The Old Bait-and-(non)Switch Game

There is something afoot in the Duodenal Switch world akin to the strange things afoot at the Circle K. And it's something that I believe to be wrong.

More and more of the various DS boards that I peruse are getting posts from potential DS seekers saying that the doctor they consulted with is recommending that they get their DS in two parts - one surgery to perform the gastric reduction, a.k.a. sleeve gastrectomy, and then a second one, later on, to perform the "switch" part of the surgery on the intestines. Okay. Fine. I can see the benefits if the person weighs upwards of 500-600 pounds. Get some weight off of them before you go mucking with their intestines. Do the easier part first and then follow up with the trickier, more dangerous part later when the patient is healthier and more able to move around. Sounds reasonable. To use a visible example, the one woman that was profiled on the Discovery Channel during her plastic surgery quest was given a two-part DS by I believe Dr. Anthone. She weighed at least 600 pounds and needed a bunch of it to come off first before the intestinal switch could safely be performed.

But a lot of these people aren't weighing that much. They're weighing 250-350 pounds on average it seems from the postings I've read. So what's up with that? Why are you selling both them - and their insurance company - the DS but saying that they'll need a two-parter, which the insurance company may not be willing to pay for the second part of later on. This may leave many of these people in a ditch so to speak because the insurance companies will come back saying that there's no need for a "revision" (and that's what it will be) because they've lost some weight and no longer need the surgery. Aren't you really baiting and switching them?

If these surgeons (Prachand and Gagner seem to be the two most frequently mentioned at this point) are really wanting to sell these people on the vertical sleeve gastrectomy - a viable WLS alternative - then why aren't they up front about it? Don't go promising a person a full-on DS when you know that they'll more than likely have to pay out of pocket for the second part, which means that many will not be able to "complete" their surgery. Tell them that you recommend a VSG and be done with it!

What's even more disturbing is that some these surgeons are promising people the full DS, but are then going in and only performing the gastrectomy. The patient wakes up, and is astonished to learn that they didn't get the full-on surgery and always seem to be placated by being told that there were "problems" in the abdominal area that made doing the switch more dangerous than they needed to be - one happened before I had my surgery to a girl who flew all the way to Belgium for Dr. Himpens to operate on her. The patients are stunned. Devastated even. The girl I mentioned was given the run-around for days about why it wasn't completed and she was so upset and angry, feeling alone in a foreign country and being completely discounted.

These people didn't get all that they had bargained for. And considering that WLS is an elective surgery, their choice as to what they get should be given more weight (pardon the expression) than it would be for another type of surgery.

Now, before I get jumped on, let me say that yes, there are times when complications arise and it is just not possible to complete the switch. It is the doctor's discretion in the end, and there is a reason why we choose who we choose to operate on our bodies. But that level of trust that we have in these men and women should not be breeched just because they want to perform medical studies with these people by going with what they (the doctors/surgeons) want to do regardless of patient wishes. And it seems to be happening more and more often.

Yes, I just said it. I believe that some of these doctors may be doing this strictly to be able to gather research information. Why do I assert this? Because I had "complications" in my abdominal area and instead of simply taking the shortcut and only giving me the gastrectomy, my surgeon went ahead and painstakingly removed all of the gnarly adhesions that were in my abdominal area so that he could give me the full surgery that I had requested from him. Only if my life had been in danger would he have not completed it. He didn't betray my trust.

If these doctors want to offer their patients the VSG as a stand-alone option, please, go right ahead. But don't go selling someone a surgery and then fall short of expectations for your own personal agenda. It violates every ounce of trust these people have put in you, your skills and your ethics. If you want to set up a medical study on the benefits of doing the DS in two stages versus one, then give people the option of joining it with a guarantee that the original fees they and their insurance companies paid will pay for EVERYTHING - i.e. both surgeries.

This is our lives they are mucking around with. Most of us make serious, informed decisions about WLS before we step into the arena. We're not stupid. Don't try to pull the wool over our eyes, because it may just backfire on you.