inguinal hernia questions 
Author Message
 inguinal hernia questions

Hi,

I know someone with an inguinal hernia. It is very visible,
but isn't binding yet and hasn't started down into the
{*filter*}. He can't afford surgery, and doesn't have
insurance. He must be active in order to work. He has
heard that a truss is not a good thing, but wouldn't that
be better than nothing? He says it's slowly getting larger,
so wouldn't a truss at least slow growth down significantly
by keeping the weight of the intestine from constanty
pushing and ripping the torn muscle?

If he can figure out how to get surgery somehow, would
the muscle grow back together? If so, why wouldn't it
grow back together by itself if a truss were worn to keep
the intestine from pushing the tear apart? Would it try
to grow back, and then get torn, and then try again, and
get torn again...etc?

What about trying to let a student practice on him? Are
there medical students who would want to do surgery
like that for the practice? If so, how to find out about
that?

Thanks for any help or advice!
K

(PS: I'll ask about that last issue in another post about
the possibility of free or cheap surgery by students, or
something similar. I apologise if anyone is offended
by that somehow.)



Thu, 13 Mar 2008 00:17:00 GMT
 inguinal hernia questions

Quote:

> Hi,

> I know someone with an inguinal hernia. It is very visible,
> but isn't binding yet and hasn't started down into the
> {*filter*}. He can't afford surgery, and doesn't have
> insurance. He must be active in order to work. He has
> heard that a truss is not a good thing, but wouldn't that
> be better than nothing? He says it's slowly getting larger,
> so wouldn't a truss at least slow growth down significantly
> by keeping the weight of the intestine from constanty
> pushing and ripping the torn muscle?

> If he can figure out how to get surgery somehow, would
> the muscle grow back together? If so, why wouldn't it
> grow back together by itself if a truss were worn to keep
> the intestine from pushing the tear apart? Would it try
> to grow back, and then get torn, and then try again, and
> get torn again...etc?

> What about trying to let a student practice on him? Are
> there medical students who would want to do surgery
> like that for the practice? If so, how to find out about
> that?

> Thanks for any help or advice!
> K

> (PS: I'll ask about that last issue in another post about
> the possibility of free or cheap surgery by students, or
> something similar. I apologise if anyone is offended
> by that somehow.)

Medical students can't do surgery.

A truss won't hurt him, and if it decreases the discomfort, he should get
one. No, the hernia won't go away without surgery.

HMc



Thu, 13 Mar 2008 01:39:02 GMT
 inguinal hernia questions

Quote:

>I know someone with an inguinal hernia. It is very visible,
>but isn't binding yet and hasn't started down into the
>{*filter*}. He can't afford surgery, and doesn't have
>insurance. He must be active in order to work. He has
>heard that a truss is not a good thing, but wouldn't that
>be better than nothing? He says it's slowly getting larger,
>so wouldn't a truss at least slow growth down significantly
>by keeping the weight of the intestine from constanty
>pushing and ripping the torn muscle?

>If he can figure out how to get surgery somehow, would
>the muscle grow back together? If so, why wouldn't it
>grow back together by itself if a truss were worn to keep
>the intestine from pushing the tear apart? Would it try
>to grow back, and then get torn, and then try again, and
>get torn again...etc?

>What about trying to let a student practice on him? Are
>there medical students who would want to do surgery
>like that for the practice? If so, how to find out about
>that?

>Thanks for any help or advice!

Some admonitions for the fellow that should do no
harm:

(1) Lose weight.  Any reduction in abdominal visceral
fat (central adiposity) will help to slow further progress
of an inguinal hernia, direct or indirect.  

(2) Exercise.  Building up the abdominal muscles can
be effective both in slowing further progress of the
hernia *and* will increase the strength and viability of
the fascia and muscle with which the operating surgeon
will have to work.  "Piss-poor protoplasm" makes for
bad surgical results.  

(3) Increase dietary vegetable fiber intake and, if
necessary, make use of stool softeners (surfactant
"wetting" agents like sodium docusate) to increase
the bulk and frequency of bowel movements while
reducing stool obduracy.  If the individual strains at
stool, he will increase intraabdominal pressure and
that tends to speed the progress of herniation.  

