“Just so you know, money is not an issue. Should I have the best robotic knee or settle for the regular operation?”
That’s what my friend’s mother said when she couldn’t walk anymore, and her words stung my ears for two reasons. I had never heard the first statement in my modest Indian upbringing that value for money was king. But more importantly, my own mother, of a similar age, was scheduled for a knee replacement and her surgeon hadn’t even mentioned a robot.
My friend’s mother sent me a curated list of websites touting the benefits of robotic joint replacement, a new technology with supposedly better results. Some websites contained glowing patient testimonials and others hailed the surgeon’s expertise as second to none, accompanied by slightly impressive illustrations of how the robots worked and exhortations to schedule a consultation now. I felt guilty for relegating my mother to less.
When searching for a surgeon, I assumed that over 15 years of training meant that all Australian orthopedic surgeons were technically sound. So the choice depended on proper fit and I did what any experienced doctor would do: I asked the nurses. doctors they rarely see how their colleagues interact with patients. Nurses, on the other hand, look at the crux of physician behavior.
My mother, for whom English is a second language, needed a calm, firm, non-dramatic surgeon. I watched how quickly “they’re all good” boiled down to “but here’s my pick.”
The surgeon was so personable that it didn’t feel criminal to ask why he wasn’t equipping himself with a robotic arm to help my mother. He explained that while he knew how to do it, he chose not to use a robot because it did not offer better results compared to conventional surgery. In fact, the evidence suggested that robotic joint surgery required longer anesthesia with its attendant complications and more consumables, creating greater environmental waste. Recovery was not faster, and it was not clear whether more precise prosthetic placement translated into better patient outcomes, such as reduced pain, better mobility, or longer implant life.
In other words, joint surgery had a dramatic impact on quality of life, but this was attributed to the surgery and not to the robot. Robots had the potential to transform the patient experience, but not yet. When I asked him about the enthusiastic publicity of robotic surgery by surgeons and hospitals, he mentioned the commercial incentive to promote a technology which cost a million dollars each. My mother underwent the “regular” surgery not once but twice.
I remembered that conversation when I met an australian study which found that many orthopedic surgeons do not adhere to advertising guidelines set by their own professional association, the Australian Orthopedic Association (AOA) or Ahpra (Australian Health Practitioners Regulatory Agency).
Under Australian law, it is an offense to promote a regulated health service in a way that could unduly influence health care choices and Ahpra has published guidelines to protect patients from false or misleading claims and to facilitate informed health care choices. . The AOA advises surgeons not to claim superior performance, not to conflate anecdotal experience with validated evidence, not to claim to be “excellence by claim,” and not to point out that the newest or first adopter technology was necessarily the best.
Since direct-to-consumer advertising influences patients by shaping their perception of what is “best” and creates demand that fuels health care spending, the researchers wanted to determine patients’ compliance with professional guidelines. surgeons.
The results were sobering.
Of 81 randomly selected AOA surgeons, 65% did not meet at least one aspect of the guidelines. Of 59 surgeons in a second sample obtained through a Google search that included paid ads and sponsored results, 81% did not comply. Surgeons who did not comply made unverified claims of reputation and skill, misrepresented the benefit of treatment, and did not specify industry ties. The information on your website was low quality, exaggerated and subjective.
In light of an aging population facing increasing rates of joint replacement and prevailing low health literacy, coupled with web surfing disguised as online “research,” these findings are in the public interest.
I have been reflecting on two aspects.
One is the rather awkward business of a doctor claiming to be “the best”, as if there was a metric for it.
As an oncologist in sustained patient relationships, I’m glad to hear a spontaneous “you’re amazing!” or “you saved my life”. Such heartfelt words are like a balm for the soul, but do they appropriate them for an advertorial? Only with the simultaneous confession that a long career has a few disappointed patients who are closer to filing a complaint than finding amazing care. As one website explains, the best surgeon is the one who gets along with the patient. While it takes a healthy ego (and a lot of training) to scale the heights of a profession, a dose of humility is never lost.
A second theme is integrity. The AOA guidelines specifically advise surgeons not to claim that the clinical results of robotic surgery are superior to the standard procedure, but 14% of surgeons in one sample and 29% in the second sample violated this advice. They tarnish the reputation of the one quarter of surgeons in the first sample and the 12% in the second sample who were fully compliant with both sets of guidelines and many others not included in the study who are doing the right thing.
Surgeons hold a sacred place in the medical hierarchy and there is a striking power imbalance between them and their patients. Therefore, surgeons have an enormous duty of care to maintain the highest professional standards.
The authors generously admit that noncompliant surgeons simply don’t understand the guidelines, but I suspect the public will agree with their alternative hypothesis that the guidelines are violated for commercial gain. If so, it is time for the profession and the authorities to act because when an expensive and not fully proven health intervention enters the market, we all pay the price.
Denouncing the hype, one surgeon recently joked that robotic joint surgery was “not a penicillin moment” in orthopedics. It made me think that this might be the new tagline added to all the ads that go against professional standards.