Despite rare exceptions, I think most people believe surgeons are ethical and recommend only those procedures they deem truly necessary.
Diagnostics, drugs and other areas of medical practice, I'm afraid, may be another story. In the mistrustful environment that pervades medicine and most other areas of society, that question's evil cousins are not far behind: Is this really procedure necessary? Do I really need this diagnostic test? Or is this surgeon recommending it because he's got a hammer, and he gets paid for hitting nails?
A study released last month by the Center for Studying Health System Change showed that physicians' income from the practice of medicine declined about 7 percent between 1995 and 2003 after adjusting for inflation. (In contrast, by the way, to other professionals' income, which rose by 7 percent in the same period.)
In response to that loss of income, "The volume of physician services increased substantially between 1999 and 2003, largely because of growth in the number of tests and procedures," the authors report. Among Medicare beneficiaries, minor procedures grew 6 percent a year on average in the study period, while office visits grew 4 percent and major procedures 3 percent.
At one point, the most obvious theme for this Refractive Surgery issue seemed to be incremental improvement. All of our features, beginning with Chris Kent's excellent cover story on tips for making your LASIK better, seem to deal with innovations and ideas that have emerged from "field testing" of approved technologies by practicing refractive surgeons. That's still a viable theme.
But I think "Is This Test Really Necessary?" is a better one. And I hope that just about everything we offer in this section will enable you to answer that question when it comes up with your refractive surgery patients.
