ANA Discussion Forum
General Category => AN Issues => Topic started by: Derek on November 22, 2008, 01:15:39 pm
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Hi all...
The topic heading was an actual article headline in todays Daily Telegraph, a quality daily British broadsheet newspaper, which albeit not wishing to be alarmist, I nevertheless thought it worthy of mention having regard to the well documented fact on this board that we all strive to take personal responsibility for our eventual treatment choice which should also include all aspects including the actual treatment process.
The article was based upon research within the UK by the National Patient Safety Agency (NPSA) which in 2005 issued an alert to all UK neurosurgical units after an audit ascertained that there was no standard method of identifying which side of the head that patients were to have surgery performed, with some units marking with pen the side to be operated on and other units choosing to mark the side which was NOT to be subjected to the relevant surgical procedure.
Since then the NPSA reports that despite issuing the alert, 15 incidents have been reported in 25% of all 36 UK based neuro centres within the past 3 years whereby surgeons have commenced surgery on the wrong side of the head often involving drilling of the skull before the mistake was discovered. The report indicates that fortunately whilst none of the incidents resulted in death, all of them could have been avoided.
The UK Chief Medical Officer has indicated in the relevant article that such mistakes should never occur as earlier this year the World Health Organisation Surgical Safety Checklist was introduced and lists a series of checks that should be carried out to ensure the correct patient is in the operating theatre; the correct surgical procedure is about to be performed and on the correct body part.
I am sure that such occurrences are rare and not confined to the UK but thought that the article was worthy of mention. I personally will be ultra vigilent in ensuring that prior to any future treatment being undertaken, whether it be microsurgery or radiosurgery, I will ensure that I will personally be involved in carrying out my own final pre-surgery check!
Regards
Derek
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wow! just about every nasty thing that could go wrong happened to me but i cant even imagine having to live with 2 holes in my head! anyway dont the docs usually have the pics hanging up all around? they did for my surgery.
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Moderators...
Sorry... I've become so used to only posting in the 'watch & wait' forum these days...posted in wrong forum...can you switch this to the General Category forum under AN Issues please.
Regards
Derek
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We can do that. ;)
I have heard of marking the side to be operated on; marking the side not to be operated on seems like it is asking for a mistake to be made.
Steve
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Derek:
This is almost absurd but unfortunately true...I've read similar stories. It seems that having a standard of marking ONLY the side of the head to be operated on is the sensible way to resolve this.
I agree that - as a patient - being your own advocate in matters you have some control over is crucial. I was and my wife did the rest. Fortunately, my surgeon knew what side my AN was on and this wasn't an issue.
Jim
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I was also asked to verify which side of the head I was being operated on, before surgery.
Anne Marie
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This issue of drilling on the wrong side could easily happen if you are like me with multiple problems like an AN on the Right side, A Meningioma on the left and an Anuerysm in the middle! Whew, what a scary thought for those also that are NF-2. We must be active in the procedural part of our care!
Jackie
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I had "YES" written in huge letters on the correct side just below the ear. It took forever to get the ink off - but I'm not complaining. :)
Nancy
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I reminded the docs right before my GK.......LEFT SIDE. They said it wouldn't be an issue since they had the MRI and CAT scan to go by when making the treatment plan. However, when they were putting the head frame on, one of the docs said, "That looks a little crooked." Fortunately it was the first screw, and they hadn't gotten in very far with it. PLEASE don't freak out those of you who are contemplating GK. The head frame was no big deal. And, Steve, they used the cordless drill to take the screws out, but they put them in with what looked like a regular screw driver. At that moment, I didn't care if it was a Craftsman!!! ;D
Whenever I have had surgery in the past, I have always asked the anesthesiologist and surgeons if they were out partying the night before!!! Joking with them, and I think they took it at that. Still, I needed to make a point!
