Scalpel's Edge

A surgeon's notes

Valuing medicine and buying the right to complain

I have been considering undergoing laser correction surgery for myopia. This surgery is viewed with suspicion by people around me, because it is “cosmetic” (why would you do something risky, when you can just choose to wear glasses?) and expensive.

zoeglasses.jpg

Prime time advertisements for the procedure raise my suspicions, and I automatically assume it is purely business. But businesses also go broke if the product is faulty. And this business and this product have been around for 20 years. And despite natural schadenfreude, I have not been able to find anyone who has a true horror story. (Of course it could hurt! I mean, really!)

In Australia medicine is not seen as a business. I mean, being a doctor is a profession, but they shouldn’t be able to make a living out of it, should they? Doctors are held up as the stereotype of money-grubbing selfish scrooges, running down their doddering patients in their luxury cars. And then charging them for roadside care. And we are always a target for the info-tainment “current affairs” shows – when they get bored of of dodgy real estate agents, pregnant teenagers and internet scams.

Partly, this attitude is due to the medical system in Australia. In Australia, you don’t have to pay for quality medical care. Free healthcare is provided by the government through medicare. But if you choose to pay for health insurance, you can access prompter service, and select your doctor. Patients think they deserve good healthcare, and they have a right not to have to pay for it.

Our wonderful system fails to remind everyone that healthcare is expensive. Machines, test, staff and time to burn all cost money. I love our free system, but I will no longer stand for people who complain that they can’t find a doctor they are happy who doesn’t charge a co-payment. If you are willing to pay for your dog’s operation, you should be prepared to pay for a doctor you are happy with.

Viva la free healthcare! However, if you want to complain, then open your wallet. And don’t be suspicious of me if I choose to spend thousands of dollars on my healthcare.

14 responses to “Valuing medicine and buying the right to complain”

  1. jeff says:

    who would be suspicious? i think everyone ought to be able to decide what they want to do to their bodies. autonomy – one of tenets of biomedical ethics? no?

    i’m concerned about LASIK. i’ve heard of things like depth perception problems which will be vital for a surgeon like you.

    and for me, i would definitely opt for safer options like PRK or flapless LASIK because i want to go sky-diving and scuba-diving at some stage. and the flap-way of LASIK carries a risk of your cornea bursting at these high pressures. or so i heard.

  2. jeff says:

    may i add that in the military (at least for Singapore), the pilots and special operation force troops go for PRK instead of LASIK. that was 2 years ago. maybe flapless LASIK has taken over.

  3. Cris says:

    @jeff Thanks for your concern, but they have not offered me Lasik. They are recommending PRK for my eyes. I didn’t know the reservations that you have brought up, so thanks for that.

    As to depth perception, I have spoken to quite a few people who have had simialr procedures, even surgeons. Part of the reason I am thinking about this now is that I still am on the upward learning curve with surgery. I would be wary about doing somehting to my eyesight when I am a fellow, but I am more comfortable knowing that I have a few years to learn how to use my new eyes.

  4. dragonfly says:

    I have been thinking about investing in LASIK when I graduate (it would save me money definitely, I have a SCARY prescription, I believe there is an extra Medicare rebate for seeing people with my level of blindedness and I don’t have to pay for contact lens fittings and the rest) but the depth perception thing had me wondering.
    Having it earlier on in ones (possibly surgical) career makes sense though..

  5. jeff says:

    yea thats true i suppose, with the time to get used to the new eyes. benefits outweigh potential disadvantages. imagine waking up, and not having to put on contact lens. i would say, the thousands u spend on the PRK, can be easily recovered by not getting glasses (+optometrist consults) year in year out, in about 5 years or so?

  6. Cris says:

    @jeff: It is definitely a personal decision. And one I am still struggling with. I think the money stacks up over time, and you have to consider the difference in related things like buying loupes, and sunglasses. But any surgery whouldn’t be something you do because it is cheap. It should be something you chose to do despite the financial cost.

  7. Cris says:

    @dragonfly: The earlier you ask someone about it, the more chance you have to think about it. And you have the opportunity to ask all the questions you need to. As a surgeon, I think you have to consider every procedure in terms of what you would do if the worst possible outcome occurred. Then decide based onthe likely outcomes. If the extremely rare outcome would ruin your life, then avoid the procedure.

  8. jeff says:

    yeap. good point there. but im still not entirely convinced about depth perception. does PRK come with the same problems as LASIK? even with the learning curve, is the depth perception variable after the procedure? or does it change once and stays changed at that altered level? if u get what i mean.

    well, good luck there with your decision!

  9. Cris says:

    @jeff: Do you have a reference for this depth perception issue? Certainly nothing mentioned about it in my very extensive interview, and notes, or discussions with the opthalmologists and optometrists. Seems like a strange thing, as I understand depth perception is related to binocular vision. Post laser, binocular vision is maintained. I am not sure how alterations to corneal thickness would alter your depth perception. I would love to see your reference on this.

  10. jeff says:

    im not sure how reliable this site is, but here’s what i found. hope it helps.

    some complications listed, by procedure.

    depth perception addressed. also called LASIK eye strain.

  11. jeff says:

    and if you wanted to be a tough patient, ask 50 tough questions. some are not relevant for australia, and some are just too probing that no one will actually ask.

  12. Cris says:

    @jeff: Great references, and great list of questions. I think that you need to ask those fifty tough questions whether you are a tough patient or not, or expect that the proceduralist answers them for you.

    As to depth perception, the reference you gave was quite interesting. It seems that eye fatigue (due to losing the short vision advantage) is important. In fact, a major risk is progression of myopia due to fatigue. This is also a risk for others who do a lot of close vision work, like computer vision.

  13. dragonfly says:

    I have heard that depth perception thing from a few people…..hope it is just an urban myth.
    Btw, have you ever thought of this route? Might save some money:-)
    http://www.lasikathome.com/
    (Please note that that was a joke).

  14. Cris says:

    @dragonfly: “Lasik@home: pay to carry the risk yourself!”

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