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 Surgery: Medical Disasters and How to Avoid Them (Part 2) 
The new documentary by Michael Moore called SICKO has launched nationwide heralding the cry of health care reform due to the inadequacies of the health care system. Dr. Pierce Scranton, an Orthopedic Surgeon, arms us with practical tips on how to take charge of our own experiences while at a hospital and he teaches us how to protect ourselves and prevent any travesty that could occur.

In the second installment of "Medical Disasters and How to Avoid Them" with Dr. Pierce Scranton, you will see what can go wrong in a large teaching institution where inadvertent errors can occur when many people are involved in your care. Dr. Scranton will give you tips and questions to ask so you can avoid these problems.

Case 2 - J.G.'s Gall Bladder Surgery
J. G. was referred to a regional teaching hospital for abdominal surgery to resect a chronically inflamed gall bladder. For months he'd ignored chronic symptoms of abdominal pain and indigestion, hoping it would "get better on its own". This led to the formation of significant scar tissue and inflammation and thus the referral. He was impressed with the attending surgeon who was nationally known and well-respected, and he was pleased with all the bright medical students and surgical residents that came by the clinic on rounds to discuss his case. The next day the attending surgeon reassuringly said hello to him in the pre-op holding area. However, when J.G. went under anesthesia this surgeon handed off the case to the chief resident, and he left the room to make phone calls. The gall bladder had been chronically infected and there was a great deal of inflammation and bleeding. Lots of hemostats and electro-cautery were necessary to control the hemorrhage. After the chief resident had controlled bleeding, he successfully removed the gall bladder which had several gall stones in it. He then handed-off the case to the junior resident to close. The attending surgeon poked his head in to make sure everything was well and then left. The chief resident took a phone call himself and then left to see consults. The junior resident irrigated the wound with saline, and then used the abdominal closure as an opportunity to teach medical students how to tie surgical knots. Two days later J.G. was running a high fever. He alternated between vomiting and hiccoughing. Then the lower part of his wound popped open where the sutures hadn't been tied properly. Later, an X-ray showed a hemostat was still in his abdomen. This time the attending surgeon personally performed the entire surgery skin-to-skin to remove the hemostat.

How to avoid this problem and not be a "teaching case."

  1. Be actively engage don't be afraid to ask questions. Write down your questions so that you're organized, making efficient use of your time with the doctor. Carefully listen to the doctor's answers and do not waste time asking the same questions twice or lecturing the doctor on what you've learned on the internet.

  2. You must realize that, by definition, in a teaching institution someone is going to be learning on you. Be vigilant, especially about the daily medicine that arrives and when anyone shows up to provide treatment. Don't be afraid to ask what it is they are going to do.

  3. Do not be afraid to ask, "Doctor, are you personally going to perform my surgery and be there for the entire case?" On the OR Consent form you can cross out the part that allows others "designated by the doctor" to assist and provide care. You can in effect negotiate with the surgeon to guarantee that he personally is going to perform your operation.

  4. Be informed! Ask what can go wrong, and what the doctor will do to avoid these problems or treat them if they occur.
Remember, it's your health and well-being that's on the line. Be engaged in the process, and stay healthy!

(Excerpted from Death on the Learning Curve: The Making of a Surgeon ISBN: 1600700144)
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 About The Author
Pierce Scranton MDPierce Scranton Jr. is a graduate of Kenyon College. After completing medical school and an orthopedic residency he entered private practice in Seattle, Washington. He was team physician for the Seattle Seahawks......more
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