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Re: Ob: Cesareans galore and no discussion about staples (long)From: ainsron (ainsron@sbcglobal.net)Thu Aug 17 18:27:24 2006
When I started in this business, about 30 years ago, it was sufficient to write in the chart notes: "The procedure, risks, alternatives and complications have been discussed with the patient and questions answered." In fact, I remember words like that being recommended by my malpractice carrier 25 years ago as sufficient evidence of informed consent. It amazes me how we have reached the transition where seemingly every potential complication has to not only be discussed, but specifically mentioned in our written consent to satisfy the legal eagles (and hospital bylaws, JCAHO, insurance carriers, etc.), and still we aren't protected from unwarranted suits because of our patient's expectation of perfection; if everything doesn't turn out perfect, somebody is responsible and someone has to pay. Personal responsibility, uncontrollable risk, and "poor protoplasm," are not familiar concepts or popular sentiments. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry Gregor Sent: Thursday, August 17, 2006 3:32 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Ob: Cesareans galore and no discussion about staples (long) Good comments Ashley, but I would say those same misconceptions and unrealistic expectations apply to numerous other procedures, surgeries, treatments, etc....universal human capacity to not hear what one doesn't want to hear or know, unrealistic tort system feeding into those misperceptions. Once some years ago I asked about ten patients in one week if they though it was possible in this day and age to die from pneumonia...a typical response "Not in this day and age, what with all the antibiotic and other treatments that could be used." "D. Ashley Hill" <dahmd@cfl.rr.com> wrote: Notwithstanding the potential for recurrent SD and fistula formation you describe, we have created our own problems when it comes to informed consent for both cesareans and "minimally invasive" surgery. I couldn't count how many patients feel a cesarean is a "procedure" and not a major surgery, and are suprised when I talk about the potential for blood transfusion, etc. Additionally, many patients don't believe us when we warn that their laparoscopy could convert to a laparotomy with bowel repair or ureteral reanastomosis. Patients have extraordinary expectations and they and their families (and expert witnesses) are shocked when things don't turn out exactly as they planned. I hammer into my patients that any operation can turn bad quickly despite excellent care, due to a variety of reasons, and keep hitting them with this so that they understand, among other things, that one should not undergo surgery lightly, and that performing these operations takes a lot of practice and skill. Have a good week. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Medical Director, Loch Haven Ob/Gyn Group Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando Orlando, Florida
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