Sunday, September 16, 2012

Medical Complications and Medical Negligence: What's the Difference?

The day before this writing, a patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure.

I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I told him, yes, there have been a few perforations. I continued the dialogue in order to place the issue in context for him and his wife so he wouldn’t be spooked before his procedure. We didn’t want a panicked patient leaping off the gurney and high-tailing through our waiting room in a flapping opened-back gown to the parking lot. Fortunately, our discussion accomplished its purpose and his procedure proceeded calmly and uneventfully.

Sure, complications matter, but numbers can deceive. Our most highly experienced physicians have likely had more complications than other medical colleagues, although their complication rate may be very low. For example, a known complication of heart surgery is the dreaded complication of a stroke. A heart surgeon, who has operated on thousands of patients, may have had 25 stroke complications. A younger surgeon, however, may have only have had 3 or 4 stroke complications in his briefer career. Which surgeon would you choose?

In addition, a doctor’s higher complication rate may reflect that he accepts more risky and challenging patients that other physicians have rejected.

Perforation of the colon after a colonoscopy is a terrible event, mostly for the patient and the family, but also for the physician. While it is rare, it is inevitable. If your gastroenterologist has never had one, he likely has very limited experience. If this is the case, don’t jump off the gurney. Recognize, however, that a perfect record doesn’t mean medical perfection.

Keep in mind that complications are blameless events. They are not negligent. If you prescribe penicillin to a patient who denies allergies, and a severe rash develops, then a complication has occurred. The physician is not culpable. However, if the patient had a known penicillin allergy, and the physician neglected to inquire about medication allergies, then the same rash is not a complication, but is the result of medical negligence. The distinction between complications and negligence is not appreciated by most lay individuals and many plaintiff attorneys.

Physicians will be increasingly tracked on various ‘quality’ measurements that will be accessible to the public. While knowledge is power, incomplete and deceptive knowledge can mislead and confuse. When you are reviewing the quality statistics on your doctor, be skeptical that this data is a true measurement of medical quality.  In medicine, what really counts can't be easily counted.  Conversely, what's easy to measure rarely measures up. 

While poking a hole in the colon is thankfully a rare event, pay-for-performance and other medical quality initiatives have more holes than Swiss cheese. These are not complications.  It's negligence.


Classof65 said...

My husband had surgery for repair of an abdominal aortic aneurism. The surgery was successful and he returned home after a week or so in the hospital. Two months later he experienced an intestinal blockage, as a result of the aneurism surgery, and had emergency surgery to remove the blockage and some "dead" intestine. The surgeon really made me angry when he acted as though this was a normal occurence and we should have expected this to happen. We certainly were never informed that this could or would happen and I actually thought the second surgery was caused by negligence during the first surgery. My husband suffered a great amount of pain and his health was severely damaged as a result of "lesions and adhesions."

What is your take on this? I know that every doctor will stand up for every other doctor no matter what and I have no intention of suing, but just wonder what you have to say about the situation in broad terms.

Michael Kirsch, M.D. said...

C of 65, You are mistaken that every physician will cover any colleague. Peruse this blog for evidence. I am very sorry to hear of your husband's medical situation. Of course, I cannot comment specifically as I have no professional relationship with him. Medical advice will come from his treating physicians. In general term, physicians are not ethically obligated to disclose every conceivable complication when obtaining consent for a treatment. We do not advise patients that there is a rare risk of death with penicillin, for example. In addition, some 'complications' that occur after a medical treatment may not be necessarily linked to the treatment, although the patient may suspect such a connection. In addition, even if a connection is present, this may not be a negligent event. More important than this, I hope that your husband is recovering and on a healing path. It sounds like he (and you) have survived an ordeal. My best wishes to you both.

Anonymous said...

This post had opened my mind and understand fully what is the difference between complications and negligence. I know not all surgery or whatever treatment is not 100% sure. There are always risks involved. And not every time you need the help of medical negligence solicitors on cases such as complications.

Healthcare Information System said...

Thanks for describing the complications and negligence. People should aware of it. Generally we get confused between the complications and negligence. I think this is the best article which will make you understand between these two terms.

Belinda Jefferson said...

Thank you for sharing your insights, Dr Michael! I think it is important for medical practitioners, medical institutions, and even patients to determine the difference between medical complications and medical negligence. There is a fine line between the two, but with an in-depth look and complete documentation of the medical process, it can be easier to determine what actually transpired. From there, proper actions can be done, and it can help to clear the air.

Michael Kirsch, M.D. said...

Belinda, thanks for your comment. Regrettably, the process of reviewing complications and negligent acts is not a search for truth. It becomes an adversarial contest where winning is the objective. I have seen this countless times and I am not optimistic it will change soon.

Medical Social Media said...

The difference between Negligence and complications are very important. I think its important to establish expectations with the patient in order to reduce the confusion between the two.

Healthcare Software said...

Complications in health means more negligence towards the health so it is better time to time check up.

Best Hospital said...

You are nicely described complications & negligence in health care. There is huge difference between both as a health care professional you always need to be careful and avoid any type of negligence towards patients health.

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