The following column was published on June 5th, 2012 in USA Today.
I recently had the opportunity to try out a surgical robot, a medical device that has excited doctors, patients and hospital marketing departments. During the demonstration, I was able to precisely manipulate the robotic arms using joysticks. The experience felt right out of a Hollywood movie, as I was able to view the operating field with impeccable clarity using a sophisticated 3-D camera. As a primary care doctor who rarely uses medical devices, I was certainly impressed.
But the implications of robotic surgery go far beyond any video game or science fiction movie. We have yet to see any real data that suggest robotic surgery helps patients more than traditional surgery. What’s more certain is that expensive new high-tech robotic devices will contribute to the nation’s soaring health costs.
Robotic surgery is mostly used now for prostate surgery in men and hysterectomies in women, though it can be employed in other operations, including heart procedures or surgery in sensitive head and neck areas.
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Growing use
The number of robot-assisted devices has exploded. Last year, 360,000 procedures were robot-assisted around the globe, up 29% from 2010, according to Intuitive Surgical, the sole manufacturer of surgical robots. As of early this year, more than 1,500 robots were installed in the U.S.
Whether the influx of robots in our operating rooms benefits patients remains uncertain. Of the few studies that have compared robotic surgery head-to-head with a traditional, minimally invasive approach, there was no clear benefit from using the robot.
Unfortunately, this hasn’t stopped hospitals from aggressively marketing robots. A 2011 study of 400 random hospital websites found that 37% featured a surgical robot on their homepage. It’s no wonder hospitals are showcasing the robots. They are very expensive. At up to $2.3 million each, plus an average of $135,000 in annual service fees, they are costly hospital outlays.
Expensive devices
In a study presented last month at the American Urological Association’s annual meeting, robot-assisted prostate surgery added $6,000 to each procedure, a cost primarily absorbed by the hospital. But hospitals argue that the machines are necessary to stay competitive, especially because patients are asking for the robots.
Jeffrey Cadeddu, a urologist at the University of Texas Southwestern Medical Center, told the New York Times that patients are asking doctors: “Do you use the robot?” If the answer is no, they leave, he said. It feeds into the narrative that expensive technology must mean better health care. That mindset must stop.
In fact, hospitals have to make up the robot’s costs by performing more operations. Otherwise, hospitals might have to reduce services, or worse, the costs could be passed on to patients through higher insurance premiums.
Better studies are needed to determine whether robots really benefit patients. More important, we need to change the way hospitals are paid. Assuming the U.S. Supreme Court doesn’t strike down the Affordable Care Act, health reform will fund such comparative effectiveness research and change the financial incentives that motivate hospitals to perform costly procedures that don’t help patients.
The surgical robot is a marvel of technology. And its potential to definitively help patients, perhaps by remotely performing procedures in underserved areas, for instance, cannot be denied. No doubt, robots will play an important health care role in the future, but that time isn’t now.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