(4) If he smokes, get him to quit smoking.  This not
only will improve overall health, but it will also improve
wound healing postoperatively and reduce chances
of intra-operative respiratory and cardiac complica-
tions.  

A truss is of little or no value, and I do not recommend
it.  If your friend is willing to do a decent job of "prepping"
himself for surgery, I suspect that any teaching hospital's
general surgery service would be happy to take him on
through the outpatient clinic.  Surgical residents (not
students!) generally welcome uncomplicated inguinal
hernia cases in order to fulfill their requirements for
board eligibility.  Just make sure that the chief resident
is one of the guys scrubbing in on the case, and that
you get it done within the first six months of the calendar
year.

The new guys come on the service in July, and you
*really* don't want to come in for elective surgery
in the summer months.  

------------------------
Health care is too expensive, so the Clinton administration
is putting a high-powered corporate lawyer in charge of making
it cheaper. (This is what I always do when I want to spend less
money - hire a lawyer from Yale.) If you think health care is
expensive now, wait until you see what it costs when it's free.

          -- P.J. O'Rourke, "The Liberty Manifesto" (1993)
          ( http://www.***.com/ )



Thu, 13 Mar 2008 02:36:55 GMT
 inguinal hernia questions


Quote:

> A truss is of little or no value, and I do not recommend
> it.  If your friend is willing to do a decent job of "prepping"
> himself for surgery, I suspect that any teaching hospital's
> general surgery service would be happy to take him on
> through the outpatient clinic.  Surgical residents (not
> students!) generally welcome uncomplicated inguinal
> hernia cases in order to fulfill their requirements for
> board eligibility.  Just make sure that the chief resident
> is one of the guys scrubbing in on the case, and that
> you get it done within the first six months of the calendar
> year.

This patient will still need to be admitted, his care supervised by an
attending physician. It won't be free, or even cheaper. Certainly not in the
sense that you can get a cheap haircut at a barber college.

HMc



Thu, 13 Mar 2008 03:04:03 GMT
 inguinal hernia questions

Quote:




> > A truss is of little or no value, and I do not recommend
> > it.  If your friend is willing to do a decent job of "prepping"
> > himself for surgery, I suspect that any teaching hospital's
> > general surgery service would be happy to take him on
> > through the outpatient clinic.  Surgical residents (not
> > students!) generally welcome uncomplicated inguinal
> > hernia cases in order to fulfill their requirements for
> > board eligibility.  Just make sure that the chief resident
> > is one of the guys scrubbing in on the case, and that
> > you get it done within the first six months of the calendar
> > year.

> This patient will still need to be admitted, his care supervised by an
> attending physician. It won't be free, or even cheaper. Certainly not in the
> sense that you can get a cheap haircut at a barber college.

> HMc

He could stop driving for a month. That should do it nicely.

{Today: $1.08 a litre, down from $1.18 last week. Good thing I don't
live in the Maritimes; $2-$3 a litre}

Zee



Thu, 13 Mar 2008 03:14:27 GMT
 inguinal hernia questions

Quote:
>This patient will still need to be admitted, his care supervised by
>an attending physician. It won't be free, or even cheaper. Certainly
>not in the sense that you can get a cheap haircut at a barber college.

Where the hell have you been for the past dozen years and more?
An uncomplicated inguinal herniorrhaphy is performed on an out-
patient basis rather more often than not nowadays.  The cutters
practically slap the patient awake in the recovery room and make
him jog down the corridor to get dressed.  

You're right that having the surgery performed while on a teaching
service won't be free, but what makes you think that it will be less
expensive if it's performed by a surgeon in private practice in the
same city or surroundings?  

One measure I might recommend is considering outpatient inguinal
herniorrhaphy at a small community hospital fifty or a hundred miles
from big-city "centers of excellence" (and foci of high costs).  Sur-
geons on staff at such smaller hospitals are certainly well-practiced
in the performance of such routine surgical procedures, and can
undertake them with statistical outcomes not significantly different
from results gained in metropolitan facilities.  One might find some
surprising price advantages.  

