After century of removing appendixes, doctors find antibiotics can be enough

I had an appendectomy a few years ago (in my late 20s) and I really wish the doctors had given me the option of just antibiotics. I was in severe pain and had spent the entire day vomiting, but from the CT scan my appendix wasn't at risk of rupturing at that point. They basically told me they were going to take it out as it was faster for them to manage it that way.

It's anecdotal, but ever since I had my appendix out I've struggled with digestion issues. I've tried so many things: elimination diets to discover food allergies, probiotics, a switch to vegetarianism, tons of fiber supplements, no fiber supplements, intermittent fasting, acupuncture, traditional Chinese medicine. I tried out uBiome to see if I could discover anything with that. Nothing really has worked.

On top of that, the surgery cost $25k.

Certainly there are instances where the surgery is absolutely needed, as a rupture will kill you. I'd really like to see more research on the theory that the appendix holds a backup copy of good bacteria, because at this point I'm willing to believe the appendix isn't just vestigial and actually plays a role in intestinal health that we just don't understand.

> I've been pressured into unnecessary procedures and even given (multiple!) sales pitches for surgeries that I haven't needed or wanted, because the hospital makes huge amounts of money from it, and consumers aren't savvy enough to know when their doctor is just trying to pad his profitability figures.

That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Providers still get paid for individual services but the rate depends on quality metrics of their overall population. (Source: worked in software for Population Health)

The inefficiencies you describe are less from the clinical side and more from the administrative side. Many of these admin-level people are doing what they can in an incredibly complex maze of processes, most of which started for a good reason. But they are process bees, and unable to make any changes: there's a huge barrier to change as of course nobody wants to be responsible for worse outcomes / deaths due to failure to respect process—yet they are immune from repercussions if poor outcomes are cause by said process.

More to the point, clinicians live in a constant grey zone: everything is a risk tradeoff and they do what they can to get the best outcome. The adminstrative folk see things in black and white. Here's a real example: outpatient office has slightly expired meds that are life-saving if a procedure goes bad, but new meds are not available because factory got damaged by hurricane. Common-sense is that a med does go from perfect to useless overnight and a few weeks is no big deal, especially when there is no alternative. Administrative view is the meds can't be used and must immediately be discarded because having them around the office will expose them to liability during audits... yet of course doesn't understand why that means all procedures of that type would get cancelled.

I think the saying is, “Nobody is dead until warm and dead.”

Example: https://www.pennlive.com/midstate/index.ssf/2015/03/union_co...

Another example: http://time.com/3897897/how-an-italian-boy-survived-42-minut...

There is currently a very similar study being conducted in the US. I am a subject in this study after I got appendicitis last summer. I chose to be treated with antibiotics and have been symptom free for the last ~14 months. I could also have opted to participate in the randomized controlled trial (where a treatment would have been randomly assigned to me) but surgery isn't really something I'm comfortable leaving up to chance.

"If you don't put your finger in it, you'll put your foot in it" is still a common aphorism. Enjoy your time on surgical assessment when you get to your clinical years!