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We interview a lot of medical experts on our syndicated radio show but we don’t usually test their advice ourselves. We just had an opportunity to do that, though.We recently interviewed patients-rights advocate Janet Lynn Mitchell and Pierce Scranton, MD, for a forthcoming radio show on avoiding medical errors. They talked about how patients can protect themselves from mistakes and misadventures.
We found ourselves striving to remember Dr. Scranton’s “questions to ask first” when emergency room providers told us that Terry’s belly pain was appendicitis and that it was going to require surgery…right away. No time for homework, not even on the Web.
We asked the chief resident who was planning to do the surgery how many of these operations he had done, and he responded that he had done over a hundred. That sounded pretty good, but maybe not quite good enough if the appendix was as nasty as the radiologist suggested. We asked about potential complications and how they might be handled. We asked how long he had been on call and who, exactly, would be doing the surgery. And we asked to speak to the attending surgeon who would be supervising, since a resident, even a chief resident, is a learner who needs supervision.
We were glad we did. We were also glad we asked to speak with the anesthesiologist, so we could explain that after a previous surgery, Terry had taken an exceptionally long time to start breathing on her own again. The anesthesiologist assured us that he and the nurse anesthetist would be paying close attention so that she would be given smaller amounts of several different kinds of anesthesia to minimize post-surgical breathing problems.
As a result, though the surgery to remove the inflamed appendix laparoscopically (through a small “port” above the belly-button rather than through a large incision) took longer than expected, the recovery was far easier than with the previous surgery. When the attending surgeon came by for the post-op check the following day, he mentioned that it had been a more complicated procedure than they’d envisioned, but we had the clear impression that he had done it himself. We suspect that if we had not asked to speak with the attending surgeon, the chief resident would have done the surgery. It might have gone just as well, but he has far less experience than the attending and might not have known quite what to do when he discovered there was a lot of inflammation around the appendix.
We certainly are glad we spoke up and grateful we had had time to think about asking questions before we were faced with a crisis. Here are Dr. Scranton’s questions for you to ask your doctor:
Dr. Pierce Scranton’s questions:
1) How long have you been in practice?
2) What is your experience in treating this condition?
3) What are the treatment options, and what other options are available that you or the health plan are not offering? If you don’t understand the doctor’s basic explanation of your condition and treatment, then by all means ask him or her for more information.
4) What are the possible complications of the proposed medical treatments or surgeries?
5) If there are any complications, how will you correct the problem?
6) Aside from your own partners, who would you go to for medical treatment if you had this condition?
7) Are you personally going to perform the surgery?
8) Will others assist and participate, in a major way, in this medical treatment?
9) Can I ask your bookkeeper what my financial responsibility will be? You need to know in advance…and don’t be afraid to negotiate!
From http://seniorliving.about.com/od/doctorshospitals/a/medicaltreatmen.htm
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Very good advice. I would add that people who live in rural areas should find out who the best surgeon or specialist is and ask for him by name in an emergency situation. Hospitals in such areas do not have resident staff and all services are rendered by attending physicians.
Dr. Scranton suggested calling the local hospital OR and asking if a Doctor was a good one.
I work in the OR, and none of us can answer that question without opening ourselves up to a law suit. Can we really judge a Doctor?
The way to ask the question, that we can answer, is "If you needed to have your shoulder operated on, who would you go to?" Then, we can answer.
Over the past years I have helped my parents through illness and their ultimate decline and deaths. I cannot stress enough the power of taking notes on what the medical professionals are saying. I've caught discrepancies between what the doctor said he was ordering and what the nurses implemented. I found that the medical professionals would sometimes get defensive about the note taking, but it is your right. The information comes fast, hard and complicated. Keeping a medical journal was the only way I could keep it straight. I headed off misadministrations of meds, treatments and unecessary tests. It pays to be vigilant. Nan
These recommendations are not as straight forward as they may seem. As noted by the OR nurse, it is quite unlikely that any nurse will tell you whether a doctor is good, or not.
As regards Joe's impression that the attending physician actually did the surgery, he is probably mistaken. It is standard practice at a teaching institution for the senior resident to do the actual surgery. It may have been under the supervision of the attending staff, but probably wasn't done by the attending physician except under very unusual circumstances. Remember, these are TEACHING hospitals. You cannot be good in private practice unless you get meaningful training first. If a patient is uncomfortable with this, he or she should not go to any hospital which is a training hospital associated with a medical school. The likelihood is then greater that your doctor will have finished his training. It should be noted that certain types of surgery are best done in a teaching hospital, such as trauma cases and complicated surgeries. Young doctors in their training are much more experienced and adept at these procedures than a physician in a community hospital who may only do several complicated surgeries every year.
I agree with Andrew G's comment that in a teaching hospital, the residents will do the treatment (surgery or other) with supervision by the professor (attending staff Dr.). I worked as a technician for a cardiac catheterization lab and observed the skill possessed by the residents who were always being guided by the MD professor. (One resident later became Chief of Thoracic Surgery at the teaching hospital). I would rather have a Sr. resident than a local private practice MD for almost any medical help.