When faced with a surgical decision, who better to be than a physician? You would be among the best informed consumers. You would be well aware of the risks, benefits, and alternatives to the proposed procedure. And, according to the results of a new study, you would be less likely to have surgery at all.

Researchers compared surgical rates for physicians, lawyers, and their families to the general public in a large population in Switzerland. They looked at rates for the surgical removal of tonsils, gallbladder, uterus, hemorrhoids, appendix as well as repair of hernias and D&C (dilatation and curettage of the uterus).

For all of the operations except appendectomy, the general public went under the knife much more frequently than physicians or their families. For example, if you don’t have a physician in the family you are 50% more likely to have had a tonsillectomy, hysterectomy, or hernia repair and 80% more likely to undergo removal of hemorrhoids or gall bladder. If you want to avoid surgery, it also helps to have a lawyer in the family. Their surgical rates were almost identical to physicians!

These differences don’t seem to be due to financial barriers since all patients were covered by the public insurance programs and even the poorest had access to needed surgical services. Nor does it appear to be differences in how sick the general public was compared to physicians and lawyers. While some disease rates do vary by level of income and occupation, there is little evidence of variation in the specific types of disease for which these surgical procedures are indicated.

It appears that the more informed you are, the less likely you are to ask for or agree to elective surgery. Lawyers seem to have a special immunity to surgery. Lawyers may be more likely to challenge the surgeon’s authority and have greater potential for causing legal problems. Physicians may tend to be more cautious and prudent about recommending elective surgery to these “risky” patients.

We don’t know for sure the optimal rate of these surgical procedures that yields the best overall outcomes for patients. Nor do we know whether the reversal of financial incentives from fee-for-service to prepaid, managed care will lead us closer to optimal surgical rates. Nevertheless, we suspect that more operations are performed than are needed and that we would all do well to more closely follow the example of the most informed consumer, the physician-patient.

For More Information:


Sobel D, Ornstein R: Preparing for Surgery, Mind/Body Health Newsletter, Volume V, Number 2, 1996.

Domenighetti G, et al: Revisiting the most informed consumer of surgical services: The physician-patient. International Journal of Technology Assessment in Health Care 1993;9(4):505-513.

Domenighetti G, Casabianca A: Rate of hysterectomy is lower among female doctors and lawyers’ wives. British Medical Journal 1997 May 10;314(7091):1417.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

Snoring can be merely a nuisance or can be a signal of a serious health problem, sleep apnea, which might even require surgery. Sleep apnea is a condition where breathing is stopped for a time period of at least 10 seconds, but usually 20 to 30 seconds or even up to 1 or 2 minutes during sleep. It is more common in men than in women and typically affects men who are middle-aged and older. It can result from:

• An obstructed airway. This is more common as people age, especially those who are obese or who have smoked for many years.
  
• A central nervous system disorder such as a stroke, a brain tumor or even a viral brain infection.
  
• A chronic respiratory disease.
  

• Sleep on your side. Prop an extra pillow behind your back so you won’t roll over. Try sleeping on a narrow sofa for a few nights to get accustomed to staying on your side.
  
• Sew a large marble or tennis ball into a pocket on the back of your pajamas. The discomfort it causes will remind you to sleep on your side.
  
• If you must sleep on your back, raise the head of the bed by putting bricks or blocks between the mattress and box springs. Or buy a wedge especially made to be placed between the mattress and box spring to elevate the head section. Elevating the head prevents the tongue from falling against the back of the throat.
  
• If you are heavy, lose weight. Excess fatty tissue in the throat can cause snoring.
  
• Don’t drink alcohol or eat a heavy meal within 3 hours before bedtime. For some reason, both seem to foster snoring.
  
• If necessary, take an antihistamine or decongestant before retiring to relieve nasal congestion (which can also contribute to snoring). [Note: Older men should check with their doctor before taking decongestants. Decongestants that have ephendrine can give older men urinary problems.]
  
• Get rid of allergens in the bedroom such as dust, down filled (feathered) pillows and bed linen (this may also relieve nasal congestion).
  
• Try over-the-counter “nasal strips”. These keep the nostrils open and lift them up, keeping nasal passages unobstructed.
  

Questions to Ask

Do you notice the following signs of sleep apnea during your working hours: Sleepiness or chronic daytime drowsiness Poor memory Lack of concentration Irritability Falling asleep while driving or working Loss of sex drive Headaches
Has someone else noticed that breathing has stopped for 10 seconds or longer (sleep apnea) in the midst of snoring?
Has snoring persisted despite using the self-care tips below?