Nancy
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I was asked REPEATEDLY to verify it the morning of. They wrote on that side with a marker. They did everything short of putting a waving flag in my ear on that side to be sure it was the right side before the surgery even began. I would have been livid if they'd gotten it wrong and ended up having to drill twice.
How's that for a visual? ;)
Brian
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I shaved my own head to avoid such an issue. Yep I shaved too much but only one hole. :o
Michelle ;D
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HI,
I like michelle moved my hair, not quite to the extreame of shaving my head but i tied it to the right side in a pleat, leaving the left side exposed, but to be honest i was asked about 100 times to verify that it was the left side and I too was drawn on with a big black marker, they drew an arrow pointing up on my neck i felt like a parcel being delivered the only thing missing was the "open this side only" message.
I agree that you should be in control of your own treatment but you must also have trust in your surgeons, if your pre surgery I really don't suggest reading articals with headings such as 'Brain surgeons drilling holes on wrong side' if I'd of read that pre surgery i'd of been in pieces on the op dat, it was scary enough without having that running through my mind (pardon the pun)
Cheryl. XxX :-*
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Yep, I thought of this too ... the day before my surgery, they marked my AN ear... the morning of .. the mark was gone!! (came off in the shower) I made them put it back!!.. they smiled and gladly did it ;D plus they shaved my head while I was awake .. so I knew they were on the right side.... 8) 8)
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I was asked several times by different people which side was to be operated. Then the Dr. marked my AN ear with a red marker.
Syl
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Just clarifying that the original article was not specific to AN sugery and appeared to be relevant to all aspects of brain surgery and applicable in the main to those patients who, by reason of age or mental / physical incapacity or who have been involved in accidents / incidents whereby they have been admitted to hospital in a coma / semi comatosed state, are vulnerable and unaware of the procedures that are about to transpire in the operating theatre.
Derek
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To be fair Derek, ya didn't mention that in your opening post, bit misleading I think!
there are alot of newbies on here and I think that you should of put a bit more thought into your post before allowing it to be read by people whom are already going through quite an emotional time, If that had of been me reading that when I first found out about my AN I would of been scared to death, I found the whole ordeal very hard emotionally. I think you should think before you post from now on, one thing left to say and in your words Alarmist!!!!
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Although it was somewhat "alarmist", the story was presented as "this COULD happen to you, so make sure you take the necessary precautions" and has a basis in fact. While it was somewhat unsettling, and could be more so for someone just diagnosed and researching their options, this sort of thing DOES happen albeit VERY rarely in the United States (where most members here are from).
Granted, there might have been more disclaimer information along with the orignal post, I took it for what it was. Information about what COULD happen. I suspect most people would.
Regards,
Brian
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Although things like this do happen - with any surgery - the instances are few and far between.
My neurotologist marked my AN ear with purple marker prior to my retrosigmoid surgery - after confirming with me which side was my AN side - and he marked the same ear (again with purple marker) prior to my BAHA surgery.
Yes, horror stories do exist - but don't stress about this, newbies. Doctors DO have a clue.
Jan
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Cheryl...
I have re-read my original post and to be candid I do not consider that I have stated anything other than factual matter that was published in the originating DailyTelegraph article. I therefore do not accept your comment that I was 'misleading'.
My latter post simply clarified that the newspaper article was not specific to AN surgery but was applicable to all aspects of brain surgery. My additional comments relevant to age, mental incapacity, comatosed state etc. were my personal observations which were not mentioned in the original article and that aspect is clear in the wording of my post. Indeed my original post never implied that the news report was specific to AN related surgery as you suggest.
I have been posting on this forum since May 2006 and have always endeavoured to provide meaningful and structured input corresponding with my personal experience in the 'watch and wait' status since my diagnosis in 2002 in the fervent hope that I can assist and encourage others diagnosed with the AN condition.
Be assured that I have given total 'thought' prior to each of my 300 postings on this forum (including this one!) which have never attracted any adverse reaction, indeed the opposite applies.
