Book Review: Obesity Surgery: Patient Safety and Best Practices

| October 6, 2009

Dr. Edward Mason reviews a new patient safety text…and offers some additional pearls of wisdom on the topic for Bariatric Times readers.

According to its Preface, this book summarizes the thoughts of our countries’ leaders and was created to stimulate ideas for dealing with the national epidemic of obesity. Distributed by Cine-Med, Inc., this book updates us on the work of the Betsy Lehman Center, and is focused on patient safety and medical errors, drawing on meetings in 2005, 2007, and 2008, in conjunction with Harvard Medical School. The book title, repeated in small print on every page, is Obesity Surgery: Patient Safety and Best Practices. The hope is that the patient safety education that this book provides could help in reducing the cost of medical care—since obesity, with all of its complications, is a major cause of
that expense.

The book is beautifully bound with 12 folios stitched securely in place. It falls open to any page without any breaking in and should last for a century. It is heavy and is best read at a standup desk, but it begs reading. There is a chapter by Bariatric Times’ Colleen Hutchinson on medical journalism that reviews the extent and effects of available patient self education through the media and how that can affect their care and cure. Obesity surgeons should read the chapter to become aware of what their patients have read and interpreted.

There is a chapter by four medical students, each of whom recounts sharing an experience with a bariatric surgery patient as the patient moves into, through, and beyond his or her surgical treatment in our complex society. There is much more at risk than meets the eyes of the many care providers who enter data, check bar codes, and obtain informed consent. Listening to the patient was the most important lesson learned by these medical students. Patients need a system that provides lifelong continuity of care. An approximation of these students to the continuity of care might result from training the patients to accept increased responsibility as active members of their care team. Continuity of care is especially important during hospitalization. There are decreasing numbers of doctor and patient one-on-one pairs, with teams increasingly providing much of the patient care. The team members and services communicate through the medical record, which is, or soon will be, computerized. Continuity of care was not mentioned by the students, but it is a critical aspect of best practices in patient safety.

Some of the chapters are devoted to the need for third parties to recognize that money can be saved by the decreased cost of care following use of surgical procedures. What they do not address is the huge and rapid increase in total cost as we increase use of surgical operations by even a small percent of the total pool of candidates for surgical treatment. It is not financially realistic to treat one-third of the population with major surgical procedures. We do not have enough surgeons or hospital beds. It was agreed on at a Rome Diabetes Surgery Summit in March of 1991 that surgical operations should not be used for treatment of type 2 diabetes unless the patient has failed nonoperative treatment.

Many agree that surgical operations have been the only effective treatment. That will probably remain true for the morbidly obese and super-obese. The use of a neutraceutical to stimulate the secretion of GLP-1 may obviate the need for surgical procedures where type 2 diabetes is the major concern. That may not reduce the number of operations for treatment of type 2 diabetes so much as extend care to a few of the millions of candidates who would not otherwise receive care.

Atul Gawande’s article on the cost conundrum in the June 1, 2009 issue of the New Yorker called attention to McAllen, Texas, which has the most expensive healthcare in the country. A McAllen surgeon was quoted as saying, “The way we practice medicine has changed completely. Before it was about how to do a good job. Now it is about ‘How much will you benefit?’” El Paso has a cost one-half that of McAllen. The Mayo Clinic was sighted as a model for efficient and less expensive medical care. This was another rush of thoughts stimulated by reviewing Obesity Surgery: Patient Safety and Best Practices. In the Introduction to this book, Joseph Fischer expresses these same ideas in lauding the practice of medicine at Beth Israel Deaconess Hospital and Harvard Medical School, where the meetings were held that led to the publication of this book. Solutions to the many problems can be found by physicians working together to improve the local system of medical care.

Chapter 74, written by the editors of the book, Stephanie B. Jones and Daniel B. Jones, on implementing solutions concludes, “If you don’t know where you’re going, it is unlikely you’ll get there.” Let’s read this book and provide our resulting thoughts. As a former president of what is now called the American Society for Metabolic and Bariatric Surgery (ASMBS), I was recently asked to join all of the presidents in explaining what makes for leadership. The leadership now should focus on the local patient care system. The best care can be the least expensive. This may all sound overly simple, but 532 pages of viewpoints by 94 authors will convince you of its complexity, and highlight opportunities to become a local leader toward solutions to the problem of having “the most expensive medical care in the world.” President Obama needs your help, and we all need to take advantage of his request for changes that can make urgent improvements and reductions in cost. Healthcare expense may be the greatest threat to survival of our country.

The price of this book is $125.00. You can order your copy today at or by calling
toll-free (800)253-7657.
—Reviewed by
Edward E. Mason, MD, PhD.
Dr. Mason is from The Roy J. and Lucille A. Carver College of Medicine, Department of Surgery, University of Iowa, Department of Surgery, 4125 Westlawn, Iowa City, Iowa.

Category: Book Reviews, Past Articles

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