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Cost-Effective Surgical Management
Mayo Clin Proc, J a n u a r y 1988, Vol 63
often neglected topics of operative assistance and the contribution of nonsurgical members of the operative team is commendable. As the authors themselves comment in the foreword, surgical staplers and microsurgical techniques are not basic components of operative procedures but are being used increasingly in surgical practice. Their coverage is so brief, however, that the chapters should either be expanded or left to a text on more advanced procedures. The second half of the book addresses spe cific applications of the techniques covered in the first portion. The material on cross-sectional anatomy in the chapter entitled "Surgical Anat omy of the Abdomen" is particularly valuable because computed tomographic interpretation and three-dimensional visualization of anatomic structures are vital surgical skills. I recommend this book for medical students beginning surgical clerkships and junior surgical residents interested in a text that outlines the fundamentals of operative technique. It provides an excellent basis for understanding of operatingroom procedures—basic knowledge to which ex perience and further reading will add. John H. Donohue, M.D. Section of Gastroenterologic and General Surgery
Cost-Effective Surgical Management, edited by Ben Eiseman and LeRoy Stahlgren, 314 pp, with illus, $44.95, Philadelphia, W. B. Saunders Company, 1987 This book discusses means by which surgeons can provide efficient, cost-effective care. The book is divided into four sections. The 12 chapters that constitute the first section deal with general con siderations, such as the cost-effectiveness of rou tine tests or preoperative evaluations. The next three sections consist of 33 relatively brief chap ters, each of which presents the cost-effective approach to the evaluation of a specific symptom, the treatment of a particular disease, or the use of a certain operation. The book will be of interest primarily to physi cians and others, such as surgeons affiliated with capitation health-management organizations, who have a financial interest in limiting the expense of providing surgical care. Medical administra
BOOK REVIEWS
94
tors and other paramedical professionals who are concerned about controlling costs and are in a position to influence clinical practice would also be interested in the recommendations in this book. I found the first section of the book (general considerations) the most informative and inter esting. The chapter on routine preoperative tests reviews the associated costs and benefits and includes specific recommendations about when such tests are necessary. In the chapter on the use of intensive care units, the authors relate how a 37% cost savings was realized at the University of Miami without any decrease in the quality of care. The chapter on operating room costs in creased my awareness of the tremendous cost of managing a surgical facility. In general, I found the next three sections disappointing. The discussions are repetitious, and the recommendations are similar—that is, that cost-effective medical care is synonymous with good medical care and that major savings are possible by expeditious diagnosis, avoidance of routine or unnecessary tests, and elimination of complications. The book does not discuss the possible effects of the current malpractice climate on the cost of medical care. Also missing is a discussion of the hospice program for patients with terminal cancer. All physicians should help control the cost of medical care in the United States because if this factor is ignored, increasing restrictions will be imposed by the government and by insurance agencies. Physicians who read this book will gain an increased consciousness about cost control. Richard M. Devine, M.D. Section of Colon and Rectal Surgery
Human Ophthalmic Pathology: A Short Practice, by O. A. Jensen, 192 pp, with illus, $51.50, Copenhagen, Munksgaard, 1986 This concise text is based on lectures for post graduate students in ophthalmology and pathol ogy. Because of this dual aim, the essentials of clinical examination are described for the path ologist, and basic stains are described for the ophthalmologist.
often neglected topics of operative assistance and the contribution of nonsurgical members of the operative team is commendable. As the authors themselves comment in the foreword, surgical staplers and microsurgical techniques are not basic components of operative procedures but are being used increasingly in surgical practice. Their coverage is so brief, however, that the chapters should either be expanded or left to a text on more advanced procedures. The second half of the book addresses spe cific applications of the techniques covered in the first portion. The material on cross-sectional anatomy in the chapter entitled "Surgical Anat omy of the Abdomen" is particularly valuable because computed tomographic interpretation and three-dimensional visualization of anatomic structures are vital surgical skills. I recommend this book for medical students beginning surgical clerkships and junior surgical residents interested in a text that outlines the fundamentals of operative technique. It provides an excellent basis for understanding of operatingroom procedures—basic knowledge to which ex perience and further reading will add. John H. Donohue, M.D. Section of Gastroenterologic and General Surgery
Cost-Effective Surgical Management, edited by Ben Eiseman and LeRoy Stahlgren, 314 pp, with illus, $44.95, Philadelphia, W. B. Saunders Company, 1987 This book discusses means by which surgeons can provide efficient, cost-effective care. The book is divided into four sections. The 12 chapters that constitute the first section deal with general con siderations, such as the cost-effectiveness of rou tine tests or preoperative evaluations. The next three sections consist of 33 relatively brief chap ters, each of which presents the cost-effective approach to the evaluation of a specific symptom, the treatment of a particular disease, or the use of a certain operation. The book will be of interest primarily to physi cians and others, such as surgeons affiliated with capitation health-management organizations, who have a financial interest in limiting the expense of providing surgical care. Medical administra
BOOK REVIEWS
94
tors and other paramedical professionals who are concerned about controlling costs and are in a position to influence clinical practice would also be interested in the recommendations in this book. I found the first section of the book (general considerations) the most informative and inter esting. The chapter on routine preoperative tests reviews the associated costs and benefits and includes specific recommendations about when such tests are necessary. In the chapter on the use of intensive care units, the authors relate how a 37% cost savings was realized at the University of Miami without any decrease in the quality of care. The chapter on operating room costs in creased my awareness of the tremendous cost of managing a surgical facility. In general, I found the next three sections disappointing. The discussions are repetitious, and the recommendations are similar—that is, that cost-effective medical care is synonymous with good medical care and that major savings are possible by expeditious diagnosis, avoidance of routine or unnecessary tests, and elimination of complications. The book does not discuss the possible effects of the current malpractice climate on the cost of medical care. Also missing is a discussion of the hospice program for patients with terminal cancer. All physicians should help control the cost of medical care in the United States because if this factor is ignored, increasing restrictions will be imposed by the government and by insurance agencies. Physicians who read this book will gain an increased consciousness about cost control. Richard M. Devine, M.D. Section of Colon and Rectal Surgery
Human Ophthalmic Pathology: A Short Practice, by O. A. Jensen, 192 pp, with illus, $51.50, Copenhagen, Munksgaard, 1986 This concise text is based on lectures for post graduate students in ophthalmology and pathol ogy. Because of this dual aim, the essentials of clinical examination are described for the path ologist, and basic stains are described for the ophthalmologist.