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The Cost of Cutting was a book I picked up for a pleasure read from the library. Ruggieri also wrote Confessions of a Surgeon, which I enjoyed very much. The difference between the two books is that Cost is mostly about the money, and directly blames healthcare/insurance/government for the woes of doctors, and Confessions is mostly about activity in the hospital; more medicine oriented.

Cost will preface each chapter with a medical case and then peel away layers, explaining what the patient needs, how he is supposed to pay for it, how much profit the hospital will make (or not), and then Ruggieri ultimately rails against the system. I found this style of writing to be both good and bad.

I’ll admit, I picked this book up to gain some insight into hospitals and learn more about medical billing. There were a lot more facts and figures about healthcare than surgery, and this made for a rather flat book at times. That being said, I did learn a lot of interesting and scary things, such as: medical equipment sales reps may be INSIDE the surgery suite, guiding the surgeon as he uses robotic arms or the DaVinci system for the first time! Also: Medicare and Medicaid pays such small amounts for hospital stays that doctors can “cherry pick” which cases they will take…or not. The needs of the patient fall by the wayside if that person has no insurance at all, and with the passing of the Obamacare /Affordable Health Act, hospitals are forced to give up profits to handle cases, thereby forcing doctors in turn to take cases regardless of patient needs or wants.

For example: A woman needs surgery, and her doctor sends her to a specialist. The specialist has operating privileges at 2 hospitals. The hospital accountants/powers that be are pushing more surgeries towards Hospital One for profit. thus the surgeon tells the patient she will be going to Hospital One. This woman is upset because she heard bad things about the place, a friend of hers got awful care, and refuses to go there. The surgeon is caught in the middle between his patient’s wish and his boss. In the book, the patient wants to go to her preferred place, Hospital Two, and the surgeon gets upbraided for it. He strongly advises the woman to choose Hospital One, and she does, reluctantly. I’ll let you read how things work out yourself…no spoilers!

This is not how I’d like my surgery/medical care to be handled–would you? And let’s not even get started on hospital billing–how obscure codes control how things are handled by the insurance. Medical billing is a lucrative practice, a long cry from the “old days” when a doctor would give you a handwritten bill. We have all heard about the $300 aspirin or $1000 bandage billed to someone who has been in the hospital.

Ruggieri offers up solutions on how to make things better, and explains why hospitals are all about profits instead of medicine. Even if you have no interest in medical stories, I urge you to read this, simply to gain more awareness of how to protect yourself should you need surgery. Leave everything in the doctor’s hands? The implications are truly frightening.

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