And about twelve dollars invested in an electric hair clipper kit at
Wal-Mart is even cheaper (and much more convenient) than going
to the local barber college.  I gave up wearing my hair more than
about one-quarter of an inch long when I was faced with the choice
between wearing a surgical cap and one of those {*filter*}y ridiculous
shower cap monstrosities, and now my granddaughters wrangle over
whose turn it is to give Poppi his haircut every couple of weeks.  

--------------------
"You fool! You fell victim to one of the classic blunders!
The most famous is 'Never get involved in a land war in Asia,'
but only slightly less well-known is this: 'Never go in against
a Sicilian when death is on the line!'"

            -- Vizzini (character)
               *The Princess Bride* (William Goldman, 1973)



Thu, 13 Mar 2008 04:37:18 GMT
 inguinal hernia questions


Quote:

>>This patient will still need to be admitted, his care supervised by
>>an attending physician. It won't be free, or even cheaper. Certainly
>>not in the sense that you can get a cheap haircut at a barber college.

> Where the hell have you been for the past dozen years and more?
> An uncomplicated inguinal herniorrhaphy is performed on an out-
> patient basis rather more often than not nowadays.  The cutters
> practically slap the patient awake in the recovery room and make
> him jog down the corridor to get dressed.

better than that!!!   hubby had one this spring...in the doctor's office
(surgery "suite")...he was NOT asleep..tho anesth was there...he was WALKED
to and from the table.."recovered" in a leather lounge chair ...in and out
in less than an hour!!!

hospital was a block away...if "probs" arose...

we were both impressed...recovery is always shorter without general
anesthesia!!!

and no...not a surgical resident!!

Quote:

> You're right that having the surgery performed while on a teaching
> service won't be free, but what makes you think that it will be less
> expensive if it's performed by a surgeon in private practice in the
> same city or surroundings?

> One measure I might recommend is considering outpatient inguinal
> herniorrhaphy at a small community hospital fifty or a hundred miles
> from big-city "centers of excellence" (and foci of high costs).  Sur-
> geons on staff at such smaller hospitals are certainly well-practiced
> in the performance of such routine surgical procedures, and can
> undertake them with statistical outcomes not significantly different
> from results gained in metropolitan facilities.  One might find some
> surprising price advantages.

> And about twelve dollars invested in an electric hair clipper kit at
> Wal-Mart is even cheaper (and much more convenient) than going
> to the local barber college.  I gave up wearing my hair more than
> about one-quarter of an inch long when I was faced with the choice
> between wearing a surgical cap and one of those {*filter*}y ridiculous
> shower cap monstrosities, and now my granddaughters wrangle over
> whose turn it is to give Poppi his haircut every couple of weeks.

> --------------------
> "You fool! You fell victim to one of the classic blunders!
> The most famous is 'Never get involved in a land war in Asia,'
> but only slightly less well-known is this: 'Never go in against
> a Sicilian when death is on the line!'"

>            -- Vizzini (character)
>               *The Princess Bride* (William Goldman, 1973)



Thu, 13 Mar 2008 05:07:00 GMT
 inguinal hernia questions


Quote:

>>This patient will still need to be admitted, his care supervised by
>>an attending physician. It won't be free, or even cheaper. Certainly
>>not in the sense that you can get a cheap haircut at a barber college.

> Where the hell have you been for the past dozen years and more?
> An uncomplicated inguinal herniorrhaphy is performed on an out-
> patient basis rather more often than not nowadays.  The cutters
> practically slap the patient awake in the recovery room and make
> him jog down the corridor to get dressed.

Where have YOU been? Patients don't just walk into the surgery area, take a
number, and wait to have their hernia fixed. But by all means, I'd be very
interested to have you explain to me all the ins and outs of how surgery is
performed for inguinal hernia - or anything else where you believe your
experience exceeds mine.

Quote:
> You're right that having the surgery performed while on a teaching
> service won't be free, but what makes you think that it will be less
> expensive if it's performed by a surgeon in private practice in the
> same city or surroundings?

