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How do we make democracy work for the poor?
A nonprofit news agency promoting social justice. Seeking answers to the question:
How do we make democracy work for the poor?
By Ralph Nader · 8 Aug 2013
Do you know anybody with a hernia problem who wants to repair it and have a vacation at the same time? Well, if you do, send them to Shouldice Hospital, right outside of Toronto, Canada, situated on 23 beautifully landscaped acres with greenhouses, walking paths, stables, a tennis court and putting greens.
Over four days and twelve meals, you’ll experience the finest, friendliest, safest, surgical and post-operative recovery experience in North America. You’ll pay from one-half to one-third less, with often far better outcomes, than you would for an outpatient operation for abdominal wall hernias in the U.S.
I know this and more from personal experience – one so pleasant that from time to time I visit Shouldice to see how they’re doing. They give me a quick, free examination. And this is not special treatment; this is standard care. Some years ago they annually invited their “alumni” for reunions where up to 1,500 patients came from all over Canada and other countries to honor the staff and the institution. In addition to dinner and entertainment, they provided a free hernia examination. Any former patient dropping by can receive the same special welcome.
The Shouldice Method is known worldwide as the ever-improving “gold standard.” Harvard Business School has a bestselling case study lauding its amazing efficiency while producing a superior performance. Patients give it an evaluation that would be the envy of the best clinics in the U.S.
Over your four days at Shouldice, you are with eighty-eight other hernia patients in various stages of recovery. You dine with them, walk specially inclined stairs and walkways and perform other exercises with them. You all have something in common to discuss. You are not immediately sent home to recover with only the help of your family, friends or home care services. You recover at Shouldice with good food, and new friends.
Shouldice, with very few exceptions, does not use general anesthesia and is proud of its dramatically lower recurrence and infection rates, compared with patients who are operated on at general hospitals. General surgeons do, on average, less than one-tenth the number of hernia surgeries per year than the surgeons at Shouldice.
The ten surgeons at Shouldice perform 7,500 operations a year. All they do is hernia procedures. In their spare time they publish peer-reviewed articles in medical journals advancing the state of the art. Unfortunately too many general surgeons and hospitals have on average over 10 times the rate of recurrence, four times the rate of infection, and often use expensive mesh both to replace lack of surgical skill and to speed up the operation. Plus they charge much more before they quickly say “sayonara.”
The Shouldice procedure is described by hospital officials as a “natural tissue repair that combines the surgical technique with the body’s natural ability to heal,” and takes, on average, forty-five minutes to complete. Except in rare circumstances, “the technique does not use artificial prosthetic material such as mesh because mesh can introduce unnecessary complications such as infections or migration, dramatically increasing the cost of the operation. Shouldice does not use laparoscopic technology because of the potential intestinal punctures and bladder and blood vessel injuries, which may lead to infection and peritonitis.” Shouldice staff note that laparoscopic surgery also requires general anesthesia and hugely higher costs for disposable items per surgery than is the case at their hospital.
There are about one million abdominal wall hernia operations yearly in the U.S. Hospitals and general surgeons for the most part do not use the Shouldice Procedure. Still the deplorable “quick and dirty” that invites overuse of mesh – about 80 percent of the patients – has become a perverse incentive for higher billings in the United States. Superior talent is needed for the more natural procedure used by Shouldice.
At its annual convention, the American Hernia Society is cool to the Shouldice model which has almost seventy years of experienced application. After all, at Shouldice, there is a no “fee for service” practice. Ten physicians (licensed by the College of Physicians and Surgeons) are on the staff and make less than $200,000 salary each year.
It is consumer-driven healthcare through superior competency, where, before discharge, patients participate more actively in their own healthcare in a facility specially designed for their condition.
Shouldice’s Director Daryl J.B. Urquhart makes a strong case for small, specialized hospitals that can deliver all-around superior outcomes. As Harvard Business School Professor, Earl Sasser says: “It’s more than an operation, it’s a total experience.”
In the U.S., the healthcare industry’s rocketing costs and inferior outcomes (especially for those without health insurance), its exclusion of tens of millions of Americans from coverage, its inability to learn from others, its gouging profiteering and frequent subordination of patient wellbeing by insurance and drug companies assure that superior procedures such as those used at Shouldice are largely ignored.
U.S. Medicare does not cover Americans who go to Ontario’s Shouldice, even though it would save money on all fronts. Still, for those of you with non-emergency hernias, sizable deductibles, or even those willing to go without Medicare coverage, who just want an enjoyable, economical respite without risking more recurring visits for infections or failures, consider Shouldice Hospital.
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