OB-GYN-L Messages for August, 2005: Re: OB: Bladder Injury At Section

Re: OB: Bladder Injury At Section

From: Zachariah Newton

zbnewton@bellsouth.net

Mon Aug 1 17:48:54 2005

A matter of semantics. In a perfect world, there would be no bladder entry. In a scarred or unscarred uterus, the anatomical intimacy between the bladder and uterus predisposes to "inadvertent" entry into the bladder. It is an incidental event with most usually no consequence, if recognized and properly repaired. You and I are of the generation that just repaired the defect and closed, without after thought. We would tell the patient that prolonged indwelling catheter for 5 days was recommended because of the incident (not mistake). Really straight forward. Calling a urologist invites skepticism irt the magnitude of the issue. Big added expense, which involves patient with co-pay. Sew it up. Tell the patient. Maintain catheter for 5 days. Done and over with. Not a big deal.

ZBN

> ----- Original Message ----- From: R. Daniel Braun To: Multiple recipients of list OB-GYN-L Sent: Monday, August 01, 2005 6:16 PM Subject: Re: OB: Bladder Injury At Section

What I would like to know is since when has getting into the bladder at the time of repeat Cesarean been a mistake? The last time I knew, it was a recognized complication of the procedure. An undesired occurrence but far from being a priori a mistake.

Dan

On 8/1/05, Zachariah Newton <zbnewton@bellsouth.net> wrote: Joe-

I reckon that close to all of us have heard the apocryphal line, attributed to a surgeon:

"I have only made one mistake- I once thought I was wrong, and I wasn't." A classic.

ZBN --

> ----- Original Message ----- From: DoctorJoe@aol.com To: Multiple recipients of list OB-GYN-L Sent: Monday, August 01, 2005 5:49 PM Subject: Re: OB: Bladder Injury At Section

In a message dated 8/1/05 3:06:31 PM, evsono@pipeline.com writes:

Interesting thoughts on inadvertent bladder entry at section and medical errors in general ...

http://redstatemoron.typepad.com/red_state_moron/

Yes, very. . . .

The conclusion of the cited article and the commentary:

CONCLUSIONS: The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.

I did talk with a friend this morning about the episode. And even though everyone will be fine, and the patient will recover, and her bladder will return to normal... I still feel like shit.

Somehow, I feel like if this is what's gonna happen to you if you operate (when complications, misadventure, and HIGH adventure), then get off the pot.

Joe P.

-- R. Daniel Braun Kinky for Governor

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