American consumers are more like children than they ought to be: they tend to want the newest, shiniest thing in the surgical room – just like they do in the living room. It’s juvenile, kids-on-the-playground thinking. And it’s costing us in many more ways than one.
“Americans tend to think that the latest and greatest technology has got to be better, and it’s not in this case,” says Doctor John Santa, medical director at Consumer Reports Health.
A robotic surgery company called Intuitive has undertaken direct-to-consumer marketing for its robots. As a result, patients often demand robotic surgery, doctors say.
“I can’t tell you how many patients come in who say, ‘I want robotic surgery with a laser’ — and they’ll find somebody to do that,” said Dr. Eric Genden an ear, nose, and throat surgeon at the Mount Sinai Hospital in New York. “This is a beautiful illustration of how American medicine and the patients tend to become enamored by technology without ever really asking the question, ‘What are we actuallygetting?’”
“Patients will go to someone who has the robot because it’s been marketed so much,” he said.
Hospitals – knowing a dollar bill when they see one – advertise their da Vinci machines in part as a response to perceived consumer demand. They see the robots as a way to bring more patients through their glass doors rather than their competitors’, studies have shown. But hospital advertisements also help drive the perception that robots make the best surgeons. And that simply ain’t always true.
One study of how hospitals talk about robotic surgery found that many copied directly from Intuitive’s marketing materials. Only a minority pointed to potential risks. Unlike doctors and drug companies, hospitals aren’t required to disclose risks in their advertising.
Marketing has played such a big part in drumming up demand for da Vinci machines that one surgeon who has developed a substantial online following under the pen name Skeptical Scalpel concluded in a blog post on robotic surgery that, “The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise.”
Dr. Fabrizio Michelassi, the chair of the department of surgery at Weill Cornell Medical Center in New York, said surgeons are obligated to educate their patients on what the evidence says are the pros and cons of robotic surgery.
“Unless we inform the patient population on this, there will be a drive from the consumer that trumps everything else, because at that point hospitals and physicians are caught in a difficult dilemma,” Michelassi said. “Hospitals and physicians are caught in the dilemma to either continue to deliver optimal care or to respond to market requests.”
The ECRI Institute ranks robotic surgery among its top 10 healthcare hazards for 2015; it appeared on the same list in 2014. ECRI doesn’t fault the device. Instead, it points to inadequate certification requirements at the hospitals that use it. The group is pushing hospitals to develop appropriate processes for approving doctors to use the robotic systems.
Some hospitals may require a surgeon to perform three robotic surgeries before giving him or her the okay to operate on a patient with a robot; others may require 50 or 100 operations. Hospital policies are not routinely disclosed to the public.
“You do three robotic cases and you’re credentialed,” Redan said, by way of example. “But people spend a year in their fellowships learning how to do conventional surgeries.”
So you pay your bucks and you take your chances.