[HSF] "Easier to let pts suffer than to do what is right"

Mon Feb 11 11:52:06 EST 2008

feathers not dots.

tea

----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, February 7, 2008 8:13:42 PM
Subject: Re: [HSF] "Easier to let pts suffer than to do what is right"

Red or East Indians ? :)
Prasanna

On Feb 8, 2008 12:16 AM, Tea Acuff <tacuff at swbell.net> wrote:

> This is a problem. I have practiced primarily in small hospitals for the
> last decade and got tired initially of being the "only" surgeon who was
> having "problems" as defined by adminstrative sources. How many take backs
> for bleeding or transfusions are in an ENT practice? They don't even take
> most patients back to the room; they discharge them home.
>
> We solved this peer problem with setting up a CV section. While not
> perfect, at least cardiologists are aware of the problems that we see and
> don't immediately assume you are a wreckless operator based on the need for
> "persistent or recurrenct therapies". It is much bettter than other peers. I
> recreate this solution in different small hospitals when I set up (or
> participate in new) services.
>
> As to small practices such as n=1, it does eliminate some of the problems
> of not admitting to errors. On the recognition side everyone is on the same
> page, which gets rid on a dominate source of confusion and second guessing.
> It is like being Roberto's boss except their are no Indians under the chief.
>
>
> tea
>
>
> ----- Original Message ----
> From: John Schor <johnschor at mac.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wednesday, February 6, 2008 5:47:53 PM
> Subject: Re: [HSF] "Easier to let pts suffer than to do what is right"
>
> I have worked with people who would not admit their own errors. I have
> seen many pt's "buried" due to surgeons not doing the right thing, ie
> reoperating on a pt like Hal's while under close scrutiny. I no longer
> work with those people.
>
> I am now alone in practice in a rural area of Northern Arizona. When a
> pt has any complication, the whole medical staff immediately knows
> about it. If a surgeon reoperates, read "unplanned procedure", a flag
> is raised on the chart and it is automatically reviewed by a member of
> the "peer review committee".
>
> It's usually a primary care doc, pediatrician, radiologist, or other
> "peer" who has to figure out whether the Board Certified CT Surgeon
> knows what he's doing and has provided standard of care.
>
> I have had a couple of "unplanned procedures" because I am very
> conservative and will reexplore pt's if things "just don't look
> right". Any one on the HSF would understand and even commend such
> behavior, but small town medical politics are very interesting.
>
> On the other hand, I do have a monopoly for a 60 mile (100km) radius.
>
> John
>
>
> John Schor, MD
> Verde Valley Medical Center
> Cottonwood, AZ 86326
> Tel: 928-649-2584
>
> On Feb 6, 2008, at 2:20 PM, Nasser F. Abou'Seada wrote:
>
> > "a place that keeps tabs on which pt's go back to the
> > OR; then secret tribunals are held in order to "educate" the medical
> > staff. It takes guts to take on cases like that. It's a lot easier to
> > let pt's suffer than to do what is right."
> >
> > Dear John
> > please elaborate more ....
> > sounds the same everywhere !!!!
> >
> > NFA
> >
> >
> >
> > On Feb 6, 2008 3:06 PM, John Schor <johnschor at mac.com> wrote:
> >
> >> Hal:
> >> Great job!
> >> You prove the point that we can only know so much without operating.
> >> Pontificating is the worst place to be. It is clear you are a Jedi
> >> Master; "May the force be with you".
> >>
> >> I am currently at a place that keeps tabs on which pt's go back to
> >> the
> >> OR; then secret tribunals are held in order to "educate" the medical
> >> staff. It takes guts to take on cases like that. It's a lot easier to
> >> let pt's suffer than to do what is right.
> >> I admire your efforts.
> >> John
> >>
> >>
> >> John Schor, MD
> >> Verde Valley Medical Center
> >> Cottonwood, AZ 86326
> >>
> >>
> >> On Feb 6, 2008, at 10:03 AM, Hgrmd at aol.com wrote:
> >>
> >>>
> >>> Prasanna,
> >>>
> >>> ? Thanks.
> >>>
> >>>
> >>>
> >>> Hal
> >>>
> >>>
> >>> -----Original Message-----
> >>> From: Prasanna Simha M <prasannasimha at gmail.com>
> >>> To: OpenHeart-L at lists.hsforum.com
> >>> Sent: Wed, 6 Feb 2008 11:55 am
> >>> Subject: Re: [HSF] (no subject)
> >>>
> >>>
> >>>
> >>>
> >>> Gut instinct pays.
> >>> Prasanna
> >>>
> >>> On Feb 6, 2008 10:17 PM, <hgrmd at aol.com> wrote:
> >>>
> >>>>
> >>>> Ahmed,
> >>>>
> >>>> ? Thanks for your words.? Parenthetically, all of my partners
> >>>> advised me
> >>>> not to operate.
> >>>>
> >>>>
> >>>>
> >>>> Hal
> >>>>
> >>>>
> >>>> -----Original Message-----
> >>>> From: alsadd <alsadd at ksu.edu.sa>
> >>>> To: OpenHeart-L at lists.hsforum.com
> >>>> Sent: Wed, 6 Feb 2008 5:33 pm
> >>>> Subject: RE: [HSF] (no subject)
> >>>>
> >>>>
> >>>>
> >>>>
> >>>> Congratulations Hal a job well done. It is the thing to do bite the
> >>>> bullet.
> >>>>
> >>>>
> >>>> Ahmed
> >>>>
> >>>> -----Original Message-----
> >>>> From: openheart-l-bounces at lists.hsforum.com
> >>>> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
> >> hgrmd at aol.com
> >>>> Sent: Wednesday, February 06, 2008 3:21 AM
> >>>> To: OpenHeart-L at lists.hsforum.com
> >>>> Subject: [HSF] (no subject)
> >>>>
> >>>> Dear Members,
> >>>> ? Two days ago, I reoperated on the gentleman with the stenotic and
> >>>> thrombosed SVC.? I'm glad I did.? I femorally cannulated and went
> >>>> on pump
> >>>> prior to splitting the chest (he was 3 weeks postop).? I only
> >>>> dissected
> >>>> the
> >>>> right atrium.? The adhesions were torture.? The tip of the femoral
> >>>> cannula
> >>>> was advanced only into the IVC.? No effort was made to control
> >>>> either
> >>>> cava.?
> >>>> The heart stayed warm and beating.? A right atriotomy was made and
> >>>> extended
> >>>> across the RA-SVC junction.? It was tightly stenotic.? A large
> >>>> amount of
> >>>> clot was retrieved with a 6mm Fogarty.? A large patch of bovine
> >>>> pericardium
> >>>> was placed.? The whole operation took less than 3 hours.?
> >>>> Yesterday, it
> >>>> was
> >>>> evident that his facial and forearm edema were markedly improved.?
> >>>> He's
> >>>> already on Lovenox and Coumadin.
> >>>>
> >>>> Hal
> >>>>
> >>
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> >>>
> >>> --
> >>> Prasanna Simha M
> >>> _______________________________________________
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-- 
Prasanna Simha M
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