Surgery is safer when patients come with instructions

Doctors appreciate when you are helpful, especially if you can lend a hand with your own surgery.

A recent study conducted by the healthcare industry shows an alarming trend in America’s operating rooms. According to the study, reports of “wrong-site surgery” are on the rise.
To clarify, “wrong-site surgery” occurs when a doctor operates on, say…

Your brain.

When he was supposed to operate on, say…

Your big toe.

Or someone else.

Or even someone else’s big toe.

That’s right; in a few cases, doctors have even operated on the wrong patient. However, the report strongly emphasizes that THIS IS VERY RARE, and only occurred when doctors didn’t have the right patient to begin with:

Let’s see, according to this chart, Mrs. Freemont is 68 years old and is here for a triple by-pass. Nurse, please shave away that thick hair on her chest, right below her Hell’s Angels tattoo.”

“Doctor, are you sure this is the right patient?”

“Absolutely, it says so right here on her chart.”

“But this patient looks like a man.”

“To the untrained eye, perhaps. But if you’ll lift up her hospital gown you’ll see…HOLY COW!”

“What is it, doctor?!”

“This is going to be more complicated than I thought…”

The organization that conducted the study, which was headed up by Dr. Dennis O’Leary, says there are a number of reasons “wrong-site surgery” has increased in recent years. According to Dr. O’Leary, “Doctors are busy, and people are being put to sleep before there is an opportunity to verify who they are, what procedure is going to be performed on them, and on what site.”

What this means, of course, is that you should always insist on staying awake long enough to meet your surgeon, and, if at all possible, scrub in for the operation itself.

For situations when that isn’t possible—such as assisting with your own brain surgery, it’s a good idea to write out a list of instructions that you can keep with you at all times.

These instructions should include: Your name, the type of operation you’d like to have, and what part of your body you’d like it to happen on.

Here’s an example:

Hello.
My name is Ned.
I’d like to have brain surgery, please.
If possible, I’d like it to happen on my head.
(Please see arrows)

You should know that the surgery which holds the greatest risk to patients is orthopedic surgery, which involves operating on the arms and legs, and therefore increases possible confusion between right and left:

“Okay, let’s open up that right arm…Wait a minute. Is it supposed to be MY right, or HIS right?”

“I’m not sure, doctor.”

“Let’s see…if I turn this way, that would make it my right and his left—right?”

“That’s true, doctor, but what if it’s your left.”

“You’re right! Let’s try flipping him over, and then we can…WAIT! He’s clutching some instructions…”

I should mention that out of the estimated 40 million operations performed in the U.S. last year, only 58 resulted in “wrong-site surgery.”

I should also mention that none of them were fatal, and that all of them happened to Joan Rivers.

As you might’ve guessed, the results from this study have prompted hospitals to find ways to reduce the numbers of “wrong-site” incidents that occur each year. While I’ve had a chance to read over some of the suggestions, I’m going to refrain from including any of them here—just to avoid stepping on any toes.

Especially if they happen to be my doctor’s.

(You can write to Ned Hickson at nhickson@thesiuslawnews.com, or at the Siuslaw News at P.O. Box 10, Florence, OR 97439)

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202 thoughts on “Surgery is safer when patients come with instructions

  1. I guess I’m one of the lucky ones. I need surgery on both feet. So which ever one they pick, will be a winner. I’m just hoping they know what to do when they cut it open. As long as it’s a foot they are actually cutting. This was brilliant! Thanks for the laughs. Congratulations on being Freshly Pressed!

  2. My aunt was having surgery on her right wrist. Before her surgery, a nurse appeared and wrote “WRONG” on my aunt’s left arm with a Sharpie. She wasn’t sure whether to feel comforted by that move or whether she should get dressed and go home.

    • Ha! I had exactly that happen when I was having a surgery to install a fistula in my left arm (for dialysis purposes). They marked “Wrong” with a black sharpie on my right arm. Intrigued, I asked if they were using a special medical marker and the doctor looked at me like I was crazy: ” No, it’s from Staples.We buy them by the case, it’s cheaper.” Yikes! That’s a lot of “Wrong”‘s.

  3. I knew this could happen, but didn’t know the stats for it. Thanks for sharing. I have never had surgery, but if and when I do, I will make sure to write it in permanent market on my skin as well as have a note pinned on my gown. Sometimes a note gets lost in all the hustle and bustle, you know.

  4. LOL.

    My last surgery was on my eyes. Each time the nurse wrote on my forehead which eye was involved. (Had someone else not done it, I was prepared to mark the spot myself.) And each time I spoke to the surgeon in the OR before going to sleep. Seriously, people, make sure the surgery site is marked clearly.

    • That’s a healthy fear! Certainly healthier than liking it. Just look at most of the women of Real Beverly Hills Housewives. A healthy fear of surgery would’ve been a good thing for them.

  5. I recently had surgery, and AFTER I was drugged and a little before I fell asleep, the nurse asked me, in addition to what my name is and my date of birth, “what is the name of the surgery you are having?” Since it was a word I had avoided pronouncing completely (too long and too difficult) I gave her the lay man’s version. So she looked at me sternly and repeated, “What is the name”…. I think I fell asleep trying to say it… it was such a long name….

