The more you screen, the more you find. And the more you find, the more you find that is not really something you needed to — or wanted to — find. That’s true with just about any health screening test.
And you can include hernia screening. Yes, hernia screening, which has become a big-time target of medical center marketing. An online search turned up many examples of medical centers promoting free hernia screenings. When I asked my own physician, he said, “Huh? That’s crazy.”
Remember: screening means looking for problems in otherwise healthy people. So in this case it is looking for hernias in people who don’t have any symptoms or signs of problems now. If people did have a problem, then you’d call it a diagnostic test – looking for the right diagnosis for the cause of the symptoms.
But hospitals and surgeons are calling this screening. For one reaction to this trend in marketing, I turned to Kenny Lin, MD, MPH, deputy editor of American Family Physician and a professor of family medicine at Georgetown University School of Medicine. His reaction was blunt:
Generally, hernias don’t need to be treated unless they are causing symptoms (e.g., pain, vomiting).
Which is why screening the symptom-free general population for hernias seems really strange. I asked one of our former reviewers, Doug Campos-Outcalt, MD, for his opinion:
You are correct. It is very hard to improve on the asymptomatic healthy patient. There are many more things that can go wrong with screening and treating than can go right.
Underneath the ad pictured above was this noteworthy line:
The da Vinci® Xi Surgical System will be on-site for hands-on demonstration.
That helps to put the free screening campaign in a new light. It’s one way to find more patients to help pay off that expensive robotic surgery system. Dr. Kenny Lin again:
This is a naked attempt to drum up business for their surgeons and the hospital’s operating rooms. It’s even worse that they are advertising their da Vinci surgical system, when robotic-assisted surgery increases patient costs but has not been shown to improve surgical outcomes.
Robotic hernia surgery didn’t have any clear advantage in a recent study reported by a surgical team at the University of Virginia, which concluded:
Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection.
Just three months ago, a Cleveland Clinic surgeon told the Minimally Invasive Surgery Symposium that research on robotic inguinal hernia surgery is difficult to find. Her comments were reported by MDedge.com.
“There’s not a lot out there,” Ajita Prabhu, MD, said. “If I stood here and went through every one of those studies detail by detail, I think I could do it in 15 minutes. …We’re finding additional evidence that it adds OR [operating room] time, and it’s expensive.” … Moving forward, she said, robotic inguinal hernia surgery should be tested so “we can make sure it’s actually better, not just cool. We need to be able to justify our utilization.”
The ad pictured above was for a Chicago-area hospital. But such marketing is popping up all over the U.S. It’s happening not just in paid-for ads and marketing, but also in supposedly independently vetted journalism. Here are just a few of many examples you can find online.
In Amarillo, Texas, a TV news anchor presented a fawning promotion for a medical center’s free hernia screening which was also tied directly to a promotion of its robotic surgery system. The anchorwoman could barely contain her admiration for the effort, gushing: “It is free. How nice is that? … You’re making it easy and patient-friendly.”
A Knoxville, Tenn., TV station gave several minutes of free “news” promotion to a local hernia screening. Note that the surgeon who is interviewed had a markedly more positive view of outcomes data than what I cited above. And she and the anchorman emphasized that it’s “FREE….free….free” — even if you don’t have insurance. What they didn’t discuss was what the bills would be and who would pay them if the screening did find anything deemed operable.
Just about 110 miles away, in Chattanooga, another TV station promoted another medical center’s free screening event — again, with a direct tie to the center’s robotic surgery system.
An Indianapolis TV station promoted free hernia screenings at multiple locations, with a surgeon saying, “I think it’s important for them to know that the hernias are not going to fix themselves.” No mention of hernias that don’t need fixing.
A Connecticut news site touted a local hernia screening, emphasizing only what can go wrong if you don’t find it and treat it:
If left untreated, hernias can get bigger over time, become more visible and can cause serious problems, including blocking the intestine, pinched blood vessels and the hernia can break through the skin.
There is almost robotic repetition in the themes you hear consistently in these robotic surgery promotions. The emphasis is: It’s free. If you must have surgery, the outcomes from robotic surgery are fantastic. And if you don’t have surgery for the hernias we might find, you’re asking for big trouble.
All of these promotions occurred in recent months. Hmmm. It sure feels like a promotional push from the “mother ship” — Intuitive Surgical Systems, makers of the da Vinci robotic surgery system. Indeed, hernia repair via robotic surgery is one of the key promotions now on Intuitive’s website.
Harold DeMonaco is a visiting scientist of behavioral and policy sciences at the MIT Sloan School of Management. For years he was director of the Innovation Support Center at the Massachusetts General Hospital. He’s also reviewed countless media messages about health care for us. He emailed me his opinion of this hospital marketing trend:
I agree that this type of “screening” seems more like trolling for surgical cases. I suspect that this campaign is designed to increase hospital utilization of the very expensive robot platform (presumed advantage to the surgeon and hospital) and sale of disposables needed (a clear advantage to Intuitive Surgery).
But is there really an advantage for patients? Maybe all of that television happy talk time could be spent looking into that issue for the benefit of viewers.