In conclusion the content of my original post was (as I deliberately stated) NOT intended to be alarmist but was an important public news item which I rightly thought should be brought to the attention of others in order that they could also be aware of the possibilty of surgeon error, however remote and take whatever precautionary steps they consider personally appropriate. Whilst I accept that the subject may cause apprehension, particularly to those newly diagnosed, I nevertheless consider that such an important aspect should be publicised on this forum but unfortunately newbies cannot be screened from similar AN related subjects and posts which are numerous.
Having due regard to my hitherto unblemished antecedents on this forum Cheryl, I regretably conclude that your public condemnation of me (quote)..you should think before you post from now on etc (unquote) to be personally offensive, unwarranted and not what is expected of contributors to this unique and very special forum.
Regards
Derek
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As a newbie, I didn't take offense to the article at all - not at all alarmist - it is reality. I think one of the biggest risks any of us face in this AN journey (or any medical intervention) is the risk of human error of the surgeon, the anethesiologist (read about the rate of dosing/adminsitrative errors with drugs - staggering!), the pharmacist. Can't quite imagine the impact of the radiation oncologist or the technician/physicist calibrating the machine wrong and you got a double/triple dose, a few mm askew. It shouldn't happen, but I bet you it does.
I have heard of marking the side - cutting your own hair, even if the swath was a bit too big seems like a great idea.
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Cheryl and Derek,
Just a reminder to keep the postings on the subject material, not what the lawyers call ad hominem. There is no need to comment on each other as individuals; we can simply discuss the risk of getting the wrong side cut open, or the absence of such risk, according to your view.
Steve
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To all,
I had already made a point of joining into the discussion at the very beginning of the post, I was just making the point that maybe Derek should of put his thoughts of patients being in comas etc on from the beginning, I accept accidents/incidents do happen but to be honest the subject title its self sent a shiver down my spine.
I also acknowledge that this is a discussion forum and sometimes sensitive subjects will be discussed, but again going back to the title if it was a week or two before surgery and I was apprehensive to begin with this would not ease my mind.
As patient's we put our lives in the hands of doctors and nurses whom we have to trust to do the right thing, they have a hard enough job as it is without the media printing horror stories and I feel they probably don't get the thanks and appreciation they all truly deserve, after all once your in the operating theatre you're only a heartbeat away from life or death and they're the one's who have to live with any consequences.
I'm sorry that you felt my post was a personal attack, it was far from it, I was just trying to draw your attention to another point of view and turn the discussion in a new direction, which it would seem I have done albeit a little heated.
Regards Cheryl. XxX :-*
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Hi again Cheryl...
Please take cognizance from the salient fact that my original post replicated the actual content of the relevant Daily Telegraph news article which, in my opinion, was not a horror story but was a factual and responsible news item eminating from research undertaken by an agency of the UK National Health Service supported by meaningful and important statistics crucial to the furtherance of safety to those patients having to undergo neurosurgery and was not an attack upon the medical profession per se who of course do a fantastic job. I did not consider that it was incumbent nor appropriate upon myself to dilute or amend the text of the news report (including the leading headline) nor to append my personal observations on the article at that stage within the content of my original post.
In many respects the wording of the news article was acceptable if it has the desired effect of increasing patient safety by making both patients and medical staff aware of possible problems that can arise albeit we obviously have an implicit trust in the medics responsible for our treatment. Knowledge is power Cheryl and in that respect I am now more aware of such problems than I was prior to reading the article and in the hopefully unlikely event that I eventually have to undergo neurosurgery I am absolutely confident that they won't be drilling the wrong side of my head!
Take care and best wishes for your ongoing post-surgery recovery.
