Thursday, May 22, 2008

Appy Dogma

(Tis better to operate on a patient who doesn't need it than to not operate on a patient who needed it!) Some people are able to make decisions, others want somebody else to make the choice. Many times it is the pain in the RLQ that seperates one group from the other. I often think that you can teach anyone how to do an operation. In fact, the operation is the easy part. The hard part is knowing when to operate. In the classic trip to the operating room to rule out appendicitis, a pretty good average was to be right 90% of the time. The main idea is that you would rather go in and find out that it was a swollen lymph node or something else rather than miss the peritonitis of a missed appy. In this world where 2/3 of the attorneys on this planet are in the U.S., I wonder how long it will be before any negative appy is a lawsuit.


SeaSpray said...

I worked with a doc that felt that way about treating people for Lyme disease. she had gotten the disease herself before doctors were making that diagnosis. Instead it seemed the 1st symptom of Lyme disease was that you saw 10 doctors first before some one made the correct diagnosis.

She ended up with permanent knee damage and also Bell's Palsy. The palsy eventually got better. She told me that she would rather give a patient the antibiotics then take a chance that she missed the disease because of devastating effect of the disease going untreated.

I do wonder if she would feel the same today now that resistance to antibiotics is becoming prevalent?

You said "you can teach anyone how to do an operation. In fact, the operation is the easy part." That's interesting. It is so routine for you and you probably love it and have had so much training/experience that it is probably as natural as breathing. It has to be a calling though.

I am in awe of how you have to visualize things 3 dimensionally. How do you all know how far down to cut without going through something you didn't intend?

One of my favorite Surgeonsblog posts-Taking Trust-Oct. 06. The awe that he as a surgeon has felt just moved me so profoundly.

And you have to be in charge and make correct decisions because in the OR a mistake could mean life or death or permanent damage. You don't have the luxury of time. It's all on you. And your needing to make those decisions ahead of time...not for the faint hearted ...that's for sure.

Is that why surgical residencies are so tough? I think Panda Bear commented that in residency, surgeons eat their own or something like that vs other areas actually help each other.

Shhh! Don't give them any ideas about suing for a negative appy or negative anything else! ;)

SeaSpray said...

As a patient who has been contemplating an elective surgery since last fall and admittedly stalling...I wish someone would make the decision for me. I am capable of making my own decisions but am finding that it is so different when you have significant pain or are seriously ill and so you don't have a choice about surgery vs elective. I am a great adapter of anything and somehow manage to ignore the quality of life factor.

One of the dumbest things I ever did was put off getting seen after a knee injury..for a YEAR! Instead I lived on I-buprofen everyday for a year. And I worked around ER staff who kept telling me to get checked. Finally one night in the ER I could hardly walk.

I went to the ortho doc, he diagnosed the torn meniscus (I had no clue, I just kept hoping it would go away)I went in for the arthroscopic surgery and it was the best thing I ever did! Went to a meeting at work the next day and the day after that tossed the crutches and hit the floor running so much that I strained it but ended up ok.

Point is...I had adapted so much that I forgot what it was like to be normal!

I am probably doing it again but it's also different and I can't get past a couple of things. I trust my surgeon and he thinks it's a good idea and I believe it will be better but it's not so black and white like the knee...there are other variables. AND now...I have waited so long that I just can't go to the OR cold without contacting him or discussing it but I've already had two consults and feel silly needing to talk about it again. I know he would but then I am wasting time he could spend better with another patient. is a big deal to me.

I guess I have made a decision is a decision. I have been thinking that I am alright anyway and then something happens that tells me your not.

I know I am not alone in this. I do think there are people that would put this off.

Would you be willing to talk to a person 3 times about a surgery?

And you know what is ridiculous about this? In the past, before getting sick with the urological stuff...2 c-sections and 2 meniscal repairs...I NEVER once asked the doctors questions about the surgeries, risks or complications. Not once! Instead I went in like a lemming, knowing there can be risks but never thought about it much and then just did what they said afterward. And everything turned out well.

But now I know more and this is different. i know I am in good hands with the surgeon but it is about me post-op.

I know I digressed from your original point about surgeons needing to take the risk and make the right call prior to surgery. It just reminded how I as a patient now need to make the right call..maybe take the risk.

Hmmm perhaps my answer is here in that my surgeon already made the call but the final decision is up to me. Who am I going to trust...him with his experience or me in my fear?

SeaSpray said...
This comment has been removed by the author.
SeaSpray said...
This comment has been removed by the author.