Costs, risks, and benefits of hand surgery

The major criticism of all medicine today is spiraling cost of health care. This is fanned in intensity by economists, politicians, and social scientists who add up the costs, which, in fact, have skyrocketed, and they have concluded that it "isn't worth it." The major basis for that conclusion is that despite the fact that health care costs are gobbling up 11% of the gross national product (+189 billion), there has been an increase in life expectancy of only 1 year. Use of life expectancy as the outcome measure is simple-minded, misleading, and inappropriate, and it is used only because the objective data are clear-cut and available. Mortality is a clear endpoint. Some of the greatest advances in medicine and all of those in the field of hand surgery have nothing to do with duration of survival (quantity of life), but contribute with major impact to the productivity, adjustment, and self-satisfaction of patients (quality of life). We have the opportunity to challenge and counter some of the adverse public image that is the current portrait of all of medicine. Much of that image is based on flimsy, inaccurate data that are extrapolated into gross untruth by nonmedical, short-sighted adversaries. Hand surgeons must collect objective evidence of the rehabilitation benefits of hand surgery care to persons suffering deformity and associated disability. Such data may be extrapolated to show the true cost-risk-benefit ratios produced by hand surgeons.