The hidden risks behind 'routine' medical procedures, according to Australian oncologist

Australian oncologist Ranjana Srivastava has published an opinion piece in The Guardian arguing that the term "routine" in healthcare often misleads patients into assuming procedures are free of risk. Srivastava contends that while clinicians use the word to describe familiarity and frequency, patients frequently interpret it as a reassurance that nothing serious can happen. She suggests this linguistic gap contributes to a lack of truly informed consent, where the potential for complications is not fully acknowledged.

To illustrate the point, Srivastava cites a personal account of a friend’s husband who developed sepsis during what was termed a routine surgery. The procedure unleashed a bacterial shower, rendering him septic on the operating table and requiring days of life-sustaining treatment in an intensive care unit. Although he recovered, the incident highlighted the palpable fear associated with procedures labelled as ordinary. In contrast, another friend underwent a gastroscopy for a gastric ulcer and was subsequently subjected to a colonoscopy, which was described as "pristine" despite no clear indication for the additional test.

Srivastava notes that while colonoscopy is the gold standard for early detection of bowel cancer, its familiarity does not make it benign. Common risks include dehydration, electrolyte imbalance, bleeding, and rare perforation, with sedation carrying its own dangers. These risks are increased in elderly patients. She argues that even a small risk of complications, when multiplied by millions of procedures, results in a substantial number of people being harmed.

The piece also examines the overuse of antibiotics, noting that 40 per cent of the global population leaves doctor’s offices with an antibiotic prescription, nearly 60 per cent of which are unnecessary. Srivastava highlights that antibiotic overexposure alters the gut microbiome, predisposing patients to C. difficile infection. She states that 70 per cent of people who develop this condition have received antibiotics in the preceding 12 weeks. Furthermore, with more than a million people dying annually from drug-resistant infections, she argues that no antibiotic prescription can be safely labelled routine.

IV insertion is identified as the most common invasive procedure in hospitals, with approximately one billion performed annually. Srivastava observes that these procedures are often done unquestioningly, despite well-documented problems ranging from pain and local irritation to serious infection. She suggests that the distinction between something being medically available and medically useful has become blurred, driven by fragmented care, diagnostic uncertainty, and a lack of time.

Srivastava urges patients to ask three specific questions before consenting to treatment: "Why do I need it?", "What are the alternatives?", and "What happens if I don’t have it?" She calls on doctors to remember that familiarity does not equal harmlessness. The article concludes that good medicine is not necessarily more or less medicine, but the right medicine for the right patient at the right time, ensuring that low-value care does not divert resources from those with genuine need.