“Just so you know, money is not an issue. Should I have a better robotic knee or just stick to the regular one?”
So said my friend’s mother when she could no longer go for a walk–and her words made my ears prick up for two reasons. I had never heard the first affirmation in my humble Indian upbringing where value for money was governed. But more importantly, my mother, who was the same age, was due to have a knee replacement and her surgeon didn’t mention a robot.
My friend’s mother sent me a curated list of websites touting the benefits of robotic joint replacement – a new technology with allegedly better results. Some sites contained glowing testimonials from patients and others praised the surgeon’s expertise as unparalleled, accompanied by somewhat dazzling illustrations of how the robots work and tips for booking a consultation now. I felt guilty that I moved my mom to little.
While searching for a surgeon, I assumed that over 15 years of training meant that all Australian orthopedic surgeons were technically high quality. So, the choice was based on the right fit and I did what any experienced doctor would: I asked the nurses. Doctors rarely see how their colleagues interact with patients. On the other hand, nurses notice the nitty-gritty of physicians’ behaviors.
My mother, for whom English is a second language, needed a calm, steady and unimpressive surgeon. I watched how quickly the phrase “all good” was narrowed down to “but that’s my choice”.
The surgeon was so kind that he didn’t feel like a criminal to ask why he didn’t equip himself with a robotic arm to help my mother. He explained that while he knew how to do this, he chose not to use the robot because it did not produce better results compared to conventional surgery. In fact, Guide It has been suggested that robotic joint surgery requires longer anesthesia with attendant complications and more consumables that create greater environmental waste. Recovery hasn’t been faster, and it wasn’t clear if more precise prosthetic placement translates to better patient outcomes such as reduced pain, improved mobility, or longer implant life.
In other words, joint surgery had a significant impact on quality of life, but this was attributable to the surgery, not the robot. Robots have had the potential to change a patient’s experience, but not yet. When I asked about the enthusiastic publicity for robotic surgery by surgeons and hospitals, he mentioned Business incentive to promote technology At a cost of one million dollars apiece. My mother went for the “normal” surgery not once but twice.
I remembered that conversation when I came Australian study which found that many orthopedic surgeons do not comply with advertising guidelines set by their own professional association, the Australian Orthopedic Association (AOA) or Ahpra (the Australian health practitioner regulatory agency).
Promoting a health service regulated in a way that may improperly influence health care choices is an offense under Australian law, and Ahpra has published guidelines to protect patients from false or misleading claims and facilitate informed health care choices. The AOA advises surgeons not to make any claim of superior performance, not to confuse anecdotal experience with validated evidence, not to claim ‘excellence by assertion’ and not to indicate that newer technology or an older adopter was necessarily better.
Because direct-to-consumer advertising influences patients by shaping their perception of what is “best” and spurs demand that fuels healthcare spending, the researchers wanted to determine surgeons’ adherence to professional guidelines.
The results were realistic.
Among the 81 randomly selected AOA surgeons, 65% were inconsistent with at least one aspect of the guidelines. Of the 59 surgeons in a second sample obtained through a Google search that included both paid ads and sponsored results, 81% were noncompliant. Non-compliant surgeons made unverified claims regarding reputation and skill, misrepresented treatment benefits and did not identify industry linkages. The information on their website was of low quality, exaggerated and subjective.
In light of an aging population facing increasing rates of joint replacement and low prevalent health literacy coupled with web browsing directed as “research” over the Internet, these findings are in the public interest.
I’ve been thinking of two sides.
One is the somewhat embarrassing affair of a doctor claiming to be “the best”, as if there was a measure of it.
As an oncologist in sustainable relationships with patients, I am happy to hear the spontaneous phrase “You are amazing!” or “You saved my life.” Such heartfelt words are like salve for the soul but are they suitable for advertising? Only with the simultaneous acknowledgment that a long career holds a fair number of frustrated patients who are closer to complaining than finding one great care. As one website explains, the best surgeon is the one who deals with the patient. While it takes a healthy breath (and a lot of training) to scale a career, a dose of humility is never lost.
The second issue is integrity. The AOA guidelines specifically advise surgeons not to claim that the clinical outcomes of robotic surgery are superior to the standard procedure but 14% of surgeons in one sample and 29% in the second sample disagreed with this advice. They denigrated a quarter of the surgeons in the first sample and 12% in the second sample who were fully consistent with the two sets of guidelines and many others not included in the study who were doing the right thing.
Surgeons hold a sacred place in the medical hierarchy and there is a staggering imbalance of power between them and their patients. Therefore, surgeons have an enormous duty of care to uphold the highest professional standards.
The authors generously allowed that non-compliant surgeons simply did not understand the guidelines, but I doubt the public would agree with their alternative hypothesis that the guidelines are being violated for commercial gain. If so, it is time for the profession and the authorities to act because when a costly and completely unproven health care intervention enters the market, we all pay the price.
Denouncing the hype, one surgeon recently mocked that robotic joint surgery is “not a penicillin moment” in orthopedics. It got me thinking that this could be the new logo appended to all the ads that go against professional standards.
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