title: Discovering overtreatment: second-opinion dilemma.
abstract: An experienced vascular surgeon, Dr Al Wright, specializing in venous disease, often sees self-referred patients seeking second opinions primarily for ablation therapy and is deeply disturbed at what he finds. Some patients have no reflux on ultrasound examination and, thus, no treatment is indicated. Others were told they need a ludicrous three to seven ablations in each leg where only one or at most two are needed. Several advertise their services in the media. Dr Wright asked esteemed colleagues from the American Venous Forum what they recommended and they suggested sending a copy of his consultation to the first consultant with the goal of shaming him. He also notified the state medical board 2 years ago about one egregious repeat offender, without action. What should he do? A. Do as suggested, send your consult along with a harsh letter. B. Do nothing. It is none of your business. C. Notify the state medical board, again. D. Notify the insurance companies and regulators. E. There is no good venue to deal with the problem.
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex. Electronic address: jwjones@bcm.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D055011:Ablation Techniques / Q000941:ethics*; D016265:Conflict of Interest; D005607:Fraud / Q000941:ethics / Q000517:prevention & control; D006801:Humans; D008318:Malpractice; D028743:Professional Misconduct / Q000941:ethics*; D012017:Referral and Consultation / Q000941:ethics*; D012752:Shame; D013044:Specialty Boards / Q000941:ethics; D019564:Unnecessary Procedures / Q000941:ethics*; D014656:Vascular Surgical Procedures / Q000941:ethics*; D014689:Venous Insufficiency / Q000175:diagnosis / Q000601:surgery*