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Follow-up - Ärzteforum

Post#1 »

A simple question for a difficult answer:
What do you think is suppossed to be an accurate follow.up for the following
Inguinal hernia
incisional hernia
gastric cancer
lap cholecystectomy
classic cholecystectomy
and, BTW., how much does cost to pay (the patient or any institution for
each one of these op)

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Doctor Green

Re: Follow-up - Ärzteforum

Post#2 »

As a general rule ROUTINE FOLLOW-UP for most surgical conditions is of
academic interest only.

> Inguinal hernia:

academically (as part of a study)- for ever. Practically useless- the
patient will come when symptomatic.

> incisional hernia

same as above

> gastric cancer

same as above. academically -until death; practically follow up is useless
and futile as any recurrence means death. Remember- early diagnosis of
recurrent cancer is not associated with improved survival!

> lap cholecystectomy

Why do you want to follow up those? why not "follow up" the entire
population instead?

> classic cholecystectomy

As above

> and, BTW., how much does cost to pay (the patient or any institution for
> each one of these op)

Yes, I know that "follow up" is a good way to increase the income of
doctors and institutions but the costs to the national budget are huge.

You shoudl have asked about conditions in which follow-up may (perhaps) be
beneficial- i.e. ca colon and breat.


Re: Follow-up - Ärzteforum

Post#3 »

you are probably right but maybe not politically correct.
In my province, which is totally socialized with NO private
insurance(legislated), one (1) post op visit is included in the procedural
fee, (as well as 2 weeks postop care). The only benefit from post op visits
is the (unlikely) event of a wound infection or a postop ventral hernia.
The patient is grateful for a concerned caring clinician to expedite
management of a wound infection, and less likely to cast blame on to a
surgeon who "didn't seem to want to see me afterwards". (Damage control).
Also in the unlikely event of a wound hernia, or a recurrent hernia, the pt
is more likely to return to YOU rather than the competition down the street
or the tertiary centre that will be only to happy to indirectly cast shite
upon thee........Strictly P.R. but not a bad investment.

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Re: Follow-up - Ärzteforum

Post#4 »

Followup of routine operative procedures is covered globally, by the initial
operative fees, for at least 2 postoperative visits. There is little need to
see these patients thereafter, unless complications develop. Patients with
cancers treated operatively need some followups at regular intervals for a


Re: Follow-up - Ärzteforum

Post#5 »

As far as cholecystectomy is concerned I take minor issue with
you. No follow up is absolutely required if the patient definitely had
biliary disease, but we know that a substantial number of patients have
the "post cholecystectomy syndrome", which is a polite way of saying
that their symptoms were never biliary. Unless we follow them at least
once, we will never improve our diagnostic skill. In other words follow
up is for the benefit of the Surgeon and not the patient. I am also
worried that if I miss a port site hernia or other significant
complication, I am more likely to be sued than if I had followed them
once to be sure.
My conclusion is that every patient who has had an operative
procedure should be followed once at least - not necessarily in person,
but perhaps by phone or questionnaire. I believe it may reduce
litigation, educate me, and above all I think it polite to the patient.


Re: Follow-up - Ärzteforum

Post#6 »

One post op visit doesn't seem extravagant. As a nurse, I am
forever explaining to patients why the surgeon who operated on them never
saw them again afterwards...and they were visited by someone they had
never seen before. Operation on Friday, rounds on the weekend by the
partner....Monday starts the surgeon's few days off....and by the time he
returns the patient has been discharged. Happens all the time.
Patients aren't usually aware of how the partners cover each other.

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Re: Follow-up - Ärzteforum

Post#7 »

I am sure all of us would agree that the Surgeon who has
operated on the patient MUST see the patient postoperatively at least
I think the question of follow up really relates to what happens
on going home - i.e. medium term follow up. We are now ? all agreed that
most patients do not need follow up, but desire it, and we surgeons need
it for our education.
Surgeons are busy, and seeing ten to twenty patients per week
for follow up is a hassle. Some do it, and some don't. There is a
solution. Have a Nurse do it. Not any old Nurse, but a Surgical
Assistant who has been with the patient from the first. i.e. she has
seen the patient before admission (and done all those bits of paper
which nurses have to fill in for the most fit of patients), greeted them
when they are admitted, been to the operating room as scrub nurse for
them, been on the postop rounds with you, listened to their grumbles,
and now either phones the patient a week or two later or arranges to see
them for follow up.
In the U.K. we have been beset by the concept of the "Named
Nurse" who is the nurse deemed to be in charge of an individual patient
throughout their stay on the ward. In practice it often happens that
they only see the patient once!, and certainly they have no role in OR
or as an out patient.
The concept of the Surgical Assistant is just appearing here. It
makes the idea of the "named nurse" a reality, gives continuity of care
to the Surgeon and his Surgical Assistant, reduces the time spent by the
Surgeon on unproductive work, and I hope a better deal for the patient.
That is the theory, and I hope to have it in practice next

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Re: Follow-up - Ärzteforum

Post#8 »

We are dealing with people. Surely it is polite to meet the patient at least
once postoperatively.

Even though we see the patient preoperatively and explain what is planned,
further explanation is often needed postoperatively and usually there is nothing
further to be done. Surely the few minutes this takes is time well spent. It
is reassuring to the patient and shows that we are interested in the outcome of
the operation. So why not in person?

I do recognise that the significance of the review appointment varies from the
private fee paying patients to the patient who attends as a hospital patient
and has no interest in who did the operation provided he is getting better. I
presume surgeon and John would see the former in their office while the latter
would be seen by the assistants in the hospital outpatient clinic.


Re: Follow-up - Ärzteforum

Post#9 »

Doctor Green wrote: how much does cost to pay

Inguinal hernia $1,012 cpt 49505
incisional hernia 1,525 cpt 49560
gastric cancer (partial gastrectomy with gastroduodenostomy- 2,696 cpt
lap cholecystectomy 2,099 cpt 56340
classic cholecystectomy 2,099 cpt 47600

These are the charges submitted. The reimbursement is at the mercy of the third party payors. For non US surgeons, cpt codes are the uniform method of coding the type of surgery in the US. I'd be interested in the geographical variation of charges within and outside the US. For me, all post op visits (one in uncomplicated or as many as necessary in complicated) are included.


Re: Follow-up - Ärzteforum

Post#10 »

In Canada, although we have free trade with the US of A, Canadian surgical
fees are almost exactly 1/6 th of those you quote. I am totally shocked
that an American insurance payor wouldn't be happy to have me do their lap
choles for $270 US or even a colonoscopy for less than $100 US. I don't
think our results are any better or worse. If you want the Full Monty, a
REPEAT liver transplant pays the surgeon less than $2000US. This is the
highest fee, and a moot point, because these guys are all on salary anyway.

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