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Akron Univ. School of Law

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Tuesday, July 22, 2008

The Empowered Patient: Don't become the victim of a surgical error

CNN gives a few tips about what patients should do in the process of going through sugery to avoid error and mistake.  Elizabeth Cohen writes,

Hospital_patient2I thought my husband was crazy.  When our 2-year-old daughter had hernia surgery, he insisted on seeing the surgeon minutes before to remind him that the hernia was on her right side, not her left.

The nurses weren't happy; it wasn't protocol to have the surgeon meet with parents immediately before a procedure.

"Maybe this is overkill," I said to my husband. "He knows what side the hernia's on. He's already seen her twice in his office. Plus, we've told the pre-op nurses 10 times it's on the right side."

But experts tell me my husband was right on. Mistakes do happen, no matter how great the surgeon, and it behooves you to help them get it right. Witness these headlines: Minnesota doctors remove the healthy kidney of a cancer patient while leaving the diseased one behind; California doctors remove the appendix of the wrong patient; one of the most experienced surgeons in a Boston, Massachusetts, hospital operates on the wrong side of a patient. All of these mistakes happened in the past year.

Solid numbers are hard to come by, because most states don't require doctors to report surgical errors. To make sure you're not the next victim, you might have to get pushy, like my husband did.

"You need to be that thorn in their side," said Dr. Samuel Seiden, an anesthesiologist who's co-author of a study on surgical errors. "You will catch things. You might also frustrate the nurses, but you have to look out for yourself."

Of course, looking out for yourself can be tough when you're anesthetized. But Seiden and other surgical errors experts say there are steps you can take to lower the chances you'll become the next headline.

1. Check out your doctor and hospital

Specifically, ask your doctor how many times he or she has done this procedure, and compare that with other physicians.

You can check out the hospital by going to HealthGrades or The Leapfrog Group, which rank hospitals by specialty. (For example, you can find good places to get hip surgery in Topeka, Kansas, or to have a baby in New York.) The U.S. Department of Health and Human Services has detailed information about procedures performed at different hospitals.

2. Tell everyone who you are and why you're having surgery.

You may feel like an idiot, but tell all the nurses and doctors your name, your date of birth, and what surgery you're having (for example, "I'm John Smith, I was born 10/21/70, and I'm having arthroscopic surgery on my left knee."). This can help prevent you receiving a surgery intended for someone down the hall. (Of course, if your name really is John Smith, you might want to give your address, too). Consumer Tips Blog: Surgical errors

3. Make sure your doctor initials your site

The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site before surgery (shown in the group's public service ads, like the one pictured above). Make sure your surgeon -- not somebody else -- does the signing and that it's in the right place.

4. Confirm the surgery site with the surgeon right before the procedure

You may have already told the nurses, but it's the surgeon who's doing the actual cutting, so you need to tell him or her directly, says Dr. James Beaty, past president of the American Academy of Orthopaedic Surgeons.

"You should say, 'I'm not going back to surgery until I see my doctor and we confirm that this is the right site,' " he said.

5. Train someone to be your advocate

Don't just bring a friend or family member to your surgery; train them to advocate for you. You're likely to be anxious and a little addled before the surgery (not to mention asleep during it), so you'll need help.

"Equip them with the information they need," advised Ilene Corina, president of PULSE of New York, a patient advocacy group. For example, your advocate can help you check the initials on the surgical site or help you contact your surgeon.

So, how did my husband know to follow Tip No. 4, before he had the chance to read his lovely wife's column? He says it was just common sense -- and his submarine training. When you give an order in a submarine, the other person repeats it back to you, and then you repeat the order again. In engineering lingo, it's called creating a "closed loop."

Our daughter had a successful surgery, and I'm sure the surgeon would have gotten the correct side even without our involvement. Still, it can't hurt to check.

After checking, as they were wheeling our precious baby into surgery, my husband looked the surgeon in the eye, put his hand on his arm and said, "I know you've done this hundreds of times. But for us, she's our only one."

I'm sure that didn't hurt, either.

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