S.V. was referred to me by her friend. She was a 35-year-old with what everyone thought were fibroids. These non-cancerous lumps grow in the uterus and can cause various symptoms. She had seen a doctor who wanted to remove the rapidly growing fibroids through laparoscopic surgery (surgery through tubes sticking into the belly). S.V. was a successful writer and had a busy schedule. There was something odd about her presentation and clinical findings. This was about 15 years ago, and laparoscopic resection surgeries of fibroids were just getting started as a first-line surgery. The surgeon she was going to for the operation was fine, but he had the reputation of being a little aggressive for his abilities.
Needless to say, I suggested that she see another pelvic surgeon whom I had worked with in the past. This surgeon was also a gynecologic cancer surgeon. He was excellent in the operating room and, most importantly, knew his limitations. S.V. met with him, but ended up going with the younger, more aggressive surgeon. She liked this surgeon partly because he had a very effective social media presence. At that time, social media was also just starting but had already become a powerful tool to influence people.
It turns out S.V. had what is known as uterine leiomyosarcomas, a very rare form of cancer arising from the smooth muscle of the uterus. The surgeon she used spent 5 hours trying to remove these “fibroids” by laparoscopy before calling in a cancer surgeon to help. By the time they finished, this poor woman had her localized cancer spread throughout her body.
The 5-year survival rate for leiomyosarcoma is 63 percent at best, but goes down to 14 percent if the cancer is spread throughout the pelvis. S.V. died less than 6 months after her surgery.
S.V. would have probably died from her cancer even with the surgeon I recommended, but she may have lived for several more years. For her, that would have been a lifetime.
Excellent surgical skills and good judgment are the paramount qualities we want in a surgeon, not their bedside manner, gender, race, social media skills, or their “woke-ness.”
This was an extreme example of poor clinical judgment by the surgeon. A good surgeon must know his or her limitations. In this case, the surgeon unwittingly spread her cancer throughout her body by continuing with his laparoscopic approach. Minimally invasive surgical techniques like this were still in their early stages of development then. He failed to recognize his limitation and call in the cancer surgeon at the appropriate time. This surgeon forgot the paramount rule as a physician, “Above all, do no harm.” There are many such errors, which the patient never sees, occurring in daily medical practice. Some arise from a simple lack of basic surgical skills, which may not be life-threatening but still affect the quality of the surgery.
Medical legal experts use the term “standard of care.” Notice how they don’t use “excellence of care,” but “standard.” There is a reason for this. Not all surgeons are excellent, some are better than others. The same can be said about general physicians or even airplane pilots. Think of Captain Scully and the miracle on the Hudson. However, surgery cuts straight to the point.
We want the best surgeon possible.
My old medical school roommate is a retired Lt. Colonel and thoracic (pertaining to the chest) trauma surgeon who was stationed in Iraq. Dr. Don Reed Jr. is an exceptional surgeon who saved many soldiers’ lives with his surgical skills. The stories he tells are heart-wrenching. He is now back into the private world where he witnesses subpar surgeons and can only hope they don’t get in over their heads.
According to a paper published by the National Center for Biotechnology Information, there are some 200 million surgical procedures performed globally each year. There are at least 4,000 surgical errors occurring each year in the United States. Operating on the wrong body part still happens.
An error is completely different from complications or poor outcomes from surgery. Mediocre surgery is not negligence. Mediocre surgeons are not committing malpractice by any stretch of the imagination, it’s just not “excellence of care.” We should all want excellence.
Remember that AT&T commercial where this couple asks the nurse in the hospital just before surgery, if they ever worked with Dr. Francis? The nurse responds, “Yeah, he’s okay,” and the couple says, “Just okay?” Great commercial, and no, we don’t want that type of surgeon.
Now, all of this is not meant to scare you, but to inform you. You have choices. You can research your surgeon. Obviously, if you were brought to the emergency room for acute appendicitis, you'll get the surgeon on call. Those are pretty straightforward surgeries, and you don’t need to be the best of the best to perform them well.
If you need a planned surgery, such as cardiac bypass, or cancer surgery, do your homework. Ask a doctor or nurse friend if you know any. The internet can give you a lot of helpful information. Ask the surgeon about his or her experience. How many of these surgeries have they done before? Who will be their assistant? Also check out the hospital where you will have the surgery. The nursing staff as well as the anesthesiologist are critical. It really is a team effort. It’s just that your surgeon is the one holding the scalpel. The surgeon must have strong knowledge of their specialty as well as good motor skills. However, one of the most critical skills of a good surgeon is common sense. That has kept me out of trouble so many times.
To this day, every time I operate, I say a little prayer to myself just before I cut, “Please God, let me do good today.”
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