May 18, 2015

"In his decades of medical practice, Marsh has been a witness or a party to almost every kind of mistake."

"There are errors of commission (the hubristic removal of too much tumor) and of omission (the missed diagnosis). There are errors that go unreported (after a successful surgery, Marsh might decide not to tell a patient about a close call) and errors for which Marsh is held accountable. (He writes that, after one operation, 'I told them to sue me. I told them I had made a terrible mistake.') There are errors of delegation—as when Marsh allows a resident to perform a simple spinal surgery, and the patient is left with a paralyzed foot—and historical errors: at a mental hospital, Marsh encounters victims of lobotomy. One morning, Marsh operates after having a petty argument with another surgeon, and the operation paralyzes half the patient’s face. He writes, 'Perhaps this was going to happen anyway—it is called a "recognized complication" of that particular operation—but I know that I was not in the right state of mind to carry out such dangerous and delicate surgery, and when I saw the patient on the ward round in the days afterwards, and saw his paralyzed face, paralyzed and disfigured, I felt a deep sense of shame.'"

From a New Yorker article by Joshua Rothman — "Anatomy of Error/A surgeon remembers his mistakes" — about a book by the neurosurgeon Henry Marsh titled "Do No Harm: Stories of Life, Death, and Brain Surgery."

22 comments:

mccullough said...

We're all human

The Drill SGT said...

stuff happens

Texas Annie said...

Makes you appreciate Ben Carson's nerve.

Michael K said...

I don't believe him about not telling patient about a mistake. I have made a couple and immediately told the family.

Ann Althouse said...

@Michael K

What he chose not to tell about was a close call.

Hammond X. Gritzkofe said...

I recommend

http://www.amazon.com/Complications-Surgeons-Notes-Imperfect-Science/dp/0312421702/ref=sr_1_1?ie=UTF8&qid=1431962784&sr=8-1&keywords=complications

also available as audio-book from audible.com

Book covers the good as well as the bad and the ugly.

Skeptical Voter said...

I think I'll read the book. Neurosurgeons are strange and wonderful creatures--the result of long training.

A few years ago I had a benign tumor removed that was pressing on my optic nerve. After recovering from the operation, I was walked out of the hospital by a young doctor who was just starting his neurosurgery residency. He'd had four years of college, four years of med school, a year's internship, and a three year general surgery residency. Twelve years after high school, he was committing to an 8 year long neurosurgery residence. So somewhere between the ages of 38 and 40, he'd be the "young man" able to do complicated and lengthy operations. I wish him well.

Original Mike said...

I'd rather not know about a close call.

Michael K said...

"What he chose not to tell about was a close call."

I read the article and did not see that.

My policy was, and there not many errors, was to immediately tell the family and then the patient so that there would be no concern about hiding anything.

I did lots of trauma surgery and some of the worst outcomes were there. Still, there were some very funny moments. I am working on a Kindle book about it. My medical history book is still selling on Amazon after ten years.

Fernandinande said...

Michael K said...
I don't believe him about not telling patient about a mistake.


I believe it. My girlfriend had a hip replacement that quickly fell apart and the Dr. who did it was completely disinterested - "go to the emergency room". Assholes.

Fernandinande said...

These Are the 10 Most Psychopathic Jobs in America
CEO
Lawyer
Media (tv/radio)
Saleperson
Surgeon
Jounralist
Police Officer
Chef (!)
Clergy
Civil Servant

holdfast said...

Nothing like hearing "Oh F@ck!" when you're sitting by your wife's head duing a C-Section. It was all ok, but that gave me quite a scare.

Everyone makes mistakes. Most of us are lucky in that our professional mistakes can't kill.

Michael K said...

"My girlfriend had a hip replacement that quickly fell apart and the Dr. who did it was completely disinterested - "go to the emergency room". Assholes."

Maybe that explains your hostility to me. I couldn't figure it out but maybe that is a clue.

mikee said...

