Day 2
What exactly is the plan?
As always, medical work in a foreign hospital always brings its ups and downs. Today, I’m considering the ethical questions that seem to arise every time we visit.
As an example, a patient was scheduled today for a surgery that in our opinion was not indicated. The surgery itself is very technically difficult and we knew that without our help the surgical result would likely be poor. We debated the merits of the case and recommended the case be canceled.
The question before us is the appropriate course of action if the local team did not agree to our point of view. So what is the correct answer? I’m not sure myself. In this particular case, I explained why I thought the surgery was not appropriate. The Staff surgeon who originally posted the patient agreed, and the case was canceled. However, I have experienced the opposite situation where the case is not canceled and surgery is performed. Sometimes our surgical plan is rejected for a different plan.
Often, later in these situations, our help is then requested. this puts us in the unenviable position of trying to sort through a surgery that was not, in our opinion, indicated in the first place. However, if we do not assist, the patient could be harmed further. Further complicating the decision, if we assist and the patient does reasonably, it sends the wrong message about the appropriateness of the surgery perhaps reinforcing negative decision making or surgical plans.
As a team, we have generally opted to scrub into these cases. There have been times when we try to avoid the case altogether, but are always willing to join in if our help is requested mid case. It is an interesting dilemma.
Talk with you all soon!