Derek
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dissent among the ranks? although I did not find Derek's post as alarmist, I do find it alarmING' as I or anyone else with any serious medical issue should. We here in the western world have been groomed from birth to trust doctors implicitly for the care of all of our ailments. Well... doctors are people too! they are subjuct to human error possibly even more than the average layperson just due to the very nature of their professions. their hectic schedules, complexity of the job, and yes even jaded ignorance to the fact that patients are human beings are all contributing factors. Had i been aware of this prior to my 2005 surgery, I may have made some different choices and my overall unpleasant outcome may have been different. Any person diagnosed with AN or any other life threatening disease SHOULD be alarmed and afraid! If I had been told all of the possible outcomes instead of just the brightly painted routinely average ones, I may have even opted out entirely! Instead believing the optomistic picture painted I am left frustrated with a poor quality of life and a truckload of problems that doctors don't want to hear about or just can't fix. To this end I've pretty much had to become my own doc and now know far more than I ever wanted to about the mechanics of my malady. Emphasizing the positive is not a bad thing, infact, it is what motivates most of us to keep going but, we can't ignore possible negative aspects or possible error expecting only a positive conclusion. Kudos to you Derek! We should all be alarmed that stupid mistakes like these have and do happen as well as many other types of errors. The outcome of intracranial surgery that is considered successful is even iffy as I'm sure most of us can testify to.Lots of the "unexpected" Doctors do make foolish mistakes sometimes. I once knew of a friend of a friend who actually had the wrong kidney removed!Wow! Bummer huh? Maybe the doc was tired, overworked, hung over who knows? Maybe he was just human! Anyway it is what it is so if there's any lesson to be learned from the AN or any other disease experience it would be that we need to glean EVERY possible bit of info and be proactive in all phases of medical care, even the small ones. take nothing for granted! kerri
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I saw this a few days ago - an article in a leading Cdn newspaper - and one of the hospitals in the study is where a chunk of the Toronto ANers go for treatment (Toronto University Network Hospitals - Toronto General).
http://www.nationalpost.com/news/canada/story.html?id=1177576 (http://www.nationalpost.com/news/canada/story.html?id=1177576)
PS - to put it in perspective for the Americans here, I typically 10x all numbers quoted in Canada because the population is about 10x that of Canada - just as a baseline, of course.
It talks about surgery errors - and the role of checklists, and how key they are to avoiding errors. It is similar to the pilot checklists that have reduced airline errors ... because pilots are only human and errors do happen despite the routineness of much of what pilots (surgeons) do each day. I think many surgeons may have thought it silly that the invincible surgeon could possibly make a mistake - but it happens. It gives me comfort that the process is improving. The skill isn't necessarily a risk, the process is a risk. While it mightn't avoid the unavoidable (which AN surgery certainly has its risks), it could minimize the negative outcomes from silly processes.
I know in my job, we have checklists - my whole team does. I am simply in the financial world but I have 'supervisory checklists' (I supervise 16 people - I just don't rely on them to do their jobs right, I rely on the checklists to ensure my key risks are covered off.)
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Let's take a breath, O.K.?
I think most rational adults understand that AN surgery, whatever the approach, is very serious and that bad things can happen. That's why we have to sign lengthy release forms beforehand. Obviously, we accept that risk when we say 'yes' to surgery and sign the requisite forms. Because of the seriousness of AN surgery, newly diagnosed AN patients (usually referred to as 'newbies') initially receive a chorus of similar advice from experienced AN patients here that urge them to research their options and choose their doctors very carefully. No one pretends an AN is something trivial.
That noted, this is a support site and, as much as possible, we avoid dealing in negatives. However, AN surgery (and any surgery, for that matter) carries risks and yes, bad things can happen. Sometimes due to doctor/hospital/staff negligence and sometimes due to 'fate'. We don't propose to sugarcoat the harsh realities of acoustic neuromas and the risks involved in addressing them - but we do try to avoid bringing a 'gloom and doom' attitude to the message boards. We try to offer hope, encouragement and lots of support, no matter where a patient is in their AN journey, but especially when they're at the beginning. We don't pretend that this is an easy walk through the park, as it were, but a serious condition that requires very thoughtful evaluation, some tough decisions and of course, risks. As I've stated many, many times in thousands of posts over the past (almost) 3 years, 'there are no guarantees'. When I opted for surgery and radiation, I looked for guarantees but no doctor could give me one. My neurosurgeon basically said that the procedure he was using (debulking then radiation) had proven almost 100% effective and he would do his very best - but he couldn't 'guarantee' the results ahead of time. I understood.
