Dr. Paul Ruggieri  has been a surgeon for 20 years working as a department of surgery at several community hospitals, serving as the department of surgery chairman in the U.S. Army, and working at his  independent practice  in Fall River, Mass.  His latest book, “The Cost of Cutting,” goes behind the veneer and looks at the changing business of medicine, specifically surgery.

Some important takeaways include how money is influencing medicine, and what every patient should know before going into surgery. In an interview, Dr. Ruggieri explained that surgery is big business, there is a lot of money being spent on operations, and that money has influence on medical decision making. People are being referred to surgeons, not because of competency, but because a surgeon is in a particular network.  He also authored chapters on hospital consolidation and how hospital systems are cornering the market, the effect of insurance on independent surgeons, marketing and medical devices, and the costs associated with surgery and lack of standardization.

To combat these  trends, Dr. Ruggieri suggests that patients research their condition, their surgeon, and the costs. Patients should get a second opinion about the necessity of the operation, or consider a different surgeon. They should figure out what the costs will be, and why they were charged for particular services. Since patients are paying more out of pocket, they should be more involved in the surgical process. The more informed the patient, the better the results.