My wife's large medical practice instituted electronic medical records in 2014. This year, seeing a 20% drop in productivity from the doctors, because of all the time spent filling out forms on computers instead of seeing patients and hand-writing notes, despite 2 hours of finishing reports at home after work, they instituted training on how to do patient visits even faster than the 10minute visits now being used.

The end result? Computer-searchable records full of errors, incorrect info, unresponded-to computer-generated "warnings" varying from idiotic to life-threatening, reams of boilerplate inserted with cut&paste instead of actual descriptions of a patient visit. In other words, lawsuits up the wazoo whenever a lawyer decides to supoena any patient's records and review them for medical "malpractice."

You want errors? Electronic medical records is how you get errors.

My spouse is retiring as fast as possible. I don't blame her a damn bit.

Peter said...

What you don't want to hear the surgeon say when he's cutting on you: "Oh shit!"

Yes, that's just what I heard during some minor surgery done under local anesthetic. Perhaps he forgot that I was conscious?

All was well after the drape was removed that prevented me from seeing what was happening. And, yes, the error was minor and the consequence temporary.

But memorable.

William said...

We only expect perfection from police officers.

AJ Lynch said...

Was the book published posthumously? [I almost asked if he wrote the book posthumously heh]

jimbino said...

There is almost no way to tell a good doc from a bad doc or a good hospital from a bad one, since the primary goal of the medical-insurance-hospital complex is to hide the ball from the patients.

I personally reject any doc or dentist who says, "at risk for cancer" instead of the correct "at risk of cancer."

Faced with a doc who can't speak English, the patient may as well go to Cuba for better and cheaper medical care.

traditionalguy said...

The best bet is to get the Doc's reputation from other Docs and their staff because the insiders know what is carefully hidden from the patients and families.

And to all the conservatives out there who hate malpractice cases against Doctors because it is BAD to compensate victims and necessary trial lawyers with money, you are brainwashed idiots.

clint said...

"jimbino said...

I personally reject any doc or dentist who says, "at risk for cancer" instead of the correct "at risk of cancer.""

Interesting. I hear these as a dialect difference, not a right-and-wrong one.

I think it's because I parse "at risk" as an idiom rather than directly. I say that because "A high risk for cancer" sounds clearly wrong to me at the same time that "... especially at risk for cancer..." just sounds different from how I'd say it.

If you try to parse "He is at risk of cancer." non-idiomatically, it's a bit confusing why "risk of cancer" is a location. You wouldn't say "He's going to risk of cancer." or "He's headed towards risk of cancer."


Todd Roberson said...

I was sitting near my wife's head when my daughter was being C-sectioned out and the doctor says to my wife:

"Do you work out"?

Quite a mood lightener. Quite a job, too. Barely even a scar for a 10 lb. baby!

Francesca Sweeney said...

mikee: I don't blame your wife in the least. Doctors are being turned into 'machines of accountability', when really compassion and a qualified ear are all that should be offered to patients. I see the sense in putting ceilings on the time of visits, but the record-keeping is a huge burden on professionals, and time that effectively gets robbed from patients who often feel they are "taking up the doctor's time". Something has to give. A doctor ex-student of mine had a medical-angle reading of the NYer article:"...Sounds interesting that book, moral luck is a big issue in all medical disciplines, with a graver impact in branches like oncology and surgical oncology. Writing about outcomes and medical error takes some honesty and some balls, though he's probably trying to self-cleanse, which can also be interpreted as an act of selfishness. See no patient is getting better by his book, no family getting their loved ones back, no punishment will be inflicted on him, no good comes to medical practice - he is not writing a scientific paper to help young doctors avoid his mistakes. He is a decorated neurosurgeon who - though still active - has the time to write novels in a - I dare to say - whining tone and philosophize on how hard and psychologically exhausting his field of work is. All to shock, provoke sympathy and sell a few copies? Maybe I come across too harsh but I know there are other factors that control outcomes and the human factor is usually negligible next to the financial one..." THE HUMAN FACTOR IS USUALLY NEGLIGIBLE NEXT TO THE FINANCIAL ONE = THE ULTIMATE INDICTMENT.