    • I think they give the surgeries long names on purpose so that you WILL doze off before you can finish. That’s how they know you’re ready. Plus, if you try to sue them, you won’t be able to name the operation :)

  6. This was hilarious! In all seriousness though, you are right on point. Doctors are now strongly encouraged to ask open-ended questions to their patients prior to procedures which in turn allows more room for clear communication and mutual understanding. Often, patients don’t feel empowered to speak up and overly trust their doctors to do the right procedure. Recently, David Ring, MD spoke at our hospital about his personal experience on wrong site surgery. You can read about his story here: http://www.nejm.org/doi/full/10.1056/NEJMcpc1007085

  7. Awesome Ned. Gave me a great laugh. As a dentist I can so totally relate. I always triple check my treatment notes before doing anything. At least my patients are awake when I work on them so it is harder to get mixed up but I have seen it happen among my colleagues when they are rushed and stressed. Its not life and death but you don’t want to go home with the same toothache you came in with. Or worse still someone else’s dentures.

  8. I heard about this kind of thing happening before. Luckily the only surgeries I’ve ever had were for wisdom teeth and surface problems, but I’ve been warned to take a permanent marker if the operation site is ever one of a pair or a little bit obscure.

    Of course the best thing to do is just play it safe, eat right, and not end up in the hospital if you can!

  9. Patient should have hand bands with their surgery mentioned on it so that if patient is unable to tell the doctors about his surgery, they know by reading it on his band. :D simple :)

  10. Great post, it was a very interesting read! Good thing hospitals have a “timeout” in the OR where they verify the patient’s name, type of procedure, etc. before operating. “Oops… we amputated the wrong leg, I’m sorry…” just doesn’t cut it.

  11. If a hospital is JCAH Accredited = Joint Commission = a BIG DEAL, then this problem is pretty much resolved. Every year Joint Commission establishes National Patient Safety Goals and the more recent, say, over the past 7-8 years they have put in place standards to prevent such things. A couple of them are patient identifiers and time-outs. We have to use three identifyers with every patient on our first encounter. Not just me but EVERY staff member. So the patients are wondering why we are checking name bands constantly. Three identifiers are looking at them and saying their name, looking at their name band and saying name and birthdate, and insuring the labels on the chart are the same.
    The second thing I will mention is before we start any procedure or surgery, the entire team stops and we do a “Time-Out”. We again check the name band, state the procedure, state allergies. Everyone in the room acknowledges that everything is correct. Surgery has the surgical sites marked in marker. The Time-Out is noted in the chart. Names of all staff in the room are on the chart.
    At most facilities this is now pretty much set in stone. If you are ever caught not doing these safety measures you are called out big time. And your post is exactly why. But it’s pretty much a thing of the past now. If it happens it’s rare.
    Just thought I would allay the fears of your readers.
    Peace,
    Alexandria Sage

    • Wow, and my kids think Time-Outs at home are a pain… I appreciate all you do to help keep mistakes from happening, Doc. If I ever find myself needing any kind of surgery, I will be giving you a call. I’ll bring my own markers :)

  12. My wife had 2 c-sections, the first one we thought the doctor didnt have a ruler thats why the cute looked like a half smiley face. But the second one was worst, she had an infection for 3 months :s
    surgery sucks and they take a looooooong time to recover.
    Great post.

  13. Thanks for the humor. My health provider is the US Veterans Administration known as the VA because I have a service related disability due to serving in Vietnam in 1966. At the VA we have an ID card and must show it every step of the way and when I have procedures, the nurse holds my ID card before the procedure and asks me my name, birth date, SS #, etc.

    The VA is not satisfied with just one ID. They want to verify several facts to make sure you are who you say you are. The VA also has a computerized system with all of your health info in it. What happens if someone hacks into the system and decides a patient should have a leg removed?

    Then I wonder if patients have come in with false ID to have heart surgery, for example, because the real patient doesn’t want do go through with it but feels an obligation and pays someone to do it for him or her. Sort of like one child paying another to take the blame for something and the spanking that comes with the crime.

  14. I was just telling a couple of my friends about how difficult I think it is to pull off humour through writing. This is the perfect example except it seems easy once you read this! You had us in splits. Great read!

  15. Made me chuckle! I’m extremely allergic to plaster. I had an accident when I was 11 but the hospital didn’t pay attention to my entry form and I ended up with plaques and burns all over my face because of the plaster. When I went back for the follow up op, my mother wanted to write it on my forehead but settled for a piece of paper I took with me in the operating theatre!

  16. a friend of mine needed some minor surgery on her arm and wrote in indelible ink…surgery arm, no surgery here. I thought it was so funny. Now I suspect she was fairly smart to do that.

  17. This is incredibly frightening and yet another reason why I try to avoid hospitals. I remember a couple months ago reading an article in the Wall Street Journal about how “25% of hospitalized patients were harmed by medical errors” and that “medical mistakes in the US kill enough people each week to fill 4 jumbo jets”!!!!! Here’s the link if you want to scare yourself some more. :P http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html

    • Yikes!! Maybe we should save time and money by performing all operations on jumbo jets in the first place? “This is your captain speaking. Your stewards will be bringing the beverage cart and anesthesia momentarily…” Thanks for the link!

