Tuesday, October 21, 2008


“Got any good advice for me since you’ve seen what goes on with medical mishaps?” As attorneys who investigate and prosecute medical malpractice cases, we get this question a lot from friends, neighbors, and even family. The first thing I typically say is that the odds are in your favor. Thankfully, most physicians and hospitals do a fine job of taking care of their patients.

But we’ve learned some medical secrets over the years that are definitely worth sharing, and they just might make your medical encounter a safer one.

1. “Will You Take My Picture?”

Over 600,000 people per year in the U.S. have high tech gallbladder surgery with a scope (known as a laparoscope). It is a relatively safe procedure, but there is one SERIOUS complication you need to be aware of.

One of the most devastating injuries that can occur during gallbladder surgery is the surgeon cutting the patient’s common bile duct, which serves as the “highway” between the liver and the stomach for transporting bile. When this occurs, the surgeon has mistakenly cut the common bile duct instead of the cystic duct. The cystic duct, which is the “exit ramp” on the duct highway and which connects the gallbladder, should be cut. The common bile duct – the main highway – should NEVER be cut or damaged. Common bile duct injuries require major reconstructive surgery and can cripple a person’s ability to move bile, which can damage or even ruin the liver.

There is a valuable tool for identifying the anatomy of the bile duct system, particularly the differences between the common bile duct and the cystic duct. It is called a cholangiogram, which is simply an x-ray exam of the bile ducts taken during surgery after dye is injected into the duct. The purpose of this simple x-ray is to help the surgeon identify the bile duct anatomy before anything is cut or removed, and it will even show if a patient’s bile duct anatomy is different than normal.

So, if you are having laparoscopic gallbladder surgery, you should 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 in every surgery, they SHOULD perform one (it takes about 20 minutes) if they are not completely sure of the anatomy of the bile duct system. Any good surgeon should be willing to explain under what circumstances he or she will use a cholangiogram or take other safety steps to avoid a devastating bile duct injury. And if the surgeon is put off or offended by your question and your medical knowledge, get another surgeon!

2. Beware of Ghosts . . .

You meet with a surgeon you come to know and trust and he or she explains what is going to happen during the surgery. However, after the surgery, you find out that while you were under anesthesia, your surgeon handed off the scalpel to a resident surgeon in training. Or, equally as bad, he or she left the room to start three other surgeries, and handed your surgery off to a partner, associate, or even a resident. Of course, you’re told none of this before the surgery.

The American Medical Association coined this practice “ghost surgery.” It happens more than you think, and it happens more often in teaching hospitals. In fact, in 1995 the Cleveland Clinic was sued when an ear, nose, and throat surgeon (who had four surgeries scheduled AT THE SAME TIME) allowed a resident to perform nasal surgery and the patient went into a permanent coma. In 1998, a jury tagged the Clinic with a verdict of over $10 million in negligence and fraud damages for not disclosing these important facts to the patient beforehand.

You have the absolute right as a patient to know if, and under what circumstances, somebody other than your surgeon will be responsible for any part of your operation. This is called the law of “informed consent,” which means that each person has the right to be informed about the medical details of a procedure before giving consent to undergoing that procedure. It’s one thing to have an intern tag along during a routine hospital exam and listen to your heart or lungs or palpate a lump. And it’s quite another to become an unknowing participant in someone else’s medical learning curve during something important like surgery.

Because you deserve the right to know, don’t be afraid to ASK, and don’t be afraid to REFUSE to participate in a game of medical Russian Roulette with a doctor you don’t know and have never met. Besides, your surgeon shouldn’t take offense. If you think about it, it’s the ultimate compliment to a surgeon to say: “I want you and you only to perform my surgery 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. Although we have no hard numbers to share, we have seen a significant correlation between Friday surgeries and serious mishaps and patient mistakes that occur over the weekend. Perhaps the physician is called on a Saturday evening and doesn’t want to come in, directing an important medical decision to someone else who may not be 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 any 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 the staff. Yes, your allergies to certain 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, sometimes with disastrous results.

So don’t be afraid to say before you take a 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 on top of things. And if he or she says, “Uh . . . I’ll be right back,” and quickly leaves with the medication in hand, pat yourself on the back for speaking up!

5. When No News is Not Necessarily Good News.

Nothing is sadder than a test result showing a major problem, like cancer for example, that was not communicated to a patient for months or years because of an avoidable breakdown in communication between the lab and the physician.

Certainly, it is the physician’s job to inform you of your test results, and failure to do so, or an unacceptable delay in doing so, is inexcusable negligence. But do not assume that your physician’s silence means the results were negative. The possibilities of miscommunication between a busy laboratory and a physician’s office, or even losing the test results altogether, are real and unfortunately all too common.

So if a reasonable amount of time passes (say a week, for example), and you haven’t heard from your doctor, call or stop by the office and ask for 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 got 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.

Generally, many times the need for surgery is obvious and necessary 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 off 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 suppress the body’s ability to supply oxygen to the brain, and can lead to brain damage (anoxic encephalopathy). 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, and sound an alarm if the oxygen levels dip too low. 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 if one is not in the room.

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, if not timely documented or treated, painful and debilitating decubitus ulcers. Many of these are preventable with diligent monitoring and observation by hospital or nursing home staff.

But due to staffing problems or simple inattention, many times these sores are missed or neglected. Do not hesitate to check for signs of developing sores with your loved ones, and report them to nursing staff immediately. And always get the name of the staff person you spoke to. Your diligence and persistence may prevent a potential problem from getting worse, even though it is the staff’s responsibility to look for and treat 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 or generic version of the same drug. You may have received the wrong drug! Not only have we seen patients receive the wrong drug, have even seen situations where the pharmacy put the correct label on the pill bottle but included the wrong medication, which was the ultimate in ineptitude – and confusion-- for the patient. If you’re unsure about the medications you were given, call your pharmacist or your doctor immediately. If possible, even show them the drug you received.

* * * * * *
Why are these medical safety tips important? Here are the cold, hard facts. A 1999 Report from the Institute of Medicine revealed that 98,000 people die in hospitals each year due to medical errors. That’s double the amount of U.S. citizens that are killed on our nation’s highways (42,000). And a 2006 report from the Institute of Medicine of the National Academies concluded that medication errors harm at least 1.5 million people every year (that’s not a typo). And at least 400,000 of preventable medication errors occur in hospitals. The bottom line is that you are much safer driving across the country or flying every day than entering a hospital, which is mind boggling if you stop and think about it.

With those jaw dropping numbers in mind, perhaps one or more of these tips will increase your odds of leaving the hospital in better health than when you entered.

(visit our website at www.n-wlaw.com)

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