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Broken toe, "misunderstanding", surgery

Minor surgery and the holiday inn

 By Dr. Gifford Jones  Sunday, October 10, 2010

Harvey Cushing, Harvard’s famous neurosurgeon once remarked, “There is no such thing as minor surgery, but there are a lot of minor surgeons”. It’s still true today. This why it pays to remember Harvey Cushing’s words when a doctor says, “Don’t worry it’s only a minor procedure”.

A patient writes, “I used to skip for exercise, but one morning while skipping, I landed on the edge of a rug and broke my little toe”. Several months later she discovered that the toe rode up a bit on her next toe. She consulted her doctor who said the problem was “a minor one”, easily corrected by a little “Mickey Mouse surgery”.

The patient continued, “I told the surgeon to whom I was referred how I had broken the toe. I wasn’t told what he would do. But I was assured it was “minor surgery”.

Unfortunately the patient wasn’t scheduled for a night at the Holiday Inn where were are told “there are no surprises”. Rather, what followed was a series of unpleasant jolts. The patient expected to return to work after the “minor” surgery. But was startled to learn she would be receiving a general anesthetic. She did not return to work that day or for several more. And she was astonished to see the size of the bandage on her foot following the operation.

This was not the end of the shock. While waiting for the surgeon to change the dressing she noticed the words “congenital deformity” written on her chart. Then looked in amazement at the size of the incision that extended up her instep. And was further dumfounded when she discovered the surgeon had excised the knuckle bone leaving her with a very short toe.

The surgeon in turn was in for a jolt when the patient angrily questioned him about the congenital deformity. He calmly replied, “Of course it was a congenital problem”. But was further dismayed when she retorted, “But I broke my toe!”. The surgeon had neglected to read the note on her chart which clearly stated she had broken her toe. But some surgeons are never wrong! He recovered quickly and angrily commented, “I don’t know why you’re fussing so much, we don’t need little toes anyway”!

This patient’s minor surgery lead to other complications. Due to continuing trouble with the toe, another surgeon inserted a steel pin which failed to correct the problem. Worse still, the patient suffered a stroke coming out of the second anesthetic. Her final complaint to me? The surgeon never once stopped by to see me.

Fortunately the paralysis gradually subsided, but it did leave her with a throat problem. She was referred to another specialist who reported with disgust, “There’s nothing wrong with your throat”. The patient explained, “But I’m a soloist in the church choir.” He replied, “That’s nothing” and walked out!

I admit I don’t have the surgeon’s side of the story. So this patient may be embellishing the facts a bit. But every year enough letters of this kind arrive on my desk to make me realize all patients complaints can’t be wrong.

How can medical consumers avoid falling into the same trap? First of all, never agree to “minor” or “major” surgery without asking pertinent questions. How long will I be in hospital? When can I return to work? What are the risks? Equally important, what will happen if I don’t have the operation?

I’ve cautioned my patients for years to go into surgery on a first-class ticket. There’s little doubt that being in the hands of a well-trained surgeon will prevent many needless complications. But in an increasingly mobile society, finding him or her is easier said than done.

How do you proceed if you’ve suddenly been transferred to another part of the country? First, never, never play Russian roulette by choosing a doctor from the yellow pages of the telephone book. Or because he has a great personality. Or graduated from the Harvard Medical School. You also have to be very careful when relying on a friends referral. Even the president of your company may be in the hands of the wrong surgeon.

Only people who work with surgeons every day know who is a capable technician and possesses sound judgment. They also know who are all thumbs and should never pick up a scalpel. This means your best bet is a nurse or other surgical personnel. Even if a nurse doesn’t work in surgery he or she will have friends who do. Try to find one through a friend or someone associated with your company.

Hopefully your surgeon will also be a human being with compassion and understanding. But if you’ve been assured by operating room staff he or she is “a surgeon’s surgeon”, but has the personality of Dracula, don’t switch to another one. Remember, it’s the hands, not the personality, that will be removing the gallbladder.

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones

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