'Great patient care is great business': Dr. Matthew Goodwin on patient, price transparency in spine

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Matthew Goodwin, MD, PhD, is an assistant professor of orthopedic surgery and neurological surgery at Barnes-Jewish Hospital/Washington University in St. Louis.

Dr. Goodwin completed surgical training in both neurosurgery and orthopedics and specializes in the treatment of complex spinal conditions.

His practice focuses on spinal tumors including metastatic and primary cancers of the spine, benign-aggressive lesions of the spine and other noncancerous lesions requiring surgical treatment.

In August, SpineLine, the primary publication for North American Spine Society members, recognized Dr. Goodwin in its '20 Under 40' list of top spine surgeons for 2019.

Here, Dr. Goodwin discusses the importance of patient and price transparency and the evolution of robotics in spine.  

Note: Responses were lightly edited for style and clarity.

Question: How do you see the emerging trend of price transparency affecting the spine field?

Dr. Mathew Goodwin: I think being transparent in everything is important. This includes pricing, but also discussing possible complications as well as realistic expectations for different procedures. Again, today's patient is educated, and many times had prior spine care by the time they see me. For example, I have had multiple patients discuss their experiences with "laser spine" surgery. When a patient feels deceived by a spine care provider in the past, we should all work hard to earn their trust. I think that starts with trying to be as transparent as possible while being professional.  

Many patients get tremendous low back pain relief by seeing a chiropractor yet are often hesitant to tell me this. They seem surprised when I tell them we have some reasonable data saying that manipulation is one of the few things that helps patients with acute low back pain. Although I do not recommend having your neck manipulated, there are many situations when having a chiropractor work on your low back pain may be of great benefit. 

Q: How do you approach price transparency and the cost side of the value equation with your patients?

MG: I try to be very transparent and frank. While we need to be fiscally responsible, we have to make sure we as surgeons are staying focused on the patient, not the business. Spine care is big business, especially for hospitals, but also industry and all the other entities we rely on to help us deliver optimum care. Given our training in medicine and our devotion to our patients, I think it is ultimately up to us as providers to maintain this transparency and relationship with our patients. Often our goals are aligned, but sometimes they are not. In those situations, I think it's ok to push back and make your case for your patient. Good businesses will listen and understand that great patient care is great business. In my case, I am lucky that Barnes-Jewish Hospital/Washington University, while being very large, is also very focused on the patient.  

Q: Can you give an example of something you do differently?

MG: As a small example, some have discussed not having vendors in the OR. I think this is a bad idea. No one is more motivated to help the surgeon than the vendor — they know surgeons have a choice to use their screws or someone else's. Vendors know that all I care about is delivering the best care for my patient on that OR table. Having the vendor in the room is an example of where capitalism can be at its best in my view. The vendor wants to sell their product, and I want to do the best thing for the patient. I want a vendor who is going to do whatever they can to help me provide the best care to that patient. Sometimes that means bringing extra equipment or making a special instrument to help the case go faster. A good vendor may save you an hour or more in the OR. That means the patient is safer, on the table a for a shorter time and has fewer complications.  

My patients can tell you that I am very old school in my approach to surgery. I am not in a hurry to put in some new device without years of data. I think there is just too much to lose for the patient, and too much to gain for them if we do what we know works well. I did my fellowship training with Dr. Dan Sciubba at Johns Hopkins University in Baltimore and learned how to be very direct with patients about surgery, possible complications and what the data say. Patients get their questions answered very directly by me and I think they appreciate that. 

Q: What is your stance on robotics in spine? Would you consider adapting it in your practice down the line?

MG: As I've said, I am very old school, so I don't like adopting things right away, particularly if there is any perceivable risk to my patients. Currently I don't use robots much, although we have the two industry-leading robots available at Barnes-Jewish. I think robotics is certainly part of the future of spine surgery, but it is not clear the exact path that is going to take. I do not use the robot now only because it does not offer me any big advantage. That does not mean I may not use it moving forward, but I must be convinced it offers me a benefit. I am not in favor of using new things just for the sake of using new things. 

When I go into the OR, I don't want there to be videos or excitement about doing something out of the ordinary or using a shiny new piece of equipment. Rather, I want things to stay boring while we do what we've done many times on other patients. We see the anatomy, place our hardware safely, check our placement and then we close up. 

To be clear, I think robotics is part of the future of spine surgery, but it should always be to augment the surgeon. It is another tool to use in the OR. The hard part about using a robot is that it introduces a new set of things that must be checked. So, if you do not have much experience using one, you may not realize that when 'X' happens, then 'Y' is what you need to check. In the hands of an inexperienced surgeon I think you are going to get poor results. The surgeon has to be good enough to recognize the error, stop any damage from happening and then complete the case without the robot if needed. 

There are lots of surgeons who trained like I did — with freehand placement of screws. We are used to knowing how to place screws freehand and more importantly, where you can err safely and how to avoid dangerous positions. Learning those things is a product of training over years, not something that can be learned in a weekend. The hard part of adopting a new device as prominent as a robot is that you have to recognize the errors and safely control and correct them. There will always be some learning curve to that.

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