  18. So hilarious! But what lovelifelaundry wrote – I just had bilateral breast surgery Friday, and I’m so glad I didn’t read this beforehand. However, now I’m GLAD it was bilateral given the possible consequences. (I still had to initial both girls – awkward!) The barcoded ID bracelet that I wore and was scanned numerous times before surgery freaked me out a little. Where will the hospital barcoding of patients lead? I’m reminded of the self-checkout at the grocery store. Can you hear the automated voice at the hospital of tomorrowland? “Thank you for using XYZ Hospital. Please scan your Health Insurance Rewards card [right – health insurance rewards – pffft!] and place your … melons … on the operating table.”

  19. When my first child was born, the epidural was not working and I was in a lot of pain. I was eventually sent for an emergency C-section although I was fully dilated – something was wrong. While I was being prepped for surgery, I overheard the OBGYN saying “it” would be done under local anesthesia. I remember feeling like he couldn’t hear me – although I was being pretty loud. Then the anesthetist replied frantically that I was feeling everything, that there was no time and that they had to put me under right away. When I woke from general anesthesia I asked if my baby was a girl or a boy. The OBGYN replied “a boy” and then again the anesthetist said “No, no, no, it’s a girl”. Years later, I ordered my medical file as I was moving out of province, and I discovered my daughter was “handed over to the anesthetist for resuscitation “. I thank God that guy was there that day. I cannot imagine what I would have gone through had it not been for him. There are many things we are not aware of and it’s pretty scary.

  20. Pingback: Surgery is safer when patients come with instructions « Iamnotyourmum's Blog

  21. I work in an orthopaedic place myself… and I have this to say…. It starts at the beginning… a parent or family member makes the apt and guesses the pt’s body side of said part. “I think its his left hand/foot…” and then there’s the pt error… they don’t know their own left/right side… (yes this does happen more than you think) and then there is the whole switch and bate as I call it… they make the apt for one part and then when they get into the doctor another part is worse and that part gets surgery orders and so it all gets mixed up… So yes there are errors on doctors… But patients need to realize we have to document things and if it starts out wrong… It can end up all wrong if it doesn’t get corrected… when you go to doctor… make sure the left/right is always correct… :-) we catch a ton of errors just by asking at check in every time… then all through the apt and re scheduling another apt… :-)

  22. Ned, I stayed awake once for a surgery. I wouldn’t let them put me to sleep for fear I’d never come out of it. The doctor asked if I was squeamish, and I told him, “Don’t let me look.” It was gross; I could feel the tugging and pulling when they were sewing me back up. ;-)

    • The data was from a single article which caught my eye. However, I am thinking about producing “surgery labels” people can buy and attach to themselves before the operation. It all hinges on getting Hello Kitty on board…

  23. Pingback: Meet Edward “Ned” Hickson | Alan W. King's Blog

  24. Hey Ned! As a newbie Ned groupie, just checking out some of your back posts (as required in the latest version of the “How to Avoid Accidentally Following the Wrong Blogger” manual). Ha! I’ve had numerous surgeries in the last 10 years to address cancer (now clear), kidney failure (result of radiiation treatment for cancer) and various other associated related ailments. Prevention of accidental surgery seems ot be taken quite seriously up here in Canada. Before even entering the surgical suite you are visited by a continuous stream of attending personnel, all of whom seem mostly intent on making sure you are the right patient and they are doing the right procedure. Doctors, anesthesiologist, headnurse, interns, even occassionally the janitor will drop by – all when you are looking your very best while laying half-naked on a stretcher in the hall. Recently, they had decided to put stents in my ureters to improve function. They had done one and were preparing for the second (on a different day) when the doctor visited as I lay outside the operating room. “So”, he said conversationally as he examined the X-rays, ” we’re putting a stent in the left ureter today.” Me: “Ummm, No. There is already one there – we are doing the right side today.” Doctor, while carefully scrutinizing the X-rays; ” We are? You’re sure?” Me: “Yep” Doctor stares silently and seriously for a few minutes at the X-rays, then his face lights up, and he flips the X-rays over. “Ah, there we go! The X-ray techs mislabelled ‘anterior’ and ‘posterior’ on the pictures. Sorry about that!” Me, silently, “Shit!!”

  25. Pingback: Detours, Hookers and Rockstars (Life is a Highway Vol. 3) | MamaMick

  26. Hello this is kind of of offf topic but I was wondering if
    blogs use WYSIWYG editors or if you hwve to manually code with HTML.

    I’m starting a blog soon but have no coding expertise so I wanted to
    get guidance from someone with experience. Any help would be enormously appreciated!

    • Hi Joyce,
      I must confess to being a techno-dunce. Aside from linking my blog to my Facebook, Twitter and Instagram accounts, I know nothing about coding anything. I wish I could be more help, but it would probably be dangerous.

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