Surgeons boldly reject accusations of poor patient selection and medtech influence in low value care delivery

MedTech & Diagnostics News: The Royal Australasian College of Surgeons (RACS) has firmly rejected allegations made by Dr Rachel David, CEO of Private Healthcare Australia, suggesting that surgeons play a intentional role in the delivery of low value care within the Australian healthcare system. Dr David’s claims revolve around the poor selection of patients for surgical procedures and the purported influence exerted by medical technology company representatives on surgeons’ choices.

The contentious issue came to light during a panel discussion held by the Australian Healthcare and Hospitals Association (AHHA) last week. Dr David identified several factors that she believes contribute to low value care. She provided an example of hip replacement surgery, claiming how the surgeon’s choice of implant that is influenced by medtech company sales incentives can impact the overall value of the procedure.

Responding to these allegations, Professor Mark Frydenberg, RACS Councillor, emphasised that the concept of low value care is subjective and can vary from one case to another.

“One needs to recognise that guideline medicine is very different to real world medicine as not everyone exactly fits into the same category,” he said.

He illustrated the case of low-risk prostate cancer, which may be considered low value care when treated with surgery or radiotherapy due to the potential risks outweighing the survival benefits for some patients. However, for individuals with a known BRCA 2 gene defect, the biological context changes, making surgery or radiotherapy a more suitable option.

Professor Frydenberg added “While surgery for knee pain or back pain may in some cases be considered low value care, in other circumstances it may be entirely appropriate. Clinician and surgeon judgement in conjunction with existing guidelines is crucial rather than guidelines alone without clinical input.”

In defence of the surgical profession, he also highlighted that there is no concrete evidence to support the claim that surgeons’ decisions are influenced by medical technology companies or their representatives in the operating room. Typically, these representatives are present to ensure that devices are used correctly and in line with specifications, rather than engaging in sales activities during surgical procedures.

Professor Frydenberg stressed the ethical commitment of RACS, asserting, “There is no doubt that we would never condone any decisions made in such a fashion with all decisions made being done to enhance the patient’s outcomes, and allowing industry to influence decisions is a breach of the code of conduct of RACS.”

He added “Patient choice is obviously essential as part of an informed consent process, however RACS would always encourage surgeons to provide the necessary verbal and written information to ensure all treatment recommendations were evidence based hence avoiding low level care.”

Health Industry Hub is awaiting commentary from the Australian Society of Orthopaedic Surgeons (ASO) and the Medical Technology Association of Australia (MTAA) to further illuminate this ongoing debate.

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