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The RAConteurProgress occurs when preconceived notions, even briefly, intersect with possibility.
The world of science, taken as a whole, has proven this thesis true time and again in human history. Whether it was Copernicus and Galileo challenging the Earth’s place in the universe, or the first doctor who dared to think that bleeding with leeches may not be the upper reaches of medical care, the presentation of possibility has assisted in human evolution and extension. There have been mistakes, such as the Nobel Prize for physiology and medicine being awarded in 1926 to Johannes Fibiger for his “discovery” that parasitic worms cause cancer (later widely disproved). Yet it is the unique role of the scientist to never give up. Science remains the welcoming home to the curious and impatient.
With this in mind, I relate the preliminary findings of a small Belgian study that showed that hypnosis, coupled with local anesthesia, led to an improved postsurgical outcome than the use of general anesthesia. Follow the pocket watch as it swings back and forth while I give you the details.
In the study, 18 of 76 breast cancer surgery patients and 18 of 54 patients undergoing thyroid procedures underwent a combination of hypnosis and local anesthesia for their procedures. The remainder of the patients in the study received general anesthesia. In both sides of the study, the patients who were hypnotized experienced improved recovery times, shorter hospital stays and decreased post-operative opioid use. Twenty percent of the patients were later observed to cluck like chickens as they crossed the street on rainy days. OK, I made that part up.
Up to this point, hypnosis has existed solely in the realms of psychotherapy, complementary medicine and vaudeville. The usage of such techniques in the operating room represents quite a shift. Because this was a small scale study, one would not expect surgical suites to immediately begin trading in their bulky anesthesia equipment in favor of spinning black and white spirals on sticks.
However, let’s take a look at this study as part of the larger argument going on currently with regard to ACOs and the desired savings that this model is hoping to provide. Everything being projected in the ACO model lacks imagination, mainly because medical treatment standards and protocols are being viewed through the ACO looking glass as stagnant and non-evolving, when nothing could be further from the truth. As the Belgian study shows, science continues on even as the American health care system and its underpinnings remain in a sort of money-inhaling vacuum.
Innovation is not forced, but rather imagined, tested and implemented. The ACO model as currently proposed constitutes unreasonable experimentation lacking in anecdotal example. Think of it in terms of trying to tune a banjo by putting it through a cycle in the dishwasher, then subsequently wondering why it sounds worse. ACOs, as envisioned in the proposed rules, are at best a guess, and not a particularly good one.
The nascent Belgian hypnosis study holds the promise of enormous savings, but like any scientific experiment it requires further study. If industry comments regarding the proposed ACO rules are any indication, many elements of the ACO model require further testing. Perhaps it’s as easy as waving a pocket watch in front of Kathleen Sebelius and Don Berwick, watching their eyelids close and subconsciously planting a different model in their heads. One can imagine the possibilities.
