Skip to main content

High Drama in an Ambulatory Surgery Center

A few days before I wrote this, a patient had a complication in my office.  I have discussed on this blog the distinction between a complication, which is a blameless event, and a negligent act.  In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence.   This is the basis for my strong belief that the current medical malpractice system is unfair.  It ensnares the innocent much more often that it targets the negligent.

I performed a scope examination through one of the two orifices that gastroenterologists routinely probe.  In this instance, the scope was destined to travel inside a patient’s esophagus on route to her stomach and into the first portion of the small intestine.  Sedation was expertly administered by our nurse anesthetist (CRNA).   The procedure was quickly and successfully performed.  The patient’s breathing became very impaired and her oxygen level decreased markedly, a known and uncommon complication of sedation medications.   We took the appropriate measures, but her low oxygen level did not respond.

At that point, our experienced and calm CRNA decided to intubate the patient by passing a breathing tube into her lungs, in the same manner as is routinely performed prior to surgery.   The RN on the case, an ICU veteran, showed how quickly and superbly her medical skills and judgment could be recalled.  In decades of medical practice, I had never had a patient whose scoping test and sedation led to a breathing tube insertion.   Moreover, this procedure was performed in our outpatient ambulatory surgery center, not in the hospital, so drama like this is exceedingly rare.

Physicians prefer to see drama in the theater.

The patient’s oxygen level immediately returned to normal and she was transferred to the hospital in stable condition.  She was appropriately treated and discharged after a few days. 

I was so grateful to have a team in place that had the skills to rescue a patient who was in a dire situation.   I told this to them directly and they seemed to regard the matter in a more routine manner than I did.  They saved her life.   Nothing routine about this, as I see it. 

For nearly all of the patients we see in the office, our staff is overqualified.  But, once or twice a year, we need these folks on site, locked and loaded.

Physicians and the rest of us need back up.  Do you have a contingency plan in your job if a crisis befalls you?  Will you wait for a catastrophe before implementing one?  We’ve all heard vignettes about cities who were warned about a dangerous intersection, but failed to ask until a tragedy occurred.

Finally, if someone helps you out of the abyss, give the credit to whom it is deserved.   Conversely, if something goes wrong and it’s your fault, do the right thing.  

Comments

  1. You've given me food for thought and a new question to ask before my endoscopy on Thursday; it will take place in the doc's office. Isn't the worst possible scenario what happened to Joan Rivers? I've had Propofol twice in the last two months with no adverse effects. If I have what they suspect, it would be a much better way to go......

    I will make sure he knows that, and I will have a copy of my advance directives.



    ReplyDelete
  2. Barbara, I'm hoping for good news for you. All the best, MK

    ReplyDelete
  3. The expert care is avoiding the tube, not placing it.

    ReplyDelete
  4. @anonymous, respectfully, your comment is misguided.

    ReplyDelete

Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary