Tuesday, December 12, 2006

No Answer Expected

I just read on a doctor’s blog that “. . . there is a generally accepted rule that one surgeon does not clean up another surgeon's mess. It's a bad idea for many reasons not the least of which is a liability one.”

How many chances does one give a surgeon to clean up his own mess?

I don’t expect an answer.

I'm not really picking on surgeons. I'm just in that kind of mood.

16 comments:

Working the shallow end of the gene pool said...

Usually it is not necessarilly the surgeons mess, but rather the patient was a mess in the first place. example: obese, massive rolls of fat -- has appendicitis -- undergoes surgery -- develops wound complications because can't keep twinkies out of the wounds -- needs revision -- develops incisional hernias, abscess, etc.... Who would want to go stepping into that after someone already had the unfortunate luck of stepping into ii the first place?

#1 Dinosaur said...

And sometimes it *is* the surgeon's mess. Or a whole bunch of surgeons, like the trauma service at a big downtown trauma center who mis-managed a pancreatic injury from a gunshot wound in a thin healthy man in his 30s. (Not a gang member,either; just a guy with a crazy neighbor who, after years of feuding, followed him into Home Despot and shot him.)

When I got him back two months later, he was in full blown narcotic withdrawal (among other things) because although Percocet was listed on his meds, no one had given him a prescription. It took a lot of calling around and cajoling to find the sainted suburban surgeon who finally agreed to see him through the rest of his 18 month recovery.

Medblog Addict said...

I guess my mood has improved because I am sitting here laughing at the picture in my head that “can't keep twinkies out of the wounds” conjures up. Thanks to both of you for stopping by and offering your perspectives.

Anonymous said...

I think there's a mid point to this too. Although I increasingly see my fellow knife men disregard their patients post op, they're not all bad. And in many cases, the 'mess' will be a ligament repair (i.e cruciates in the knee), or somesuch, that has failed - often through no-ones's fault, but because shit happens. And ANY re-operation is going to be harder than a virgin case, what with scarring and abnormal anatomy. 'Top' surgeons won't see other people's 'mess' because it is bound to besmirch their figures.
Personally, I think it's the true masters of their art that will take on any case, no matter who's hands have been there first... but that's just one shroom's opinion

Anonymous said...

I would not agree that it's a generally accepted rule. If a patient is in need, their needs must be met. It's certainly true that I hated to have to go in where another had made some sort of mess: for many reasons, it's ideal if the original surgeon continues care. But when that surgeon is -- for whatever reason -- no longer part of the picture, you do what you have to do. It's also true that I've been shotgun named in a couple of suits directed at the original surgeon; but my name got dropped sooner or later.

Nor can I resist saying that a person who lived through a gunshot to the pancreas was not necessarily mismanaged, even if his narcotic needs were.

It was certainly my view that I'd rather manage all aspects of my patients' care until they were fully recovered. Having the primary doc wander into the hospital, occasionally leaving irrelevant or inappropriate orders did nothing but complicate the good care I was providing. So there.

#1 Dinosaur said...

So there yourself, Sid. I agree that wandering primaries with inappropriate orders are a PITA, though in this case I never saw him in the hospital. And it was the sainted suburban surgeon who later told me (privately) that the original injury had been mismanaged. (Apparently it hadn't been properly explored -- perhaps not even found -- at the original surgery.)

*channeling Prissy* "I don't know nuttin' 'bout no surgical management of pancreatic gunshot wounds."

Medblog Addict said...

What do you mean, stir up trouble? I just wanted to make sure Dr. Dino had an opportunity to respond.

Really.

Anonymous said...

It was said tongue in cheek. Couldn't you see the bulge? On the other hand, Dino and I seem to have had a couple of dust-ups already, and although I'm pretty sure it's in the spirit of honest (if piquant) dialog, and given that I can't seem to stop myself, I don't want to get into a continues pricking, as it were. I like the guy. And you.

Anonymous said...

continuous, supposed to have been.

Medblog Addict said...

I’m just having some fun with you. I’ll try to play nice from now on. And in case I haven’t said it lately, I really appreciate you stopping by and commenting.

Medblog Addict said...

"Personally, I think it's the true masters of their art that will take on any case, no matter who's hands have been there first..."

I like that. Very nicely said.

(I thought I said this in an earlier comment, but I guess it didn't show up.)

Anonymous said...

I agree with Sid on this issue.

One area of contention in general surgery in my region just now is that the general surgeons (transplant surgeons, actually) still perform the vast majority of thyroid and parathyroid surgery.

When they run into trouble, the call an otolaryngologist. The otolaryngologists think the general surgeons shouldn't be operating on cases where they're unable to manage their own complications... but the general surgeons want to keep the thyroids and parathyroids for a whole host of other reasons.

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Medblog Addict said...

SeaSpray - I tried to e-mail you but had a problem with the e-mail address on your blog. I don't link to this blog for a reason.

If you’d like to, e-mail me at medblogaddict at yahoo dot com. One day, I am going to learn how to add that to my blog.

Dr. S – Off topic, but I loved your story. I am now seeing you in a whole new light.

Hospital Phoenix – Thanks for stopping by. I found your blog via Angry Medic. I was supposed to try to cheer you up, but being “comment challenged” I couldn’t think of anything to say. I can say that every time I left your blog, I was cheered up. I love the adventures of N.Q.

Anonymous said...

I think in an ideal world, the operating surgeon should follow the case through... this should mean, in an ideal world, that they are able to deal with any expected complications. If you can't, I'm not sure you should be doing the cutting... it's a very contentious issue, evidently. I think I'm biased because Pa Shroom was an old school general surgeon, happy to open from top to tail when necessary, and manage his own complications... but I wonder if his figures would compare well to a practitioner who limits his scope. This sort of angst led to me putting the knife down in the first place...