* * Anonymous Doc

Sunday, March 21, 2010

I haven't posted in a week because I've been dealing with a family medical issue, and have been realizing what a tremendous ordeal it is to be on the patient side of things-- or at least the family side of things. And that even when you're a doctor, even when you're part of the system-- it still doesn't necessarily make things much easier.

My dad had a routine medical procedure performed a couple of weeks ago-- the details don't matter-- and was still feeling some pain at the wound site this past Monday, so he went to the doctor, was sent for an ultrasound, and they discovered a small leak in a blood vessel-- an unusual but not unheard-of complication from the procedure. He was sent to a vascular surgeon for a simple injection-- the standard treatment-- and somehow everything went awry.

From what I was able to gather, the surgeon was in a bit of a rush, a packed day of patients, and should have realized that this particular leak-- due to size and placement-- was not a good candidate for the injection, and he should have scheduled a very minor outpatient surgery to deal with the problem. Instead, he decided to go ahead with the injection, and it immediately caused a blood clot, stopping flow to my dad's entire leg and causing him to need to be rushed into emergency surgery to save the limb.

If this wasn't enough-- while in the recovery room from this surgery, after my mom had gone home, thinking everything was okay-- they discovered my dad was rapidly losing blood, and had to go back in and do a second surgery-- the surgeon (same guy who had botched the injection) had ineffectively tied off a vein in the first surgery-- the tie came loose-- and they had to repair that, and in the process replace 4 units of blood he lost.

Fortunately, this surgery seems to have gone well, with no further complications, and as of this morning, he's out of the hospital-- albeit in pain and with restricted activity for the next 6 weeks-- and doing well.

Beyond questioning the actual competence of the doctor-- the botched injection and improperly tied-off vein in the surgery-- what truly disappointed mewas the lack of communication and accountability throughout the process. When my dad was rushed into the second surgery, my mom received a phone call saying he needed another procedure-- was not told the extent of the problem, nor what had happened in the first surgery to make this one necessary-- and was promised she would be called with an update. She wasn't, and was up the entire night assuming the worst. At the same time, throughout the hospital stay, I was unable to get anyone on the phone to tell me anything, despite being a doctor, despite having attendings here call on my behalf, despite trying to explain that I merely wanted the information about what was going on, and wasn't trying to blame the surgeon.

Immediately after the injection, the surgeon's first priority became protecting himself-- from any criticism, from any accountability, from any possibility of blame-- by making it impossible to get any information from him. The morning after the second surgery, after trying unsuccessfully to get him on the phone, I sent him an e-mail-- explaining I was my dad's health care proxy, I wanted to talk to him about what had happened, I was disappointed my family was not kept in the loop overnight to know what was going on and whether my dad was alive or dead, I wanted to know the risks going forward, the treatment plan. 12 hours later I received a response saying he does not communicate with patients via e-mail and that his first priority is patient care and not "coddling the family." Again I tried calling and could not reach him-- it was not until I got the head of the resident program at my hospital to place a call that I was able to get a response, and that response was severely lacking.

The lesson learned-- and I've changed a lot of details here, so I don't want to get into the medicine specifically-- the lesson learned for me as a doctor has been about communication. Problems get worse when families aren't kept in the loop. They don't always know how you best like to communicate, they don't always know the questions to ask, they don't necessarily how to reach you, and it shouldn't be their responsibility, it should be ours. Having seen how anxious my mom became, how out of the loop I felt even as a doctor-- I realize that even on the medicine side (as opposed to surgery), it's on me to reach out, it's on me to share promptly and completely, and not to always put "call patient's family" at the bottom of the list. Better to over-communicate than under-communicate. Better to assure them you're on their side instead of fighting against them and treating them as a nuisance. I will communicate more, after this. I will learn a lesson even if that surgeon won't.


  1. Unfortunately, at least some of the problem can be traced to the legal department at the hospital where your parent was treated. They drill their attendings with what they can and cannot say to patients and their families.

    And of course the irony is that communication is all that most patients want. And most litigation--what the hospital so fears--can be prevented through good communication.

    Glad the end result seems to be okay.

  2. Best wishes for his recovery. I'm appalled at how bad the surgeon is (on so many levels).

  3. Hope your Dad recovers quickly.

    And seriously, you just learned an incredibly important lesson. I bet your patients will appreciate it more than you even realize it. Well done!

  4. Glad he's okay. Our hospital system is putting a huge focus on patient and family centered care. I think it's an invaluable lesson that you learned. I'm just sorry you had to learn it that way.