Granted, the media thrives on 'bad news' and loves to spotlight 'horror stories' because this sells papers, magazines and gains viewers and listeners. Surgical blunders and horrible results to patients can be somewhat macabre but perversely attractive to the public. The media certainly doesn't mind tearing down doctors, who generally are well respected in civilized societies...and everyone worries about their health and needing an operation, so these kinds of stories, whether factual or mere hyperbole, 'sell'. That doesn't mean we have to inculcate their morbid conclusions into our individual psyche. I didn't, although I knew full well the risks my surgery incurred. While I would avoid spotlighting medical 'horror stories', being realistic is never wrong. I also question the level of care in the taxpayer-supported British NHS compared with that in the U.S. We certainly have our problems, all well-documented, but I notice wealthy people from Europe and elsewhere often travel to America for surgery and other necessary medical procedures. That is both telling and encouraging.
I conclude that Derek simply posted a factual tabloid article. I can't condemn him for that. Many of us responded to it (me included) and most didn't see this as a big issue. 'Alarmist'? Well, now. Webster's Dictionary defines that as "the often unwarranted exciting of fears or warning of danger". I don't believe Derek's initial post fits that definition. Although not a major cause for anxiety in AN surgical patients, it does happen and knowing that - and taking precautions beforehand - is simply prudent. Besides, I'm sure many of us had heard or read about this problem (doctors drilling on the wrong side) before. Unfortunately, it isn't something new. As I stated at the start of this post, as a support site we avoid dealing in negatives - but we're grown-ups here and have to be realistic or the message boards would be useless, all flowers and sunshine with nary a negative word ever posted, which would be totally unrealistic and unproductive for the 'newbie' seeking honest information. I appreciate members being alert to possible problems with posts but in this case, I think the problem is far more apparent than real. I would hope we'll all be a tad more cautious in any future 'negative' postings and move on from here. :)
Jim
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Well said as usual Jim. I agree, let's all move on.
Patrick
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It has just been the last 2-3 years where it is watched more, the what and where of ones surgery. The permit we had where I worked changed to where things had to be checked more by more than one person. Once you are in surgery then there is "timeout" where they check it all again. This is at a smaller hospital. I did not read the article earlier so was it from several years back when things weren't checked as well?
Cheryl R
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Well Jim you basically said everything I wanted to say but clearly didn't manage to, so thank you!!!
I would just like to say one thing though, My consultant, Professor Ramsden has been referred to on many occasions as the world leader in ANs and if he doesn't know it, well then its just not worth knowing, I have been told I am a very lucky girl because my neurologist is also one of leaders in his field too and they both work for the NHS.
Many people give the NHS a hard time, but I have never Known or seen a profession that work so hard or care so much. Jim I know you were not having a pop at the NHS far from it, even so I feel I have to defend it.
I am very lucky to live in a country where I can get free (albeit paid for in my taxes) health care and Know that I am in such capable hands with two Doctors that both choose to work for our national health rather than offering their expertise only to those who can afford to pay for it in the private sector and that is something for what I am truly thankful.
That is my final thought on this matter.
Yours Cheryl XxX :-*
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I fully endorse Cheryl's complimentary comments relevant to the UK National Health Service (NHS) albeit I am not personally aware of any neurosurgeons or neurologists within the UK who exclusively offer treatment only to the private sector.
