in children's ears didn't meet the criteria for surgery ("Overtreated" by Shannon Brownlee) ... nor did thousands of stents, hysterectomies, spinal fusions or knee arthroscopies.

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In a five year period beginning in 2002, for example, spinal fusions increased by 1400 percent. Last year, AARP ran a story on never surgeries advising the general public to question their doctors if they were looking at a stent for stable angina, spinal fusion for stenosis, hysterectomies for fibroids or a knee arthroscopy for osteoarthritis. Why? Because there is no research that backs up these surgeries and the risks often far outweigh the benefit. For instance, if you've had a hysterectomy then you are 60 percent more likely to experience incontinence by the age of 60.

Bad physicians? No again.

Just human beings who think they're doing the right thing, looking at life through the lenses of their own self-interest without realizing it--"when all you have is a hammer, everything looks like a nail." In her book, "The Treatment Trap," Rosemary Gibson poignantly speaks to the unnecessary surgeries and treatments administered right under our noses by physicians we blindly trust. Her book should be mandatory reading for all healthcare executives. But consumers aren't getting this information from books, their medical facilities or physicians. Benefit managers are creating lists of surgeons with whom they will not do business ever again. And when the list gets long enough, maybe healthcare will do more than raise an eyebrow. As Tom says, "Nothing is going to change the methodology these overtreating doctors use until someone takes their patients away." Who in your facility is on one of those lists? You have no idea because the culture is set up to protect them--just like John F. Kennedy.

In a special last week on Kennedy's affair with a 19-year-old intern, the question was raised: "Why didn't anyone say anything? Lot's of people knew ... the secret service, reporters, friends. The reason no one said anything was because his actions were inconceivable. It went against the grain of what everyone wanted to believe--just as with doctors. We trust and respect them immensely and it is inconceivable to us that they would ever, ever operate unnecessarily.

How did we get here? We build a citadel of payment reimbursement around unquestioned physician autonomy. But it's time to take a hard look at the realities long before the lawsuits begin, or the impact hits the bottom line, or "do not use" lists start accumulating names from your institution. It is more than your moral, ethical and fiduciary responsibility to ferret out and know which surgical procedures are questionable, shaky or even wrong in your facility. Do you?

Kathleen Bartholomew, RN, MN (www.kathleenbartholomew.com) is an author, international speaker and national expert on healthcare culture.