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Quality Problems in Surgery


Lasik Story

A bright-eyed college senior, I sat in the leather exam room chair for my first LASIK consult. I had chosen the nearest ophthalmologist in my small town, to evaluate my candidacy. “Do you have any questions for me?”, the doctor asked as he twisted off the cap on the bottle of eye drops. My mind went blank- “I can’t think of any questions…”

As I waited in the room for my eyes to dilate, I typed into my phone “Questions to ask my doctor about LASIK” and was inundated by a list of blurry points to discuss when he returned. Fifteen minutes later, he shined a bright light into my eyes, asking if I had a familial history of glaucoma. I shook my head and shrugged. With a sigh, he explained to me about the diagnosis of glaucoma. In an instant, my plans for LASIK had dissipated as he encouraged selective laser trabeculoplasty and handed me an informational pamphlet. “How many of these procedures have you performed?”, I asked, fiddling with the stack of papers in my hand. Confidently, he reported “I’ve completed hundreds of these surgeries… I’ve lost count.” “Do you think I should get a second opinion?” I asked. “If you want to,” he responded, “but I’m fairly confident in this diagnosis.” He stepped out of the exam room and I heard him tell the receptionist “Not a LASIK consult anymore; it’s a glaucoma evaluation.” I walked out of the office with confusion, shock, and a surgery appointment card.

Because of the looming wave of COVID-19 cases, I later received a call from the doctor’s office to reschedule my procedure, as they postponed all non-emergency cases. My roommate recommended that I seek a second opinion and sung praises of her family ophthalmologist who practiced 1.5 hours away. Three months later, we took a trip together to the big city and visited the much larger ophthalmology facility. After several diagnostic tests, the doctor notified me that I do not have glaucoma and do not need surgical intervention. Explaining the indecipherable results in his hands, he educated me about congenitally large optic discs, a more common finding in my ethnic group.

Looking back on this experience, my naivety was saved by word-of-mouth and access to a provider experienced in diverse populations. I avoided spending thousands of dollars on a needless surgery. I couldn’t help but wonder about the hundreds of potentially misdiagnosed patients who underwent this procedure unnecessarily. Patients like me need resources to find the best doctor and guidance to be able to ask the right questions.


Hip Surgery Story

Wednesday evening, the phone rang, and those dreaded words came across the earpiece; your mother is in the emergency room and has fallen and broken her right hip.

To create context for this story, allow me a moment to give you some relevance to my mother as an individual. She has been an independent soul all her life. My father’s career was very demanding; therefore, he traveled four out of five days every week. To survive, my mother became extraordinarily independent. Over time, autonomy was her comfort zone, and no other environment would be acceptable.

In the Emergency Department, the on-call orthopedic surgeon entered to assess my mother. As the family sat on pins and needles, the surgeon stated due to my mother’s medical history, the only option was to place her into palliative care and keep her comfortable on painkillers. My mother began to sob; the family asked if there were any other options, especially considering the rampant opioid pandemic. We collectively realized that for my mother, this was a death sentence.  This “treatment” meant that she would be in a nursing home for the rest of her life and be relegated to a bed with a slow miserable death ahead of her.

After the surgeon left the room, arguments ensued between family members and my mother’s face looked as though she had seen a ghost. She profoundly stated, “I’d rather die here and now. I will not live the rest of my life confined to a bed.” The family was distraught, confused, and angry. It was time to act. I pledged to find other opportunities to fix my mother’s broken hip and provide her a higher level of mobility.

I utilized some of my available resources. A surgeon from outside the area directed me to a local hospital’s Chairman of Orthopedics, who performs orthopedic surgery daily. Using my referral, the surgeon took my call immediately. I forwarded him the pertinent medical records, and he called me the very next day. He opened the conversation with, “Your mother has some options!” With relief, I brought my mother options that she could live with – literally.  The first option would strengthen the hip enough to use stairs, however, this procedure had a high risk because it required general anesthesia. Option two involved a 45-minute surgery using a regional block to allow the surgeon to place two plates with screws into the fracture point. The procedure would take place under monitored anesthesia care with a prognosis that my mother should be up and walking in 24 hours. She would not be strong enough to take stairs, but she could walk as far as her strength would allow.

When she heard her options, my mother’s eyes filled with tears of joy and she immediately selected option two: walking with no stairs. The surgeon scheduled the procedure for the upcoming Saturday morning. The surgery lasted 41 minutes and was a success. He later asked me who gave us the palliative care prognosis. When I gave him the first surgeon’s name, a furious look came upon his face. He then advised us that the surgeon was his student, and he was disheartened that better treatment options were not offered to us earlier.

Six years later, my mother is now independent and walking. She averages half a mile to a mile daily. She occasionally uses a walker for unsteady gait, but because of the surgery, she has, in her words, a nomadic life that brings her great joy.

Options are all around us – we just have to find them.

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