Avoiding Unnecessary Operations and Procedures - An Advocacy - A Legacy
My advocacy on avoiding unnecessary operations and procedures has its beginning when I started my private practice in 1982. It is still evolving up to the present (2018). Discernment and compassion for patients are the key factors that have led to my advocacy in avoiding unnecessary operations and procedures on patients. Discernment essentially means discovering or realizing that a certain operation or procedure is not necessary after all after doing a post-treatment evaluation on patients that I have treated. Compassion essentially means thinking of the welfare of the patient that I am treating, asking or questioning myself why I should subject a patient an operation or procedure which is not necessary.
There is lot of confusions going on in the practice of medicine. Even in the presence of clinical practice guidelines, confusions still exist. Some physicians would do this and that while some physicians would not do this and that. Physicians always have their own justifications to do this and that and not to do this and that. I have my own justifications. I don't expect everybody (physicians and patients) to agree with me. As mentioned, I have being using discernment and compassion to advocate operations and procedures which I think are not necessary. Furthermore, to assist in my decision-making on whether an operation or procedure is necessary or not, I have developed the "Management of a Patient Process" circa 1985.
To assist in my problem-solving and decision-making on diagnostic procedures, whether they are needed or not, I ask two questions:
1. What is the certainty or uncertainty level of my working diagnosis? As a rule, if I am quite certain, I do not need diagnostic procedure anymore. I proceed to treatment. If I not certain, I go for a diagnostic procedure.
2. If I am not certain of the working diagnosis, is there a marked difference in the treatment of the primary and secondary diagnoses? As a rule, if the treatment is the same, there is no need for diagnostic procedure anymore.
Supposing there is a need for a diagnostic procedure, I list down the various options that can be done and then compare them in terms of benefits (diagnostic yield); risks; costs; and availability of procedures. Then, I recommend to the patient the most cost-effective option and get his or her consent.
To assist in my problem-solving and decision-making on treatment procedures, I list down the various options that can be done including the non-operative procedures and then compare them in terms of benefits (treatment outcomes); risks; costs; and availability of procedures. Then, I recommend to the patient the most cost-effective option and get his or her consent.
This "Management of a Patient Process" has helped me significantly in avoiding unnecessary operations and procedures.
https://www.slideshare.net/rjoson/management-of-a-patient-all-types-rojoson
In 2000, when I became Chairman of the Department of Surgery of Ospital ng Maynila Medical Center, I was given the opportunity to intensify my advocacy against unnecessary operations and procedures.
Here is an excerpts from a document in 2004:
Advocacy against Unnecessary Operations, Procedures, and Health Practices (AUOPHP)
Department of Surgery
Ospital ng Maynila Medical Center
Driving Forces behind AUOPHP
The Advocacy Marketing Program of the Department of Surgery of Ospital ng Maynila Medical Center (OMMC Surgery) was initiated by the new vision-mission-core value statement and Project Optimal Surgical Services formulated in 2001. Specifically, the core value of social responsibility served as the driving force for an advocacy program whereas the need to be branded as a department of surgery offering quality care served as the stimulus for a marketing program. The Advocacy Marketing Program of the Department of Surgery was also in line with the vision-mission of OMMC, which was to provide the highest quality medical services at the lowest possible cost through quality service, training, and research.
The Advocacy against Unnecessary Operations, Procedures, and Health Practices (AUOPHP) constituted the Advocacy Marketing Program of OMMC Surgery. It actually has three interfacing and collaborative projects: Advocacy against Unnecessary Operations and Procedures Project, Public Health Education Project, and Cost-Effective Patient Management Project.
Goals of AUOPHP
The goals of AUOPHP were to prevent unnecessary pain, complications and expenses from unnecessary operations and procedures and to help the Filipino citizenry avoid common and dangerous surgical disorders.
Summary of Advocacies under AUOPHP
Summary of Communication Tools and Venues and Beneficiaries of Different Advocacies (from 2001 to August, 2004)
Legends:
Fora – Public presentation, discussion, and debates
Public Internal – Patients inside OMMC
Public External – Filipinos citizenry outside OMMC
MD Internal – Physicians Inside OMMC Surgery
MD External – Physicians Outside OMMC Surgery, Outside OMMC
Up to now, I still am advocating against what I honestly think are unnecessary operations and procedures.
This is one of the legacies that I will leave behind for my patients – saving them from unnecessary operations and procedures.
Actually, I have saved hundreds, if not thousands, of patients from unnecessary operations and procedures since I started my surgical practice in 1982.
My latest advocacies are on unnecessary breast surgery and unnecessary thyroid surgery.
Excluding unnecessary breast operations , the following medical conditions are usually those that I have saved from unnecessary operations and procedures.
Patients with normal thyroid and benign thyroid disorders, such as colloid goiter and thyroiditis
Patients with ganglion cysts which I usually just aspirate
Patients with gallbladder polyps which I just recommend watchful waiting
Patients with asymptomatic gallstones which I just recommend watchful waiting
Patients with parotitis and submandibular gland inflammation
Patients with nonspecific reactive cervical lymphadenopathy
Patients with small hemorrhoids
Others which I will try to recall.
Links:
A Lot of Unnecessary Breast Procedures Still Going On – Let’s Do Something About it!
OMMC Surgery Social Responsibility Program Framework – 2005
ROJ@18nov20