I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life - well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.
But then I read what killed me: “serious complications following minor surgery.”
Now what the heck is that?
Indeed.
There is no such thing as moinor surgery when it comes to performing surgery on 90 plus year olds. any operative procedure is frought with more risk than a young healthy patient. the question to ask is was his minor surgery necesary surgery in the first place. Did the potential benefits outweight the risks (including death).
ReplyDeleteWe need a story-corps of preventable harm. Each entry might begin:
ReplyDelete"I loved my (family/friend). She/he died of serious complications following minor surgery."
Then, the host presses the guest:
"What did you do? What did you think? What questions did you ask the doctor? What answers were you given?"
I would be forgiving: "Of course, it was vascular surgery. There was a risk." But then I remember those doubts, and I might add, "She was 57. She was not in poor health."
"What were you told that she died of?" "Pneumonia." "From carotid surgery?"
"Sepsis." "From a uterine polyp?"
"Hemorrhaging." "From an endoscopy?"
Who is asking? Who is counting? Who is archiving? Where is the media? Where is the archaeologist of medical records? Where is predictive modeling of the past? Who are those protected doctors with the long list of failed work?
I don't think - at this tortured stage of the game - that unimpeachable accuracy is warranted. I'm not a doctor. I'm just reporting what I know.
Perhaps where all else has failed, the dreadful, unnecessary, very personal experience of loss deserves and demands telling. Not for catharsis, but for the value it holds to every future patient. Therefore, to every one of us, and those whom we love. And blessed be the doctor who holds my hand and tells me the truth of why my lovely aunt died. She left three children, who were never the same. Was he?
I don't know if it was preventable. But if I put it out - with the medical record - in the public sphere, perhaps you can tell me?
Anon 10:35 makes a telling point. I believe e-patient Dave and others are showing us the power of story. These are the stories we all hear at cocktail parties and from our neighbors - how powerful it would be to get them out in public. Recall the overwhelming public responses when someone's plight is reported in the newspaper - help and cash always pour in.
ReplyDeleteA certain level of outrage must be reached - only then will the Establishment change.
nonlocal MD
From Facebook:
ReplyDeleteCheryl Clark: I wondered about that too!
Mass Mouth: Thank you for posting this!
Marilyn Morrissey: As an MD friend of mine once said, "Minor surgery is what happens to other people".
Mass Mouth: My father the Doctor used to say that "no surgery is minor."
Unfortunately, death of an elderly man is considered a "minor" death. Even though Andy Rooney was elderly, if he was in decent health and certainly considered healthy enough for his
ReplyDelete"minor" surgery, then preventable harm is just that....preventable. The real complications and cause of Mr Rooney's death will likely never be revealed, because most people just excuse the death of elderly patients as unavoidable. Not true!
Bill Heisel, of the Reporting on Health blog where my Andy Rooney piece was first posted, has undertaken a daunting but worthwhile project: scouring all 50 states to learn their respective policies on releasing death certificates publicly. (link is at end of this comment). Information is power, and transparency is the best driver of improvement. I applaud Bill in this quest to undertake such a valuable public service.
ReplyDeleteSuch information is not always illuminating, however; in my father's case, we were told by hospital staff my dad probably aspirated in his sleep and choked; however his
death certificate listed COD as sepsis. When I later learned (on my own) he'd had a virulent C-diff infection, it explained
everything that had happened. To this day I can't honestly blame the docs for any "mistakes" (this strain of C-diff, I
later learned, was brand new at the time in the US, and
releases toxins into the colon at a much greater rate than
the more common strain - sometimes rupturing the colon,
which is what happened with my father.) EXCEPT that the
docs were not forthcoming with what they knew in real time. If they had raised a flag, all of us could have perhaps been
more proactive in alerting other families and providers
about the risk of this infection, and shared strategies to prevent its transmission.
http://www.boston.com/Boston/whitecoatnotes/2011/12/clipboard-private-lives-public-deaths/2HlN7IYf4LOggEopD4YPBL/index.html
Wow. What a perfect example of how waiting for all the facts puts us at an advantage to prevent them.
ReplyDeleteIf there is a culture of information sharing - which finally happened to mobilize medicine against a brilliant variant of primate virus HIV - we might be better poised for war against a world of newly emerging pathogens rather than creating monsters to distract and defeat our efforts to heal here at home (i.e. hospital).