It’s not that they are greedy or unethical. They have a particular worldview , and often suffer from tunnel vision . All they are taught is how to operate and when you have a hammer in your hands, you see nails all over the places ! Unfortunately, very few surgeons are taught when not to operate !
It's possible to wax eloquent about the importance of medical ethics and why and how doctors need to be professionals , who should not operate when not required. However, we can talk till we are blue in the face , but we know that the reality will not change. Just like financial advisors will push a particular product , because they are paid to do so , doctors also are likely to respond in exactly the same manner! It's unfair to hold them to a superhuman standard , because this is extremely unrealistic and smacks of wishful thinking.
However, there is a solution – we need to develop clever ways in which we could incentivize surgeons not to do surgery ! There was a time in the US not too long ago, when repeat cesarean sections were the norm because obstetricians would get paid much more doing a cesarean section , rather than allowing vaginal birth ( VBACs). It’s only when insurance company started to refuse to pay for repeat cesarean sections that the VBAC rate decreased from virtually zero percent in private hospitals to up to 50 percent - which is what the optimal number should be !
We need an entrepreneur who can come up with a clever solution which will help to ensure that surgeons do not benefit by doing unnecessary surgery. One solution is to slap penalties for doing unnecessary surgery , but this is something which is very hard to implement in real life . Clinical decisions are rarely made by following a cookbook protocol slavishly - we need to come up with more ingenious methods .
One of the best methods would be empowering patients with information , so they can discuss non-surgical treatment options with their surgeon ! We need to align incentives for both patients and surgeons – and find ways to pay surgeons for not operating ! Retired surgeons, who are no longer active in the OR can provide lots of useful insights !