| March 19, 2006
More on the wrong kidney removal. The surgeon relied on the dictated report and GP’s letter, rather than seeing the films himself.
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Inexcusable. Interesting how the article said very little about the radiologist’s role in this.
As a urologist, this is one of my worst fears and something that I have had nightmares of.
As a surgeon who performs this operation on a regular basis, a few points should be mentioned.
1) I have never operated on a kidney without reviewing the films myself and having them in the operating room.
2) At 4 cm, this tumor may have been amenable to removing part of the kidney, making it even more important to review the films.
3) The patient should still have a reasonable chance at having someone remove just part of the kidney and then not needing dialysis.
4) We also use the preoperative pen marking in the US and this doesnt help this type of problem. My suggestion would be not to have a surgery if teh films aren’t in the room.
shouldn’t the surgeon be able to visually inspect the kidney to see the tumor if it is 4 cm?
Tumor inspection of kidney:
The operation for kidney tumors, if you are removing the whole thing, involves taking the kidney out with the surrounding fat attached. You won’t usually see the tumor until you cut the specimen in half afterwards.
I remarked before that wrong site surgery is always below standard of care. This article merely muddies the issue of figuring out who is responsible. The surgeon is kicking himself after the event for not double checking. But he did rely on two other physicians, the GP and the radiologist, who were both unequivocably wrong.
I too compulsively double check everything I can, going back to original sources of information if at all possible. Doing this, I have uncovered some potential errors; the last being a missed cervical fracture that might have been disastrous had I anesthetized and intubated the patient based upon the all-clear from the trauma surgeon.
But the reality is that health care would grind to a halt if every doc had to check everything back to primary sources themselves. Further, the health care information system is designed to thwart the transmission of medical records (think HIPPA).
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