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Anecdotal response

Posted by plosmedicine on 31 Mar 2009 at 00:33 GMT

Author: Marcel Horowitz, MD
Position: physician
Submitted Date: January 06, 2009
Published Date: January 8, 2009
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Physicians have been doing this for years. For my part, I had an esophagectomy for cancer thirteen years ago. I recall an exceptionally stormy immediate postoperative course and I remain certain to this day that if not for the expertise and experience of my surgeon, one of the folks that "wrote the book" on the procedure and the nursing care that he assembled to care for his postoperative patients, I would not have survived the peri-operative period.

Several months after my recovery, I visited a small hospital where I used to admit some patients. I met a colleague, an anesthesiologist, who was surprised that he had not seen me in several months. When I told him what I had been doing during this time, he told me that they had done some of these cases at the hospital, but all of the patients had died in the postoperative period. He agreed that the small hospital did not have the experience of the facilities necessary to handle these complex procedures.

I am not aware that most patients have the sophistication to ask their physicians the questions that they ought to be asking. To be sure, many of them do.

The responsibility of informing the patient that the individual physician lacks appropriate skill or that his facility lacks sufficient experience then falls on the shoulders of the individual physician involved. It has to do with personal maturity and personal ethics. It is a subject that should be mentioned in medical training, but I am not aware of having heard this discussion either in school or in the half century since my graduation.

No competing interests declared.