The Swiss Surgeons (Swiss Society of Surgery [SGC]), represented by its President Prof. Dr. med. Ralph Alexander Schmid and Prof. Dr. med. Dr. phil. Hubert Steinke, called for a charter to prevent abuse in the DRG financial incentive system on March 6 in Bern.
When surgery becomes a business and patients are operated on hastily or unnecessarily to serve particular financial interests, the treatment ethics of surgery threaten to falter. The fact that this problem is being addressed by surgeons is courageous and breaks a taboo.
The guest villa of Theodor Koch, the first surgeon to receive the Nobel Prize, served as an appropriate backdrop to the Swiss Surgeons’ (SGC) call for a charter for their guild. Prof. Ralph Alexander Schmid, MD, President of the SGC and Director of the University Clinic for Thoracic Surgery at the Inselspital Bern, and Prof. Hubert Steinke, MD, Professor of Medical History at the University of Bern, called for a departure from the prevailing financial incentive system in surgery. Prof. Schmid also sees one reason for the “business of surgery” in the extreme efficiency of therapy in the specialty: “We surgeons are also a bit victims of our own dynamics, which means that surgery can also become a business. We have to ask ourselves the question: How much of medicine is business and how much is truly healing? At the moment, I see us at a point where the balance is in danger of becoming skewed,” says Prof. Schmid. The basic problem is inherent in the system, since both institutions and the surgeons themselves earn money from the operations performed. This leads, for example, to employment contracts in which the earnings of surgeons increase with the number of operations performed. The development in Germany, where medicine has tilted strongly to the side of the market, also serves as a negative demarcation – Prof. Schmid wants to warn against this on behalf of the SGC. Known points from the FMH Code of Professional Conduct, the Charter of Surgeons is intended to stimulate thinking and help the issues to become more important:
- Surgical procedures are performed for medical reasons.
- No referral or assignment of patients for financial gain and no compensation to referring physicians.
- The fee must be commensurate with the medical service provided.
- No treatment based on volume-driven, financial incentives.
The SGC urged its members to sign on “for their own protection as well,” saying it protects surgeons themselves from market mechanisms as well as their patients.
Another project of the professional society is the establishment of a register that can be viewed on the Internet, in which it is recorded where physicians have obtained their titles. This is to create transparency and confidence in surgery. The new registry has already been well received in surgeon circles – after just two weeks, more than half of SGC members had volunteered their information. So it remains to be seen whether the charter will also be well received and signed by surgeons across the board.
Source: Media conference Swiss Surgeons, Bern, March 6, 2013
