Why would a reasonable surgeon consider performing unneeded surgical procedures?” From a surgeon’s perspective, two distinct answers appear intuitive:

  1. We perform surgery because we have been trained to do so and because “we have always done it this way” or we simply do not know any better. In German psychology, this behavior is analogous to a historic entity termed “Funktionslust” [1].
  2. We are incentivized to perform surgical procedures, either for financial gain, renown, or both.

From a historic perspective, the threat of unnecessary surgery has been publicized as far back as the 1950s, when Dr. Paul Hawley, the Director of the American College of Surgeons (ACS), stated that “the public would be shocked if it knew the amount of unnecessary surgery performed (…)” [16]. More than twenty years later, in 1976, the American Medical Association (AMA) called for a congressional hearing on unnecessary surgery, claiming that there were “2.4 million unnecessary operations performed on Americans at a cost of $3.9 billion and that 11,900 patients had died from unneeded operations (…)” [17].

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