Reply to the letters to the editor: Safety in surgery and overall health: What is the responsibility of the patient?

摘要

I appreciate the letters to the editor by Drs. Woo and DiCuccio. The incentive to optimize a patient's health for surgery is often countered by the financial incentive of productivity. Orthopaedic surgeons generally are not compensated to engage in smoking cessation, weight loss or glycemic optimization. As Dr. Woo points out, if Surgeon A delays elective surgery until a patient is healthier, there is nothing stopping that patient from going across town to Surgeon B who is willing to offer the surgery immediately. As a result Surgeon A gets nothing for trying to improve a patient's health, and Surgeon B gets paid for rendering lower-quality care. It would be easy to see how in the long run, Surgeon A can get frustrated in this system and perhaps change his/her practice patterns. This is not to say that surgeons or physicians are incentivized solely by financial gain. However, we would be naive and delusional to assume that finances play zero role in physicians' decision-making.