Two stories caught my attention recently which unfortunately demonstrate the truth behind a classic quote you’ll sometimes hear in the halls of medicine: “There is no such thing as a minor surgery.” The first was a story in the New York Times about vascular surgeons who have apparently made a habit of over-selling the benefits and under-selling the risks of atherectomies. These “minimally invasive surgical procedures” are meant to remove plaques from arteries, similar to ones that can cause heart attacks when found in coronary vessels. Terrible things happened, including the amputation of limbs which were probably never in danger beforehand. It’s nauseating to think of physicians putting profit over their patients’ own safety. And while I doubt many of these doctors
My father died from a “routine” procedure in 1997. He lived back East and I didn’t even know he was having it done until my sister called me the next day( I had worked a night shift) to tell he he was in the ICU
Took a red eye. I was sad, angry, appalled by the care he received. Yes he was old but an avid walker and leader of wildflower hikes so had iliac stents placed. He arrested, died from a massive retroperitoneal bleed. I know there are complications as I work with these patients .I insisted I look at his chart and they obliged. So ,so many clues were missed that would have prevented his death . Flank pain,HR elevated in a patient with well controlled a fib, a “ normal “ BP in someone with hypertension , heparin drip restarted with no serial PTT’s
I was embarrassed by the care given by the nursing staff. I wasn’t upset at the cardiologist , apparently he wasn’t notified until it was too late. He was close to tears
To add insult to this horrifying episode I also insisted on a post Mortem as I was thinking of suing. Not to make money but to change practice
Well the older lawyer my sister hired advised against it.My father was was old ,had lots of cardiovascular disease yadda yadda yadda . Nothing about not catching a complication that led to his death
I almost left nursing I was so disillusioned
Instead I decided to stay and make sure any patient and family I cared for would not have to suffer like this
I do want to point out that neither doctor mentioned is a Vascular Surgeon. Dr. Mustapha is an interventional cardiologist. Dr. Allie is trained in General and Cardiothoracic surgery and boarded in both.
The first vascular surgery accredited programs by ACGME were in 1984, but there is still a shortage in the community and other specialties have come to fill the space such as IR, Cardiology, and even some cardiac surgeons. It is important for patients to check their physicians credentials and unless it is an emergency, a second opinion is often valuable.
I had a bunionectomy done back in 2017. The podiatrist said that while he was "in there" he might as well straighten out my big toe. He put a metal rod in and apparently also cut some bone away making the toe shorter. Although the rod didn't traverse the joint, scar tissue built up and I found that I lost a considerable range of motion in that toe. Since I do a lot of Yoga, i.e. planks, etc. not being able to flex that big toe back as far as the other one has been a serious impairment. He was very dismissive when I expressed concern about it seeming to only be concerned with how well I could point the toe. Now six years later, an orthopedist has said that I may eventually want to have that joint fused to reduce the pain, and at that time, the rod would be taken out. But, the recovery from the initial surgery took months, having to wear a boot and not being able to do most of my workouts, which was horrible for my osteoarthritis and overall pain level. This has had real consequences for me, and now I look forward to another surgery to deal with what he did in the best way possible. I'll never get full range of motion back in that toe.
As a working economist and heavy practitioner of applied statistics, I really enjoy these articles, especially the emphasis on data and understanding risk.
A medical topic that seems to get a lot of political attention from both sides is that of gender-affirming care for children. I would welcome your take on the subject based on data.
Here is what, at least as a first cut, seems to be a fairly reasonable but very skeptical review of American practice on this subject:
My father died from a “routine” procedure in 1997. He lived back East and I didn’t even know he was having it done until my sister called me the next day( I had worked a night shift) to tell he he was in the ICU
Took a red eye. I was sad, angry, appalled by the care he received. Yes he was old but an avid walker and leader of wildflower hikes so had iliac stents placed. He arrested, died from a massive retroperitoneal bleed. I know there are complications as I work with these patients .I insisted I look at his chart and they obliged. So ,so many clues were missed that would have prevented his death . Flank pain,HR elevated in a patient with well controlled a fib, a “ normal “ BP in someone with hypertension , heparin drip restarted with no serial PTT’s
I was embarrassed by the care given by the nursing staff. I wasn’t upset at the cardiologist , apparently he wasn’t notified until it was too late. He was close to tears
To add insult to this horrifying episode I also insisted on a post Mortem as I was thinking of suing. Not to make money but to change practice
Well the older lawyer my sister hired advised against it.My father was was old ,had lots of cardiovascular disease yadda yadda yadda . Nothing about not catching a complication that led to his death
I almost left nursing I was so disillusioned
Instead I decided to stay and make sure any patient and family I cared for would not have to suffer like this
Thanks for this important article. When I was in nursing, it was said that minor surgery depends on which end of the scalpel you’re on
I do want to point out that neither doctor mentioned is a Vascular Surgeon. Dr. Mustapha is an interventional cardiologist. Dr. Allie is trained in General and Cardiothoracic surgery and boarded in both.
The first vascular surgery accredited programs by ACGME were in 1984, but there is still a shortage in the community and other specialties have come to fill the space such as IR, Cardiology, and even some cardiac surgeons. It is important for patients to check their physicians credentials and unless it is an emergency, a second opinion is often valuable.
I had a bunionectomy done back in 2017. The podiatrist said that while he was "in there" he might as well straighten out my big toe. He put a metal rod in and apparently also cut some bone away making the toe shorter. Although the rod didn't traverse the joint, scar tissue built up and I found that I lost a considerable range of motion in that toe. Since I do a lot of Yoga, i.e. planks, etc. not being able to flex that big toe back as far as the other one has been a serious impairment. He was very dismissive when I expressed concern about it seeming to only be concerned with how well I could point the toe. Now six years later, an orthopedist has said that I may eventually want to have that joint fused to reduce the pain, and at that time, the rod would be taken out. But, the recovery from the initial surgery took months, having to wear a boot and not being able to do most of my workouts, which was horrible for my osteoarthritis and overall pain level. This has had real consequences for me, and now I look forward to another surgery to deal with what he did in the best way possible. I'll never get full range of motion back in that toe.
Thank you! Have have family members who believe "to cut is to cure" and I try and explain, but this is so helpful!
Thank you for elucidation this
Excellent article which explains why procedures are not “routine.”
As a working economist and heavy practitioner of applied statistics, I really enjoy these articles, especially the emphasis on data and understanding risk.
A medical topic that seems to get a lot of political attention from both sides is that of gender-affirming care for children. I would welcome your take on the subject based on data.
Here is what, at least as a first cut, seems to be a fairly reasonable but very skeptical review of American practice on this subject:
https://thehill.com/opinion/healthcare/4070174-why-europe-and-america-are-going-in-opposite-directions-on-youth-transgender-medicine/
Would you consider publishing an article on this topic?