Tuesday, February 7, 2012

Textbook FAIL! First paragraph.

As I said before, this letter has too much going on to comment fully in just one post. Here's the first paragraph;

I've written to you in the past never imagining I would need your advice. I had surgery in August. (BTW IF you ever need abdominal type surgery run, don't walk, to the surgeon who uses the DaVinci robotic method. Fabulous! One surgeon (who fired me for asking too many questions!) was going to cut me from navel to pubis, I was to be in the hospital for 3-5 days, on pain meds for who knows how long, with six weeks' recovery time. My surgery? (same as the doctor who fired me with a little added extra fixing - a total hysterectomy and bladder fix). I was in the hospital only overnight, no pain meds necessary past day one post op, and felt as if I could go back to work the second day post op!"

Here we have our patient clearly outlining the need for second opinions. She wrote that she saw 3 doctors total, but one passed a way. She was searching for a doctor with at least 15 years of experience. The difference between what the first doctor desired and what the second doctor supplied is stark. I imagine that the COST is also a factor between the two. Kinda makes you wonder if doctor 1 had a financial interest in the treatment center doesn't it? The patient also gave her permission to do the extras. Beware of the fact that many (all?) informed consent documents have verbiage about "doctor has permission to do anything else that they deem necessary during the procedure." Cross that out. This patient was LUCKY that they actually went over the additional parts of the surgery, that MIGHT become extant. If you give them permission through vague statements on the consent form, you may end up with WAAAAY more than you ever anticipated or expected.

In my never humble opinion, allowing the doctors to do other things that they might deem "necessary" while you are unconscious or amnestic defeats the ENTIRE PURPOSE of the "informed" consent. It opens the door to abuse. It also could cause the doctor to have something in mind about what they want to do, but they don't want to even TRY to get your consent for it. So, with the vagueness of the consent, they can get you to agree to one thing specifically, knowing full well that they are going to go far beyond what was stated on the consent. You can't be too careful with medical care.


  1. Different doctors have different training. They also have different equipment and resources available to them. Doctor number one has most likely not been trained on the DiVinci system. It is not widely available in many areas. Because he performs the surgery differently than doctor number two does not make him evil, money-grubbing, or even incompetent. (I do admit, however, that there are doctors who think the know all and are not to be questioned. That is a reflection on them as people, not on the healthcare community as a whole.)

    As for your ideas on informed consent, all I can say is that you sound paranoid. Perhaps this is understandable given your past experiences. I have to tell you, though, that in this EXTREMELY litigious society, doctors can and will do whatever is necessary to cover their butts. No surgeon is going to rationalize doing anything experimental or unnecessarry simply because you signed a consent form. The clause that you are referring to is there for a couple of reasons: 1) If your surgeon is inside of you and spots something that (s)he deems to me life-threatening, (s)he has your permission to remove it. It has to be an immediate threat. If you cross out the phrase, should (s)he ignore the threat? 2) Suppose that during an orthopedic procedure to remove a bone spur that has been causing you pain, the surgeon spots a small cyst that could be contributing to the problem. Should (s)he finish up the consented procedure, close you up, wait until the drugs wear off and THEN mention what was seen? At this point you could sign another consent and have a second procedure, I suppose. Twice the pain, twice the bill, twice the anesthesia? Seems kind of silly doesn't it? If you choose to cross anything off the Informed Consent, please make sure you ask questions and think about the consequences. If you were the patient in one of the above situations, would you be okay with the surgeon following your wishes and NOT doing what should have been done? Or would you awake from anesthesia, find out what happened and become angry and indignant? Things that make you go hmmmmm...

    I fully agree that one should seek out second (or even third) opinions. Discuss and weigh your options. But please know that healthcare workers chose their field to help, not to hurt, their patients. Are there doctors out there who are in it for the money? I'm sure there are. But between the lawyers, the student loans, the government and the insurance companies who don't like to pay, I can assure you that most doctors don't take home as much as you might imagine.

  2. Thanks Jules. I agree with you on all points. If I hadn't had the shocking experience *I* had, I would NEVER have believed that these things could happen, for just the reasons you state. Please see the copy of my entire informed consent I put up a few posts back, and look at the way my surgery turned out. (same post)

    As for the bone spur you speak of. Apparently the cyst as a contributing problem is a common thing? Then wouldn't my surgeon describe this ahead of time and get permission? It does make me go hmmmm! However, the idea of being forcefully drugged, given GA against my will, (I know what happened and it-was-not-necessary!) and having somebody other than my surgeon perform my surgery etc. is not something that will happen to me again. I didn't even know where the incision was going to be! I was horrified to find that my tendons etc. were cut right through! No wonder I have loss of grip and numbness! This is a dirty trick to pull on a trusting patient.

    As it was my surgeon didn't have to get permission for anything as he wasn't there, (at all?) I signed that vague consent and I guess that I gave them permission to do whatever the hell they wanted regardless of my stated wishes. To include my doctor's allowing the PA to do my surgery. At least that's what I found out later. Very nasty business.

  3. Oh and Jules, if I were to have my bone spur operated on... I would be having a block and zero sedation, just like I expected and demanded for my ORIF distal radius. So I would be able to sign the additional consent right there in the OR. The same way I signed a consent for a bone graft while I was having my 3rd open reduction on my femur. I only had a block.... Problem solved!