Two wrongs don’t make a right

Hmmm. If the moron can’t figure out which knee to operate on, he does not deserve the privilage of having a license. There is absolutely no excuse for this this.

Sometimes it is not always clear which side is which. A few years ago an adult patient came in for wrist surgery. He was complaining of pain and loss of function in the right. After a pre-anesthesia evaluation and consent his brachial plexus was anesthetized on the right. The patient found this satisfactory but then inquired about when his other arm would get numb because it was the left that was to be operated upon.

Doesn’t seem to be a complete story, but news sources are typically hyperbolic about any story that alleges wrong side or site surgery. They usually can’t resist the opportunity to bloviate.

It is easy to mistake the side if the patient isn’t sure. I have had patients tell me, after lengthy preoperative presentations, preop meetings for physicals and signing a consent form (none of which took place in a rushed manner) that they were expecting surgery on a side of a paired organ that was not diseased or needing surgery. Why that happens is a mystery. The chart and every document
supported the surgery as planned, the patient signed off and yet there is a last-minute controversy. I have had patients tell me during last minute remarks before going to the OR that they want extra procedures done, even though these procedures were not contemplated, planned or necessary. When told what the correct plan is and that extra things would not be done, some even act as if they were told differently, contrary to every piece of documentation from office visits through operative consent. Patients confabulate sometimes.
Sometimes they say what they want to believe even if it is squarely contrary to the facts. So I rely on the chart. And if the patient claims they are having something other than what they were presented and can’t be brought around to a clear understanding of what is planned and why, the surgery is cancelled.

As for operating on the other knee after a mistaken start on the opposite knee, all I can say is I don’t have the chart or the facts to judge whether harm was done as a result. Greed? That is bloated lawyer talk and typical for their practices in seeking a settlement. If the patient was charged for two surgeries when they consented for one, I might agree. If they were harmed as a result of either, that is another matter.

Anon 4:35 thinks the surgeon a moron for not knowing which side to operate on. I can’t say since I don’t have all the facts. Maybe it is true. And maybe Anon 4:35 does have the facts, but somehow I doubt it.

If I expected more, I would be shocked that there are some here that are providing excuses for this type of obvious error. Unfortunately (or fortunately) I have come to expect that every medical error will be passed of as being not an error, unrpeventable or just (my favorite) “a bad outcome.” Read the fricking MRI and CT studies if you are unsure as to which side the lesion is on. Have the patient write “operate here – $$$” in big letters using a permanent marker prior to the procedure. Another stellar example of do no harm applying to the provider and not the patient.

All of the facts are not present. Therefore it is impossible to have a meaningful discussion about this case, aside from maybes and ifs.

God knows that news story is terribly biased.

Making judgements about someone’s intelligence or skill based on incomplete information serves only to show how lacking the finger-pointer is, not the person he is pointing his finger at.

Have the patient write “operate here – $$$” in big letters using a permanent marker prior to the procedure. from Anon at 9:31.

In the end it is not about having a lot of people in agreement about a few hearsay facts, but having reasonable primary sources available to double check. That is it doesn’t mean crap to have legions of people check that the patient-surgeon follie a dieu (pardon my french spelling) are in agreement with each other. The verifying team of nurses and anesthesiologist needs all other primary data to review such as office charts, x-rays (clearly labeled for laterality, not the usual microprint for left/right) and any other data that could support or refute the lateralizing diagnosis.

I can help insure that you get the procedure you agreed to with the surgeon. As it stands with medical informatics as they presently exist though, I cannot do much to be certain that you get the procedure you need.

“My view is that under no conditions would such an event be acceptable. There is no defense for this.”

You are probably not an orthopedist, so your opinion is not that of an expert.

I suppose whether there is a defense for this will depend to some degree on the professional opinion of the counsel representing the defendant. Are you, dear poster that person. Probably not.

So what exactly are we to make of your “opinion”. It is nothing more than a blogger opinion by someone neither an orthopedist (I am supposing here, you didn’t claim to be an orthopedist) nor an attorney.

Anon 9:22

Whether I am an ortho or attorney or anything else is immaterial to the discussion. You can save the MDiety act for the next patient you butcher and have to apologize to in order to not get your pants sued off.

Please inform us with your on-high opinion of when it is acceptable to perform a wrong limb surgery. It is beyond amazing to see anyone try to justify this blatant malpractice. It is providers with your form of enabling attitude that gives the whole profession a bit of a rotten stench when it comes to standards and accountability.

My acerbic personality notwithstanding, the issue of justifying or finding the obtuse hypothetical to the allowance of acceptability of wrong limb surgery remains. This would appear to be a problem that could easily be corrected with some rather simple prophylactic measures. While one can understand the defensiveness of some providers regarding every potential action that could constitute the basis of a malpractice claim, the application of this manner of thinking to the most obvious and unjustifiable cases is quite perplexing and equivalent of denying the obvious. Undoubtedly, some portion of the medical malpractice problem arises from trial attorneys pursuing every and all dubious causation claim with the aid of streetwalker physicians that are more then happy to bed the trial attorneys when they are able to profit from the legal system (all PI and med-mal cases require an acquiescing provider who is more than happy to peddle post hoc ergo propter hoc junk science theories of causation). Another aspect of the problem is removing the actual malpractice that occurs. One would think, unless one is dealing with a provider that has made a similar mistake and is effectively justifying their own malpractice, that competent providers would find wrong limb orthopedic surgery to be grossly unjustifiable from the ethical, medical and financial standpoint. Would you really want to have a wrong limb surgeon in your insurance risk pool?