I didn't say that. Did I?

HMc



Fri, 14 Mar 2008 04:08:10 GMT
 inguinal hernia questions

Quote:
>>>This patient will still need to be admitted, his care supervised by
>>>an attending physician. It won't be free, or even cheaper. Certainly
>>>not in the sense that you can get a cheap haircut at a barber college.

...to which SJ Doc responded:

Quote:
>> Where the hell have you been for the past dozen years and more?
>> An uncomplicated inguinal herniorrhaphy is performed on an out-
>> patient basis rather more often than not nowadays.  The cutters
>> practically slap the patient awake in the recovery room and make
>> him jog down the corridor to get dressed.

>Where have YOU been? Patients don't just walk into the surgery area, take a
>number, and wait to have their hernia fixed. But by all means, I'd be very
>interested to have you explain to me all the ins and outs of how surgery is
>performed for inguinal hernia - or anything else where you believe your
>experience exceeds mine.

I haven't had all that much trouble getting patients referred to
general surgeons who will evaluate an uncomplicated individual
in the office or the clinic, "buff" him preoperatively, and get him
scheduled for an outpatient inguinal herniorrhapy.  What's so
damned complicated about the process?  And what's *your*
experience in the medical and/or surgical management of such
patients?  Do you prefer the Halstead technique or the Bassini?
And what's your opinion of endoscopic extraperitoneal hernia
repair (see http://www.sma.org.sg/smj/4506/4506a1.pdf)
procedures?  

Quote:
>> You're right that having the surgery performed while on a teaching
>> service won't be free, but what makes you think that it will be less
>> expensive if it's performed by a surgeon in private practice in the
>> same city or surroundings?
>I didn't say that. Did I?

And what has that to do with the price of pearls in Perth Amboy?  
What you had said was: "This patient will still need to be admitted,
his care supervised by an attending physician. It won't be free, or
even cheaper."  That was the comment to which I responded.

As a rule, a patient seeking care through the outpatient clinic of a
surgical training program tends to pay less for his/her care than one
who consults a surgeon in private practice in the same health care
market.  Your particular bucketful of bilge about how "It won't be
free, or even cheaper" was sloshed all over that fact.  

Do you believe that valuable goods and services should be devoted
to the benefit of a patient with no expectation of payment whatso-
ever?  Or that a patient is not free to determine for him/herself
whether or not he/she will seek care of possibly lesser quality (on
a teaching service) in exchange for a lesser price?

Hm.  What *do* you say?  Thus far, not much worth listening to.

----------------------
...[E]very individual necessarily labours to render the annual
revenue of the society as great as he can. He generally, indeed,
neither intends to promote the public interest, nor knows how
much he is promoting it. By preferring the support of domestic
to that of foreign industry, he intends only his own security; and
by directing that industry in such a manner as its produce may be
of the greatest value, he intends only his own gain, and he is in
this, as in many other cases, led by an invisible hand to promote
an end which was no part of his intention. Nor is it always the
worse for the society that it was no part of it. By pursuing his
own interest he frequently promotes that of the society more
effectually than when he really intends to promote it. I have
never known much good done by those who affected to trade
for the public good.

          -- Adam Smith, *The Wealth of Nations* (1776)



Fri, 14 Mar 2008 05:31:53 GMT
 inguinal hernia questions


Quote:

>>>>This patient will still need to be admitted, his care supervised by
>>>>an attending physician. It won't be free, or even cheaper. Certainly
>>>>not in the sense that you can get a cheap haircut at a barber college.

> ...to which SJ Doc responded:
>>> Where the hell have you been for the past dozen years and more?
>>> An uncomplicated inguinal herniorrhaphy is performed on an out-
>>> patient basis rather more often than not nowadays.  The cutters
>>> practically slap the patient awake in the recovery room and make
>>> him jog down the corridor to get dressed.


>>Where have YOU been? Patients don't just walk into the surgery area, take
>>a
>>number, and wait to have their hernia fixed. But by all means, I'd be very
>>interested to have you explain to me all the ins and outs of how surgery
>>is
>>performed for inguinal hernia - or anything else where you believe your
>>experience exceeds mine.

