Gall Bladder Disorders – Healthy.net

Medical Disasters and How to Avoid Them (Part 2)

Pierce Scranton MD — Sat, 14 Jul 2007 13:37:21 +0000

The new documentary by Michael Moore called SICKO has launched nationwide heralding the cry of health care reform due to the inadequacies of the health care system. Dr. Pierce Scranton, an Orthopedic Surgeon, arms us with practical tips on how to take charge of our own experiences while at a hospital and he teaches us how to protect ourselves and prevent any travesty that could occur.

In the second installment of “Medical Disasters and How to Avoid Them” with Dr. Pierce Scranton, you will see what can go wrong in a large teaching institution where inadvertent errors can occur when many people are involved in your care. Dr. Scranton will give you tips and questions to ask so you can avoid these problems.

Case 2 – J.G.’s Gall Bladder Surgery

J. G. was referred to a regional teaching hospital for abdominal surgery to resect a chronically inflamed gall bladder. For months he’d ignored chronic symptoms of abdominal pain and indigestion, hoping it would “get better on its own”. This led to the formation of significant scar tissue and inflammation and thus the referral. He was impressed with the attending surgeon who was nationally known and well-respected, and he was pleased with all the bright medical students and surgical residents that came by the clinic on rounds to discuss his case. The next day the attending surgeon reassuringly said hello to him in the pre-op holding area. However, when J.G. went under anesthesia this surgeon handed off the case to the chief resident, and he left the room to make phone calls. The gall bladder had been chronically infected and there was a great deal of inflammation and bleeding. Lots of hemostats and electro-cautery were necessary to control the hemorrhage. After the chief resident had controlled bleeding, he successfully removed the gall bladder which had several gall stones in it. He then handed-off the case to the junior resident to close. The attending surgeon poked his head in to make sure everything was well and then left. The chief resident took a phone call himself and then left to see consults. The junior resident irrigated the wound with saline, and then used the abdominal closure as an opportunity to teach medical students how to tie surgical knots. Two days later J.G. was running a high fever. He alternated between vomiting and hiccoughing. Then the lower part of his wound popped open where the sutures hadn’t been tied properly. Later, an X-ray showed a hemostat was still in his abdomen. This time the attending surgeon personally performed the entire surgery skin-to-skin to remove the hemostat.

How to avoid this problem and not be a “teaching case.”

Be actively engage don’t be afraid to ask questions. Write down your questions so that you’re organized, making efficient use of your time with the doctor. Carefully listen to the doctor’s answers and do not waste time asking the same questions twice or lecturing the doctor on what you’ve learned on the internet.
You must realize that, by definition, in a teaching institution someone is going to be learning on you. Be vigilant, especially about the daily medicine that arrives and when anyone shows up to provide treatment. Don’t be afraid to ask what it is they are going to do.
Do not be afraid to ask, “Doctor, are you personally going to perform my surgery and be there for the entire case?” On the OR Consent form you can cross out the part that allows others “designated by the doctor” to assist and provide care. You can in effect negotiate with the surgeon to guarantee that he personally is going to perform your operation.
Be informed! Ask what can go wrong, and what the doctor will do to avoid these problems or treat them if they occur.

Remember, it’s your health and well-being that’s on the line. Be engaged in the process, and stay healthy!

Physicians Have Fewer Surgeries

David S. Sobel MD — Wed, 06 Dec 2000 13:28:52 +0000

Your decision about whether or not to have non-emergency surgery will be influenced by your expectations and understanding as well as the desires and biases of your surgeon. What patient can resist an enthusiastic surgeon? Apparently, the answer is other physicians.

When faced with a surgical decision, who better to be than a physician? You would be among the best informed consumers. You would be well aware of the risks, benefits, and alternatives to the proposed procedure. And, according to the results of a new study, you would be less likely to have surgery at all.

Researchers compared surgical rates for physicians, lawyers, and their families to the general public in a large population in Switzerland. They looked at rates for the surgical removal of tonsils, gallbladder, uterus, hemorrhoids, appendix as well as repair of hernias and D&C (dilatation and curettage of the uterus).

For all of the operations except appendectomy, the general public went under the knife much more frequently than physicians or their families. For example, if you don’t have a physician in the family you are 50% more likely to have had a tonsillectomy, hysterectomy, or hernia repair and 80% more likely to undergo removal of hemorrhoids or gall bladder. If you want to avoid surgery, it also helps to have a lawyer in the family. Their surgical rates were almost identical to physicians!

These differences don’t seem to be due to financial barriers since all patients were covered by the public insurance programs and even the poorest had access to needed surgical services. Nor does it appear to be differences in how sick the general public was compared to physicians and lawyers. While some disease rates do vary by level of income and occupation, there is little evidence of variation in the specific types of disease for which these surgical procedures are indicated.

It appears that the more informed you are, the less likely you are to ask for or agree to elective surgery. Lawyers seem to have a special immunity to surgery. Lawyers may be more likely to challenge the surgeon’s authority and have greater potential for causing legal problems. Physicians may tend to be more cautious and prudent about recommending elective surgery to these “risky” patients.

We don’t know for sure the optimal rate of these surgical procedures that yields the best overall outcomes for patients. Nor do we know whether the reversal of financial incentives from fee-for-service to prepaid, managed care will lead us closer to optimal surgical rates. Nevertheless, we suspect that more operations are performed than are needed and that we would all do well to more closely follow the example of the most informed consumer, the physician-patient.

For More Information:

Sobel D, Ornstein R: Preparing for Surgery, Mind/Body Health Newsletter, Volume V, Number 2, 1996.

Domenighetti G, et al: Revisiting the most informed consumer of surgical services: The physician-patient. International Journal of Technology Assessment in Health Care 1993;9(4):505-513.

Domenighetti G, Casabianca A: Rate of hysterectomy is lower among female doctors and lawyers’ wives. British Medical Journal 1997 May 10;314(7091):1417.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

Valine

Elson M. Haas MD — Wed, 06 Dec 2000 13:28:02 +0000

Valine is found in substantial quantities in most foods and is an essential part of many proteins. Other functions of valine are not really known, though it is thought to be somewhat helpful in treating addictions. A deficiency may affect the myelin covering of nerves. Valine can be metabolized to produce energy, which spares glucose. Like leucine and isoleucine, valine is a branched-chain amino acid with similar metabolic pathways. A potentially deadly hereditary disease, commonly called the “maple syrup urine disease,” blocks the metabolism of these three amino acids. In children affected with this disease, keto acids are dumped into the urine, making it smell like maple syrup. The amino acid deficiencies that result cause problems with the nervous system, seizures, and a failure to thrive. Valine supplementation may be helpful in muscle building (along with isoleucine and leucine) and in liver and gallbladder disease.