Tuesday, July 24, 2007

Malpractice insurance optional

I like this post from inside surgery. Funny how the plaintiff's attorney scurries away down his little hole when he discovers there's no money to be won.

On related note, poor charlie weis lost his lawsuit against the surgeons who peformed his gastric bypass. I guess he'll have to crawl back to his horribly compromised post operative life as COACH OF AN NFL TEAM!!!!!! What a joke that suit was.

Let's be honest. Gastric bypass is a dangerous operation. Patients with hypertension, diabetes, and borderline heart failure aren't ideal operative candidates to begin with. Throw in the fact they allow themselves to balloon to 350-400 lbs and you're talking about a ticking time bomb. What is your life expectancy when you weigh 400 lbs anyway? Gastric bypass represents a last ditch, albeit potentially life threatening, intervention to save and extend a patient's life. Complications are higher not because of surgeon "incompetence" but rather, because of patient demographics. If I did inguinal hernia repairs on nothing but 300 pounders, my recurrence/infection/hemorrhage rate would likely be twice the acceptable norm. Gastric bypass is major abdominal surgery and, when done laparoscopically, a very technically demanding procedure. It's a recipe for disaster. Granted, gross negligence does occur. But cowboy general surgeons aren't doing this procedure anymore. You have to be practicing in a facility that carries the "Center of Excellence" designation, or else reimbursements are scanty. Fellowship trained laparoscopists are performing most of these procedures in the major tertiary referral centers. It's all very standardized and legitimate. And yet bad outcomes will continue to haunt the specialty, at least as long as very very very fat people are the patients who require the procedure.

1 comment:

Unknown said...

The fat lesson learned. When I was thinking about going into medicine I watched an OB/GYN surgeon do a few C sections. One woman was 40 and very fit, the other 20-something and quite heavy. The older woman's surgery went beautifully and quickly. Everything was so easy to see, and bleeding easily controlled. The other woman had a lot of bleeding and a lot of "stuff" to hold out of the way, making the surgery much less efficient. Let's just say it's motivation to keep that 80 lbs. off I lost. . .