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Monday, June 09, 2008


I once heard a nurse suggest that doctors should be required to take a class in apologies, particularly to nurses. But upon reflection I’m not sure that would be a good idea. Back in May of 2001 a 68 year old Australian woman had part of her colon removed. The surgery was a success but the patient, Ms. Pat Skinner, insisted that something was wrong. Her doctors assured her that she was merely suffering the psychological effects of major surgery.
But eighteen months later, when Ms. Skinner still refused to accept her doctors’ assurance that no matter what she felt she felt she was actually feeling just fine, the hospital relented and finally agreed to re-x-ray her abdomen. Her doctors were stunned to discover this woman who had no medical training had been right all along. On the x-ray was a clear image of a 7 inch-long pair of surgical scissors that had been left in her abdomen: Ooops. In October of 2002 the chastised surgeons removed the forgotten tool and Ms. Skinner made a full recovery. And then, in April of 2004, Ms .Skinner went public, holding a press conference and hiring an attorney. St. George’s Hospital in Sydney professed to be surprised that Ms. Skinner had waited so long to take action legal action. I suspect Ms. Sinner was motivated to finally go public once it became clear that, as the hospital was forced to admit, that no one on the operating team had been disciplined in anyway. The CEO told a local radio station, “I’ve been executive director here for four years and this is the first time this incident has occurred”. Ms. Skinner’s lawyer might have been quick to add, “That they know of”.
Depending upon which study you are reading, medical screw-ups injure or kill 100,000 patients every year in America (Institute of Medicine study – 1999), or 3 patients out of every 100 ( HealthGrades – 2005). And the Harvard School of Public Health published a study in the November 2007 “Annals of Surgery” that indicated a surgical error rate of 52%, including everything from minor recording errors to 84 cases in 2006 of wrong site surgery. All of which makes the results of a survey of airline pilots and surgeons even more interesting: 90% of pilots said they would be willing to listen if a team member had reservations, while only 50% of surgeons would listen to another doctor or nurse trying to tell them they were cutting the wrong thing.
This past week Doctors at the Asahi General Hospital outside of Tokyo delivered some good news to a 49 year old male patient. He had experienced general good health all his life, except for a minor surgery in 1983 to treat an ulcer. But this May he was forced to seek treatment for abdominal pain, and was diagnosed as suffering from a softball-sized likely malignant tumor in his gut. However the surgery discovered not a tumor (thank goodness) but a “crumpled… greenish-blue surgical towel”, missed and forgotten by the ulcer surgery a quarter of a century before. This being Japan the hospital administrators apologized, but if this had happened in the United States the hospital would have probably threatened to sue the patient to recover the cost of the towel, and some congressman on retainer to an insurance lobbyist would have suggested a bill to protect health insurance providers from being held responsible for “towel-frauds”.
In February of 2006 doctors at the Rhode Island Hospital performed brain surgery on the wrong side of a patient’s head. And then in August of that year they did it again, on a different patient. In July of 2007 neurosurgeons at the very same hospital performed an emergency surgery on a patient with a bleed inside his skull,…and again they opened the wrong side of his head. I guess in this case the third time is not the charm, since the hospital was fined $50,000. In June of 2006 a surgeon at the Milford Regional Medical Center in Massachusetts removed an 84 year old woman’s kidney, when they were supposed to be removing her gallbladder. But that worked out okay since it was later discovered that her gallbladder didn’t need to be removed. And that same year, a 47 year old patient at the West L.A. Veterans VA Medical Center had his possibly cancerous right testicle successfully removed: except they were supposed to have removed his left testicle. Oops again, I guess.
Which brings us to the strange tale of Donovan’s brain: in February of this year eighteen year old Donovan McGowan was struck by a car. He was rushed to Southern General Hospital in Glasgow, Scotland, where doctors had to open his shattered skull to relieve pressure on his swelling brain. They saved his life. A month later Doctors inserted a series of metal plates to replace the sections of his damaged skull. Almost immediately after this second surgery Donovan began to report fierce headaches. The National Health Services doctors in Glasgow assured him that this was a perfectly normal reaction to coming face-to-face with your own mortality at such a young age - well, Donovan’s mortality, actually, not the doctors.
But being so young and feeling so certain of him self, Donovan refused to accept the doctors’ explanation, particularly when, by March, a large cylindrical lump began to protrude beneath his left temple. Upon being presented with the lump Doctors admitted that it did appear as if perhaps something odd was happening and they approved another C-scan to look a Donovan’s brain. After the scan the doctors and hospital administrators explained, according to Donovan, “This is quite embarrassing but there is something metallic, like a tube, still in your head from the operation.” According to the well educated medical experts it appeared that somehow, someone involved in Donovan’s surgery had forgotten to remove a four inch a surgical swab after the operation. Originally it had been left in the back of Donovan’s head, but like the proverbial bad penny, had worked it’s way around the outside of the boy’s skull to it’s present location, bulging out of the side of his head like some bad horror movie affliction. Donovan was insulted. “I can’t believe they were saying it’s embarrassing for them. It’s been more than embarrassing for me having to walk around with his lump on my head” Donovan described the staff as “groveling” in their apologies to him, and added “They weren’t quite so pleased with themselves when I told them I’d called (The tabloid newspaper, the Glasgow) Sun, though.”
And in March of 2008 there occurred a surgical screw-up that exemplified the entire range of medical screw-ups. A retired German woman went into a Bavarian clinic for an operation on her leg and awoke in the recovery room to discover instead that her sphincter had been removed. It reminds me of the observation by that world famous medical expert, Doctor Nick Rivera, who once said, "Well if it isn't my old friend Mr. McGregg — with a leg for an arm and an arm for a leg." And in Doctor Nick's immortal words, "Bye, everybody!"
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