Personal view: why is my GI clinic filled with surgical mishaps? Post‐operative syndromes as an externality problem

Summary The aim of the present analysis was to review why gastroenterology clinics appear filled with patients suffering from postsurgical syndromes. The long‐term sequelae of gastrointestinal surgery can be modelled as a negative production externality of surgical operations. When seeking to maximize their profits, surgeons are primarily concerned with the price and cost of surgery alone. They tend to ignore parts of the ensuing long‐term costs they impose through postsurgical syndromes on other medical specialties. The complication‐related rise in the cost of gastroenterology practice reflects parts of the societal costs of surgery that are not included on the surgical balance sheet. To the surgeon, surgery appears cheaper than to the rest of the medical community, because cost shifting from surgery to other medical specialties leads to a favourable surgical outcome with more surgical operations performed than medically needed or economically feasible. The amount of surgical sequelae could drop, if surgeons were forced to care for all their own postsurgical syndromes or if surgery entered a joint enterprise with gastroenterology caring for the same patient pool.