Whilst they are obviously available for private consultation and treatment to cater for those patients who wish to avail themselves of particular medical professionals who are known to have an expertise in a specialist field such as acoustic neuromas rather than to to take 'pot luck' as an NHS patient in being provided with the services of a neurosurgeon who may not have the same expertise, they nevertheless remain an NHS resource and Cheryl is most fortunate to have been under the care of Professor Ramsden.
By example and with regard to my personal circumstances, from diagnosis in 2002 until now I have been a private patient of two eminent neurosurgeons (one also a professor) who were recommended to me because of their respective renowned expertise in the treatment of acoustic neuromas by way of microsurgery and stereotactic radiosurgery. My private medical insurers without prior warning have decided that they now have an upper age limit which instantly precluded me from cover and because of my pre-existing medical condition I was of course unable to find an alternative insurer who was willing to accept me.
In consequence both neurosurgeons agreed to continue providing me with their professional services as an NHS patient which has considerably alleviated a very stessful situation for me and for which I am most grateful to them and for the NHS protocols which allows for private to NHS transfer in such circumstances.
This information will of course have greater significance and interest to those who come within the remit of the UK NHS and who may have to contend with similar circumstances in the future.
Derek
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Hi there,
I know I know I said that my last post was my last word but just wanted to add to what Derek Just said, I think that its fantastic that Derek’s Doctors/Surgeons were able to continue with his treatment regardless of medical insurance, I too understand that finding insurance is a real grind after such a major operation (I am currently trying to get travel insurance to cover me medically when I go to the US in April, oddly nobody wants to insure me ???)
Anyway getting back to what I was saying, I referred to the whole private sector thing because when my family asked about going private Prof Ramsden told us "well you can pay if you want to but you won't get it done any faster or by a better team, I don't believe in going private but the choice is yours" he seemed to take a very dim view on private healthcare I don't know why, I didn't ask, I just figured that if there are Doctors whom solely work for the NHS then there must be those who solely work for private healthcare, I could be wrong of course.
Regards Cheryl XxX :-*
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Cheryl...
Re the difficulty experienced in attempting to obtain travel insurance..I bank with LloydsTSB and one of the various benefits of their Platinum and Premier current accounts is that they offer gratuitous Travel Insurance. I have trawled through the 'small print' of the conditions of acceptance and I cannot find anything adverse relevant to neurological conditions particularly with regard to acoustic neuromas whether it be the pre or post-op situation. If you bank with them it may be worth considering but if you are not a client, the other major banks might also offer a similar incentive. Worth checking out perhaps?
Derek
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Derek,
Thanks for the tip, I bank with Natwest, I know they offer a gold account to customers but I've never taken advantage of it, in fact I'd forgotten all about the benefits they have to offer, I'll give them a call, thank you.
Regards Cheryl XxX :-*
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Okay, Derek and Cheryl, if this gets any cozier, we may have to intervene for a different reason...
Thanks for making up, though. :)
Steve
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Must admit I did not read everyone's post for the sake of conserving time and getting to bed before the alarm goes off.
In the US the Joint Commission for Accreditation of Hospitals (JCAHO) instituted national patient safety goals to ensure patient safety due to wrong site, wrong side kind of errors. This is the reason all of you in the US who have ANY kind of surgery that could be confused as wrong side or wrong site should be asked which side, or what site and it should be marked either by you, or a representative (meaning a family member, or physician, nurse etc. depending on the policy of the institution) and you should confirm it.
You should also be asked for two patient identifiers, such as your name and date of birth to verify who you are.
If you want to know what goes on behind the scenes to assure your safety in the US, google JCAHO and review some of the National patient safety goals. Medicine is a science, not an exact one, and where humans are involved, mistakes do happen. In the medical community, we take mistakes very seriously and do all we can to prevent them. Marking the operative site before the patient is asleep is one way to avoid surgical errors.
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For some reason all that I can picture is the surgeon talking to the patient saying "Oh, you mean YOUR right side???" ::)