The Tonsil Removal Nonsense

[roster]

Nancy Reyes is a retired physician living in the rural Philippines.

Posted on July 24th, 2009 by Nancy Reyes

To stress how he plans to save money under government guidelines for care, President Obama used as an example the idea that the new health care bill would prevent physicians from deciding to take out your kids tonsils just so he could make money.

I’ve heard this argument before, when feminists started hounding physicians for doing “unnecessary” hysterectomies. One result of this was that a lot of us who could have been “cured” of our endometriosis by a simple hysterectomy ended up being treated with less serious surgery and pills that caused lots of side effects and after years of pain ended up with surgery anyway.

But at least the hysterectomy argument had some merit. When it comes to taking a kids’s tonsils out, the President is indeed clueless.

Essentially the President said that if your kids has a sore throat, and the doctor needs money, the love of money might lead him to decide to take the kid’s tonsils out rather than treat “his allergies”.

Reality check, please.

Most people go to primary care physicians when they or their kids are sick.

Yet almost no Family practitioners, and Pediatricians take out tonsils.

Usually we are the ones who check if the tonsils are so badly infected that they need removal, if the obstruction from large tonsils is causing sleep apnea, or if the problem is allergic rhinitis.

We then treat the problem. If we keep seeing a child with tonsillitis, or if his symtoms of sleep apnea from enlarged tonsils doesn’t improve with antibiotics and is causing problems, we are the one who decides where to refer the child. If it is allergies, we send them to an allergist. If it is infection, or sleep apnea, we send the to an Ear Nose Throat specialist.

He or she may indeed see the kid and quickly agree with our evaluation, but maybe not (I’ve had about one third of these kids sent back for more treatment…half ended up not needing surgery, and half went back six months and three more infections later to get cured).

The point is that by the time the specialist sees the kid the decision has pretty well been made by the primary care physician.

And ironically, by taking out the the tonsils, it means less money for the primary care physician. I often joked with mom that I refer them when I’m tired of seeing them in my office (my “criteria” used to be three to five episodes of tonsillitis per year for two years in a row, or evidence of breathing problems from the large tonsils).

But, tell you the truth, I rarely referred children for tonsillectomy: about one or two a year. In contrast, I have had to refer 2-3 adults a year for tonsillectomies for sleep apnea.

But there is another complication of not taking out tonsils: in the years before I retired I started seeing something in middle class patients that I hadn’t seen since working in the slums in the 1960’s: Peritonsillar abcesses. Only one of these was in a young child: the others were in teens or young adults who had “a lot of sore thoats” all the time but unlike the good old days, they never did get referred for tonsillectomies.

Luckily, we have specialists even in rural areas, so a specialist can put them under general anesthesia to drain the abscess, so I no longer have to drain them with the patient wide awake sitting in a chair at the local Emergency room which was one of the messiest procedures that I have had to do as a physician.

So one wonders why this health care bill is being passed by demonizing physicians.

Well, I guess community organizers with easy 40 hour work weeks think docs who train eight years plus three to seven years after medical school, and then work 60 hour weeks are just being plain greedy when they expect to make six figure salaries.

But few physicians are looking for more work. Most of us are too busy to start with, and since our billing is done by the front office, we do not have direct contact with what we are paid, or even if the bill is paid.

Do I know about greedy physicians? Yes, but I doubt that the rate of greedy physicians is higher than the rate of greedy politicians.

To have the President use false data to demonize medicine as a profession is unlikely to win him support from those in the medical profession.

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[Juliebove]

I'm 50 years old. When I was a kid, I think it was very common to yank out the tonsils. My brother and I both had ours out. It didn't seem to help much. These days it is far less common.

[grandmma]

Interesting article, Rooster. Although, whilst I know it sounds naive, I'd like to think that the majority of doctors have patient's health in their minds rather than their wallet. Good point too that GPs don't (usually) operate, the surgeons do, so referring patients on for surgery won't gain them any income.

But on the other side of the coin, in Australia apparently (don't know if it's everywhere) they don't like taking kids tonsils out until they're at least 7 preferably 8.

My granddaughter had hers out at just 5, and that was a nasty wait. Her 3 year old brother now has the same issues. Tonsils so large that the doctor was shocked. Throat almost completely blocked when she lay down. She seemed to suffer from the sleep apnea symptoms we experience, and referred to in the article - she snored shockingly and just could not get a good night's sleep. It was distressing to listen to her. Great now they're out, but her brother is far too young, and that is a problem for him at this stage.

For those not as clear cut as my grandkids, I wonder if the "cavalier" attitude shown in the past to yanking tonsils out at the slightest inflammation was just barbaric, or as the article also implies, a blessing in disguise which often pre-empted later issues?

Never had mine out, never want to be faced with that necessity!

[Bearded_One]

I am 53 and used to have chronic strep throat; I also had scarlet fever several times and rheumatic fever -- but I never had my tonsils out. When I was nearly 40, I had a UPPP and my tonsils were removed. The only good thing that came out of the UPPP was that the tonsillectomy cured my chronic strep throat. I have had strep throat only about four times since I had my tonsils out about 13 years ago. Yes, you can get strep throat after a tonsillectomy.