> I haven't had all that much trouble getting patients referred to
> general surgeons who will evaluate an uncomplicated individual
> in the office or the clinic, "buff" him preoperatively, and get him
> scheduled for an outpatient inguinal herniorrhapy.  What's so
> damned complicated about the process?  And what's *your*
> experience in the medical and/or surgical management of such
> patients?  Do you prefer the Halstead technique or the Bassini?
> And what's your opinion of endoscopic extraperitoneal hernia
> repair (see http://www.sma.org.sg/smj/4506/4506a1.pdf)
> procedures?

>>> You're right that having the surgery performed while on a teaching
>>> service won't be free, but what makes you think that it will be less
>>> expensive if it's performed by a surgeon in private practice in the
>>> same city or surroundings?

>>I didn't say that. Did I?

> And what has that to do with the price of pearls in Perth Amboy?
> What you had said was: "This patient will still need to be admitted,
> his care supervised by an attending physician. It won't be free, or
> even cheaper."  That was the comment to which I responded.

> As a rule, a patient seeking care through the outpatient clinic of a
> surgical training program tends to pay less for his/her care than one
> who consults a surgeon in private practice in the same health care
> market.  Your particular bucketful of bilge about how "It won't be
> free, or even cheaper" was sloshed all over that fact.

> Do you believe that valuable goods and services should be devoted
> to the benefit of a patient with no expectation of payment whatso-
> ever?  Or that a patient is not free to determine for him/herself
> whether or not he/she will seek care of possibly lesser quality (on
> a teaching service) in exchange for a lesser price?

> Hm.  What *do* you say?  Thus far, not much worth listening to.

Your ignorance is disappointing.

Nobody does Halsted or Bassini hernia repairs anymore. Endoscopic repairs
are done mainly for recurrent or bilateral hernias but are not cost
effective for a simple inguinal hernia, do require general anesthesia, and
are substantially more expensive because of those increased hospital costs.

Surgery residents can't practice surgery on their own. In clinic, the
medical student sees the patient, he is evaluated by the resident, may be
run by the chief resident, and arrangements for surgery made after assigning
the patient to the attending, who may or may not see the patient. The
attending will participate in the operation to some extent, although may not
scrub. He will charge the usual fees and bill the patient and/or insurance
company. The surgeons fees will be the same as anywhere else, the hospital's
costs are the same as anywhere else and the charges will be comparable. It's
not a complicated process.

It's entirely outpatient. Some surgeons have the facilities for doing these
in the office or some other type of pure outpatient facility, and in that
case the facility charges *may* be less, but the surgeon's fee is the same.

Clearly, you're just spitballing what you *think* is the mechanism for the
process of inguinal hernia repair, but just as clearly you don't have any
real experience with it.

HMc



Fri, 14 Mar 2008 19:57:02 GMT
 inguinal hernia questions

Quote:
>Surgery residents can't practice surgery on their own. In clinic, the
>medical student sees the patient, he is evaluated by the resident, may be
>run by the chief resident, and arrangements for surgery made after assigning
>the patient to the attending, who may or may not see the patient. The
>attending will participate in the operation to some extent, although may not
>scrub.

    Is the attending the person who takes charge of the operation?

Quote:
>He will charge the usual fees and bill the patient and/or insurance
>company. The surgeons fees will be the same as anywhere else, the hospital's
>costs are the same as anywhere else

    So regardless of whether a student actually does the job, or
the I'm supposing much more experienced attending (attendant?
attender?) does the job, the cost is the same?

Quote:
>and the charges will be comparable. It's
>not a complicated process.

>It's entirely outpatient. Some surgeons have the facilities for doing these
>in the office or some other type of pure outpatient facility, and in that
>case the facility charges *may* be less, but the surgeon's fee is the same.

    Even if he doesn't do the surgery. From my ingnorant position,
it still seems that may not always be the case, but my entire education
about it so far is from you people having this discussion.


