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A Bluep rint for Lowering Spine Surgery Rates

The BackLetter® 34 Volume 19, Number 3, 2004 Communities that would like to lower their spine surgery rates will find very few blueprints for change in the medical literature. One potential template for altering surgery rates was a 2001 study from the state of Washington. “We were able to use scientific evidence to engender voluntary change in back pain practice patterns across entire communities,” according to Harold I. Goldberg et al. (See Goldberg et al., 2001.) “Our study showed that one could influence the behavior of physicians through an educational process,” says co-author John Loeser, MD, a neurosurgeon and pain specialist. But Loeser stresses that this type of process is dependent on openness and diplomacy. Loeser recommends that those advocating change should engage in a dialogue with surgeons and other spine care providers. They should explain why changes in practice style might improve patient outcomes and then let the participants make up their own minds based on the evidence presented. If physicians believe that changes in practice style will benefit their patients—and improve their performance—they will readily agree. Loeser, however, is not enthusiastic about the imposition of guidelines on physicians, particularly in the chronic pain area, where guidelines may lack scientific validity. “Decision-making by fiat will be met with great resistance,” he suggests.