Is surgery always necessary? To cut or not to cut

While most surgery can't be avoided, is it always necessary?

Few people would willingly put their hand up for unnecessary surgery, but it seems many of us are doing just that. In recent times, a number of surgeons have spoken out with concerns about complex medical procedures that lack any real clinical evidence. This focus on over-prescribed diagnostic tests and unnecessary surgery encourages patients to look more thoroughly into preventative or alternative treatment options.

If a particular surgery hasn’t been shown to lead to improved quality of life, you'd be right to question whether the risks associated with it are worth it.

Procedures to reconsider

A study published in the Medical Journal of Australia identified more than 150 'low-value' procedures. The research showed that procedures on the list were unsafe, ineffective or simply inappropriate in certain circumstances. The types of procedures on this list vary widely, and in some cases, surgery was deemed no more effective than placebo treatments. Of course, the unique circumstances of each patient must always be taken into consideration – what works for one patient may not work for another – and the specific nature of some of the procedures needs to be taken into account.

When surgery is avoidable

In many cases patients will assume that if they are offered surgery, it's the best option available. Unfortunately, this isn't always the case. According to Ian Harris, author of Surgery, The Ultimate Placebo, some surgeons may continue to offer procedures they have always done rather than looking to the latest evidence-based research. He also believes surgeons might have seen positive responses from patients and prioritise this feedback over studies they don't fully understand: in these cases, the placebo effect may be disguising the ineffectiveness of treatment. Harris also says surgeons could feel pressured by patients who want them to take action.

There is currently a taskforce of senior clinicians looking at all 5,700 items in the Medicare Benefit Schedule to align with contemporary clinical evidence, improve health outcomes for patients and deliver a Healthier Medicare.

How to decide if surgery is your best option

1. Speak to your doctor: Asking the right questions of your surgeon or doctor is the first step towards deciding whether surgery is right for you.
2. Enlist a support person: It can help to take someone with you to your appointments to provide a second pair of ears. A friend or family member will often be able to ask questions if you are feeling stressed or overwhelmed.
3. Request a thorough overview: Your doctor should be able to fully explain what the latest research says about the procedure, and how this relates to your circumstances. Your doctor should also be able to discuss alternatives.
4. Seek a second opinion: If you're still unsure after speaking to your specialist, you can always go back to your GP, discuss the surgeon's recommendations and, if you decide to get a second opinion, ask them for another referral.
5. Check your private health insurance: The cost of a procedure is an important consideration, particularly if you're going to be out of pocket. It's worth checking whether you will be covered by your private health insurance.

You may have alternatives to surgery

If a procedure is regarded as ineffective or is associated with increased ongoing risks, it's worth considering your options. In certain circumstances, lifestyle changes such as weight-loss, diet and exercise might help.

At nib, we offer a number of health management programs for eligible customers that range in focus from mental health, coronary disease and osteoarthritis. We've also helped develop Whitecoat, an online tool that gives you access to more than 200,000 healthcare providers, Australia-wide. This includes healthcare professionals specialising in preventative medicine, such as physiotherapists, chiropractors and osteopaths.