Sat, 15 Mar 2008 08:42:51 GMT
 inguinal hernia questions

Quote:

>Do you believe that valuable goods and services should be devoted
>to the benefit of a patient with no expectation of payment whatso-
>ever?  

    I'll bet that idea never lasts very long :-)

Quote:
>Or that a patient is not free to determine for him/herself
>whether or not he/she will seek care of possibly lesser quality (on
>a teaching service) in exchange for a lesser price?

    From a poor boy who can't afford surgery's pov, it seems like
some sort of exchange that could benefit the student and the
poor boy could be worked out. But. If it has already been worked
out that students get to practice, while experienced surgeons
direct the procedure and get paid just the same even if they
don't do the operation, then that ends any possibility of a mutually
beneficial exchange I guess. Oh well.


Sat, 15 Mar 2008 08:43:21 GMT
 inguinal hernia questions

Quote:


>>I know someone with an inguinal hernia. It is very visible,
>>but isn't binding yet and hasn't started down into the
>>{*filter*}. He can't afford surgery, and doesn't have
>>insurance. He must be active in order to work. He has
>>heard that a truss is not a good thing, but wouldn't that
>>be better than nothing? He says it's slowly getting larger,
>>so wouldn't a truss at least slow growth down significantly
>>by keeping the weight of the intestine from constanty
>>pushing and ripping the torn muscle?

>>If he can figure out how to get surgery somehow, would
>>the muscle grow back together? If so, why wouldn't it
>>grow back together by itself if a truss were worn to keep
>>the intestine from pushing the tear apart? Would it try
>>to grow back, and then get torn, and then try again, and
>>get torn again...etc?

>>What about trying to let a student practice on him? Are
>>there medical students who would want to do surgery
>>like that for the practice? If so, how to find out about
>>that?

>>Thanks for any help or advice!

>Some admonitions for the fellow that should do no
>harm:

>(1) Lose weight.  Any reduction in abdominal visceral
>fat (central adiposity) will help to slow further progress
>of an inguinal hernia, direct or indirect.  

He's about 5'6" and weighs about 130 lbs.

Quote:
>(2) Exercise.  Building up the abdominal muscles can
>be effective both in slowing further progress of the
>hernia *and* will increase the strength and viability of
>the fascia and muscle with which the operating surgeon
>will have to work.  "Piss-poor protoplasm" makes for
>bad surgical results.  

He likes to kayak and ride his bicycle. He was/is
afraid one or the other might cause more tearing. Are
they both a good idea? How about sit-ups? It seems
that some things must make it worse, even if others
could make it better.

Quote:
>(3) Increase dietary vegetable fiber intake and, if
>necessary, make use of stool softeners (surfactant
>"wetting" agents like sodium docusate) to increase
>the bulk and frequency of bowel movements while
>reducing stool obduracy.  If the individual strains at
>stool, he will increase intraabdominal pressure and
>that tends to speed the progress of herniation.  

He was aware of that one already.

Quote:
>(4) If he smokes, get him to quit smoking.  This not
>only will improve overall health, but it will also improve
>wound healing postoperatively and reduce chances
>of intra-operative respiratory and cardiac complica-
>tions.  

And that.

Quote:
>A truss is of little or no value, and I do not recommend
>it.  

So far it seems a lot better than nothing, because it
seems that it could reduce the tearing caused by the
weight of the intestine. Please explain why it's better
not to get one.

Quote:
>If your friend is willing to do a decent job of "prepping"
>himself for surgery, I suspect that any teaching hospital's
>general surgery service would be happy to take him on
>through the outpatient clinic.  Surgical residents (not
>students!) generally welcome uncomplicated inguinal
>hernia cases in order to fulfill their requirements for
>board eligibility.  Just make sure that the chief resident
>is one of the guys scrubbing in on the case, and that
>you get it done within the first six months of the calendar
>year.

>The new guys come on the service in July, and you
>*really* don't want to come in for elective surgery
>in the summer months.  

 I'm trying to understand. How to learn more about
elective surgery, or whatever if there is such an
option?

