"Got any advice for me since you've seen what really goes
on with medical mishaps?" As attorneys who investigate
medical malpractice cases, we're asked this alot. First,
the good news is that most physicians and hospitals do a
fine job of patient care.
But we've learned some secrets over the years that might
make your medical encounter a safer one.
1. "Will You Take My Picture?"
Thousands of Americans have gallbladder removal with a high
tech "laparoscope." It is a relatively safe procedure, but
one SERIOUS complication is cutting the common bile duct,
the "highway" between the liver and the stomach transports
bile. When this occurs, the surgeon has likely mistaken
the common bile duct for the cystic duct. The common bile
duct should NEVER be cut or damaged. The cystic duct, the
"exit ramp" on the duct highway that connects to the
gallbladder, should be cut. Common bile duct injuries
require major reconstructive surgery and can significantly
damage the liver.
A cholangiogram is a simple x-ray taken during surgery that
can identify the common bile and cystic ducts before
anthing is cut.
If you are having laparoscopic gallbladder surgery, ask
your surgeon: "If there is any doubt in your mind as to
what you are cutting, will you take an x-ray picture to
make sure before anything is cut?"
Although most surgeons do not perform cholangiograms
routinely, they SHOULD perform one if not completely sure
of the bile duct anatomy. Good surgeons should explain
under what circumstances they will use a cholangiogram or
take other steps to avoid bile duct injuries. If your
surgeon is offended by your medical knowledge, get another
surgeon!
2. Beware of Ghosts . . .
You meet with a surgeon you trust and he or she explains
what is going to happen during the surgery. After the
surgery, you discover that while you were under anesthesia,
your surgeon allowed a resident to perform the surgery. Or,
your surgeon left the room to start three other surgeries,
and delegated your surgery to someone else. You're told
none of this before surgery.
The American Medical Association coined this practice
"ghost surgery." It happens more than you think, and is
more common in teaching hospitals. In 1995 the Cleveland
Clinic was sued when a surgeon (who had four surgeries
scheduled AT THE SAME TIME) allowed a resident to perform
nasal surgery and the patient became comatose. In 1998, a
jury returned a substantial verdict in negligence and fraud
damages because these facts were not disclosed to the
patient beforehand.
You have the right to know if, and under what
circumstances, somebody other than your surgeon will be
responsible for any part of your operation. This is called
"informed consent," which means you have the right to be
informed about the medical details before giving consent to
that procedure. It's one thing to have a hospital intern
listen to your heart or lungs or palpate a lump. And it's
quite another to become an unknowing participant in
someone's medical learning curve while you're under
anesthesia.
Because you deserve the right to know, don't be afraid to
ASK about this practice, or even REFUSE to participate in a
surgery with a doctor you don't know. Besides, your surgeon
shouldn't take offense. After all, it's the ultimate
compliment to a surgeon to say: "I want you and you only to
operate because I've come to know and trust you."
3. "Can We Reschedule This for a Tuesday?"
Avoid major surgery on Fridays if at all possible. We have
seen a significant correlation between Friday surgeries and
serious mistakes that occur over the weekend. Perhaps the
physician is called on a Saturday evening and doesn't want
to come in, directing important medical decisions to others
who aren't as familiar with all the medical details. Staff
may be reduced; the possibilities are endless. And we're
willing to bet that if you asked your physician or nurse
friend about this issue, they might agree.
4. Got Allergies? Speak Up.
Don't assume that the hospital bracelet you're wearing will
be seen by staff. Yes, your allergies to medications
should be plastered all over your chart, but despite that
AND your bracelet, we have seen instances where patients
are still given medications they're allergic to, with
disastrous results.
So don't be afraid to say before receiving medication:
"I'm sure you're aware of this, but I am allergic to
________." If the nurse says, "Yeah I know," compliment
him or her for being attentive.. And if you're told, "Uh .
. . I'll be right back," and the nurse leaves with the
medication in hand, pat yourself on the back for speaking
up!
5. When No News is Not Necessarily Good News.
Test results showing a major problem, like cancer for
example, are sometimes not communicated to a patient for
months or years because of an avoidable communication
breakdown between the lab and the physician.
Any unacceptable delay in failing to inform you of your
test results is negligence. But don't assume that your
physician's silence means the results were negative. The
miscommunication possibilities between a busy laboratory
and a physician's office are real and unfortunately all too
common.
If a reasonable amount of time passes (a week, for
example), and you haven't heard from your doctor, call or
stop by the office and get a copy of the test results. Why
get a copy? If you have a common name, there might be 3 or
4 of you in your geographic area. How do you know that your
doctor received YOUR results and not some other George or
Jane Smith's? Make sure either the lab or your physician
has given you the right test results, and not somebody
else's!
6. Get a Second Opinion On That Mole.
Many times the need for surgery is obvious and your doctor
is the right person for the job. But if there is time, you
may want to explore getting a second opinion (that is, if
your insurance will allow it).
You may find out about alternatives to surgery, or you
might come away with a better appreciation of some of the
risks.
Specifically, if you've had a skin growth or mole removed
and sent to the lab, you may want to consider getting a
second opinion of the lab's findings. The reason? One
pathologist (a physician trained to read and interpret
tissues and specimens) may interpret the findings
differently than the original pathologist. This tip comes
directly from a pathologist we consulted with on a failure
to diagnose a skin cancer case. If it's good enough for
pathologists who interpret these growths daily, it's
certainly worth knowing and sharing.
7. Morphine Will Kill the Pain, But . . .
Morphine can also cause respiratory depression that, if not
detected, can cause brain damage by suppressing the body's
ability to supply oxygen to the brain. Thankfully, most
hospitals will hook up the patient to a pulse oximeter, a
painless device attached to the patient's finger that will
monitor oxygen levels. However, not all hospitals use
pulse oximeters routinely, particularly small or rural
hospitals. If your loved one is receiving narcotic drugs,
make sure he or she is hooked to a pulse oximeter, and
don't be afraid to ask for one.
8. "It Was Just a Little Ulcer and Now Look at It!"
Frequently the elderly are subject to longer hospital
stays. This means longer times of immobility, which can
lead to pressure sores and debilitating decubitus ulcers.
These are largely preventable with diligent monitoring and
observation by hospital or nursing home staff.
But due to staffing problems or inattention, many times
these sores are neglected. Do not hesitate to check for
signs of developing sores and report them to staff
immediately. And always get the name of the staff person
you spoke to. Your diligence may prevent a potential
problem from getting worse, even though it is the staff's
responsibility to look for these problems.
9. "These Don't Look Like My Blood Pressure Pills . . ."
If you receive a prescription that looks different in color
or shape than what you've been taking, do not assume you've
received some other version of your drug! Not only have we
seen patients receive the wrong drug, we have seen
pharmacies put the correct label on the pill bottle along
with the wrong medication! If you're unsure about the
medications you were given, call your pharmacist or your
doctor immediately, or even show them the drug you received.
Why are these medical safety tips important? A recent
study from the Institute of Medicine revealed that 98,000
people die in hospitals each year due to medical errors.
Translated, you are much safer driving in your car or
flying every day than entering a hospital, which is hard to
fathom.
Hopefully, one or more of these tips will increase your
odds of leaving the hospital in better health than when you
entered.
----------------------------------------------------
Brian R. Wilson is an attorney with Nicodemo and Wilson in
Canton OH and has investigated and prosecuted medical
malpractice cases for over twenty years. He is a frequent
lecturer and has written numerous publications for legal
and medical journals.
Website: http://www.n-wlaw.com
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