Hope for the best and plan for the worst!

by: Erik Peper, Professor of Holistic Health at San Francisco State University, USA.

Medical error is the third leading cause of death in the United States!

Read what had happened to Professor Peper.

It is now two years since my own surgery—double hernia repair by laparoscopy.  The recovery predicted by my surgeon, “In a week you can go swimming again,” turned out to be totally incorrect.  

Six weeks after the surgery, I was still lugging a Foley catheter with a leg collection bag that drained my bladder.  I had swelling due to blood clots in the abdominal area around my belly button, severe abdominal cramping, and at times, overwhelming spasms.  Instead of swimming, hiking, walking, working, and making love with my wife, I was totally incapacitated, unable to work, travel, or exercise.  I had to lie down every few hours to reduce the pain and the spasms. 

Instead of going to Japan for a research project, I had to cancel my trip.  Rather than teaching my class at the University, I had another faculty member teach for me.  I am a fairly athletic guy—I swim several times a week, bike the Berkeley hills, and hiked.  Yet after the surgery, I avoided even walking in order to minimize the pain.  I moved about as if I were crippled.  Now two years later, I finally feel healthy again.

How come my experiences were not what the surgeon promised? 

All those who cared for me during this journey were compassionate individuals, committed to doing their best, including the emergency staff, the nurses, my two primary physicians, my surgeon, and my urologist.

However, given the personal, professional, and economic cost to me and my family, I feel it is important to assess where things went wrong.

The research literature makes it clear that my experience was by no means unique, so I have summarized some of the most important factors that contributed to these unexpected complications, following “simple arthroscopic surgery.”

  • Underestimating the risk. Although the surgeon suggested that the operation would be very low risk with no complications, statistically, the published research data does not support his optimistic statement.  Complications for laparoscopic surgery range from 15% to as high as 38% or higher, depending on the age of the patient and how well they do with general anesthesia (Vigneswaran et al, 2015; Neumayer et al, 2004; Perugini & Callery, 2001).
  • Inappropriate post-operative procedures. In my case I was released directly after waking up from general anesthesia without checking to determine whether I could urinate or not.  The medical staff and facility should never have released me, since older males have a 30% or higher probability that urinary retention will occur after general anesthesia.   However, it was a Friday afternoon and the staff probably wanted to go home since the facility closes at 5 pm.  This landed me in the Emergency Room.
  • Medical negligence. In my case the surgeon recommended that I have my bladder in the emergency room emptied and then go home.  That was not sufficient, and my body still was not working properly, requiring a second visit to the ER and the insertion of a Foley catheter.  Following the second ER visit, the surgeon removed the catheter in his office in the late afternoon and did not check to determine whether I could urinate or not.  This resulted in a third ER visit.
  • Medical error. On my third visit to the emergency room, the nurse made the error of inflating the Foley catheter balloon when it was in the urethra (rather than the bladder) which caused tearing and bleeding of the urethra and possible irritation to the prostate.
  • Drawbacks of the ER as the primary resource for post-surgical care. Care is not scheduled for the patient’s needs, but rather based on a triage system.  In my case I had to wait sometimes two hours or more until a catheter could be inserted, which expanded and irritated the bladder further.
  • A medical system that does not track treatment outcomes. Without good follow-up and long-term data, no one is accountable or responsible.
  • Assuming the best and not planning for the worst.

Can I trust the health care provider’s statement that the procedure is low risk and that the recovery will go smoothly?

The typical outcome of a medical procedure or surgery may be significantly worse than generally reported by hospitals or medical staff.  In many cases there is no systematic follow-up nor data on outcomes and complications, thus no one knows the actual risks.

In the United States medical error results in at least 98,000 unnecessary deaths each year and 1,000,000 excess injuries (Weingart et al, 2000; Khon et al, 2000).

The Institute of Medicine reported in 2012 that one-third of hospitalized patients are harmed during their stay (Ferguson, 2012; Institute of Medicine, 2012).

To quote Dr. Marcia Angell (2009), the first woman editor of the highly respected New England Journal of Medicine“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.  I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

Many published studies on the positive clinical outcome of pharmaceuticals are suspect.  As Dr. Richard Horton (2015), Editor-in-Chief of The Lancet, wrote in 2015“A lot of what is published is incorrect … much of the scientific literature, perhaps half, may simply be untrue.  Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

Source: https://peperperspective.com/2018/03/18/surgery-hope-for-the-best-but-plan-for-the-worst/

Comment

My friend, Phillipe, came to the centre and said, “Chris, I have already fixed an appointment with my doctor to go for surgery for my backache. Don’t worry he is an expert and he knows what to do.”

I too have backache since I was in my forties (now I am 74) and I learned how to live with it. Admittedly, in Philippe’s case, his backache caused him a lot of problem.

I did not say much upon hearing this “news” except to enquire when, so that I could visit him in the hospital.

My wife and went to see Phillipe one night after his “successful” operation. We stayed on until late that night, talking about his experience. Phillipe was happy and explained to us what his surgeon did for him. “The surgeon was a real expert!”

A week later Phillipe was discharged. We had lunch together one afternoon. Everything seemed to be okay except that he walked with a walking stick.

Phillipe then started to have pain. One leg was painful, then went off. Then the pain moved to the other leg. In spite of that he was able to drive home to KL from Penang.

Then I received a message that Phillipe had to return to Penang to see his surgeon because of the severe pain. On arrival at the private hospital, he was told the surgeon was on leave. Phillipe was then sent to the government hospital. The Penang GH doctor was not able to handle his case and immediately sent him off to a KL hospital in an ambulance.

Two days later, my wife and I flew to KL and saw Philippe in the coffin. His face was bloated. I did not know why he died. But one fact is clear, as they always say — the surgery was a success but the patient died.

Sad.

Take note of what Professor Erik Peper said, Hope for the best and plan for the worst!

 

Advertisements