President Obama's comment during his press conference on the health care crisis has raised some eyebrows, including mine.
Nina L. Shapiro, MD: Obama stated that doctors are now forced to make decisions based on fee payments, and that if someone comes in with a sore throat, or multiple sore throats, a doctor may think, "Hey, I'd make a lot more money if I just took this kid's tonsils out." Well, I haven't been in proximity to Barack Obama since we were graduating from our respective schools in 1991 on the Harvard Yard -- he from Harvard Law School, me from Harvard Medical School. He has surpassed me professionally in countless ways, but medical knowledge is not one of them.
First of all, doctors who see children for a sore throat, or even repeated sore throats, are primary care doctors, pediatricians, or family practitioners. They do not remove tonsils, and they have nothing to gain financially or otherwise to recommend such an operation. Otolaryngologists (ear, nose, and throat specialists) remove tonsils. Our patients are REFERRED to us by other doctors who have recommended CONSIDERATION for a tonsillectomy. As a specialty, we otolaryngologists strive to practice evidence-based medicine, whereby we make and carry out recommendations based on medical evidence that a given recommendation will benefit the patient. This evidence is not based on an individual's experience, how one was taught in residency, anecdotes, or an article one read in a recent medical journal. Evidence-based medicine is that which is a compilation of medical literature leading to specific guidelines for specific diseases.
Second, doing ANYTHING for personal financial gain alone is unethical. Whether it's selling a lemon of a car, giving inaccurate legal advice, or doubling an initial contracting estimate, it's wrong. While there are many unethical doctors out there, believe it or not, the majority of us ARE ethical. We enjoy seeing our patients stay or become healthy, we want to do the right thing, and we try to do so to the best of our abilities.
Third, tonsillectomy is not done "for the money," and most otolaryngologists actually deplore performing this procedure. Don't get me wrong -- I love performing tonsillectomies -- it is a wonderful operation, and it can remarkably change a child's life for the better. It is not without risk, however, and those risks are not small. There is a 1-5% risk of post-operative bleeding, and children have even died after a tonsillectomy. Anyone who performs this operation knows this, and most parents whose child has had a tonsillectomy knows that there are risks.
So, Mr. President, I appreciate that the health care system is broken, but please don't break down the doctors as well.
|Dr. Nina Shapiro is a graduate of Harvard Medical School, and she completed her residency in ear, nose, and throat surgery at Harvard. She is an Associate Professor and Director of Pediatric Ear, Nose, and Throat at the Mattel Children's Hospital at UCLA. She has treated tens of thousands of children with ear problems, sleep problems, and breathing problems. She lives with her husband and two young children in Los Angeles.|