- Show quoted text -

Quote:
>------------------------
>Health care is too expensive, so the Clinton administration
>is putting a high-powered corporate lawyer in charge of making
>it cheaper. (This is what I always do when I want to spend less
>money - hire a lawyer from Yale.) If you think health care is
>expensive now, wait until you see what it costs when it's free.

>          -- P.J. O'Rourke, "The Liberty Manifesto" (1993)
>          ( http://www.***.com/ )



Sat, 15 Mar 2008 08:44:37 GMT
 inguinal hernia questions

Quote:
>A truss won't hurt him,

Some people say not to use one. Why? I've seen
something about causing scar tissue online somewhere,
but didn't see why or where it would cause it, or how.

Quote:
>and if it decreases the discomfort, he should get
>one.

So far there isn't much discomfort, but it seems that
keeping the intestine in where it belongs would
decrease the tearing and growth by a very significant
amount. It seems that would be the most significant
consideration, so why do people feel that it should
not be done at all?
Quote:
>No, the hernia won't go away without surgery.

>HMc



Sat, 15 Mar 2008 08:46:27 GMT
 inguinal hernia questions

Quote:


>>Do you believe that valuable goods and services should be devoted
>>to the benefit of a patient with no expectation of payment whatso-
>>ever?

>    I'll bet that idea never lasts very long :-)

>>Or that a patient is not free to determine for him/herself
>>whether or not he/she will seek care of possibly lesser quality (on
>>a teaching service) in exchange for a lesser price?

>    From a poor boy who can't afford surgery's pov, it seems like
> some sort of exchange that could benefit the student and the
> poor boy could be worked out. But. If it has already been worked
> out that students get to practice, while experienced surgeons
> direct the procedure and get paid just the same even if they
> don't do the operation, then that ends any possibility of a mutually
> beneficial exchange I guess. Oh well.

The exchange you're talking about is lower cost for a lesser quality of
surgery. Really now...think about that. Does that sound realistic in this
day when doctors around the world are criticized regularly for "medical
mistakes", and phone books and newspapers are crowded by ads for malpractice
lawyers? Medical students don't have malpractice insurance. Neither do
residents unless they are supervised by a qualified surgeon so designated.
That supervising surgeon is there to make sure that the quality of every
single operation done under their name is as good as it can be - he/she
stakes his/her reputation and the reputation of the institution where they
work on every single operation. You're talking about multiple standards of
care - better care if you can afford it, second-rate if you're poor. However
it works out in practice, opposition to that concept is a rallying cry (more
of a shriek, really) for watchdog groups all across the USA.

As to who is doing the operation -- we're not talking about heavy lifting
here....the attending surgeon gets paid by the patient to MAKE SURE that
their operation is done according to prevailing standards of care, for
taking that responsibility, and for imparting his/her experience and
knowledge to the extent necessary. Not for doing the physical work, which is
trivial in an energy-expenditure sense. I can assure you it is far more
stressful to teach someone to do an operation than it is to do one.

As to other questions you pose -- your friend's hernia will never get
smaller, only bigger. Strengthening the abdominl muscles won't help and are
far more likely to increase the size of the hernia, anything that increases
intraabdominal pressure such as straining will do so. Trusses -- they don't
cause scarring and do not make the operation more difficult in any way. They
don't fix the hernia, but do have the potential (in some cases) to decrease
the discomfort. If your friend isn't having pain, there's no point to
wearing a truss.

There are two problems with an inguinal hernia -- 1) causing the patient
discomfort  2) the possibility that the loop of intestine could become
trapped and {*filter*}d in the hernia sac (strangulated hernia). The
likelihood of such a strangulation is relatively low (although if it does
occur, it's a true emergency). If those two issues don't apply to your
friend, then the repair can certainly wait until he gets health insurance,
saves enough money, or can apply for some kind of medicaid-based program. In
the VA system of the US where health care is rationed, it would not
necessarily be uncommon for a patient to wait months or even years to get
his hernia operation. This is likewise true in at least a few industrialized
nations that have a nationalized health care program.

HMc



Sat, 15 Mar 2008 10:38:03 GMT
 
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