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A Dr.s moral obligation?

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Supmom810

Member
What is the name of your state?What is the name of your state? FL
Is a Dr. obligated to give you all information regarding a surgery, it's outcome expectations and complications?
Our son just had surgery for a chest deformity that was putting pressure on his heart. After all tests his condition was considered severe. The Dr. did explain how the surgery was to be performed and said the hospital would inform me of complications and what to expect. Son had surgery with less than desireable results and complications that we were not aware could happen.
When we returned for his check up and questioned the Dr. about my sons chests appearance (looks worse than before surgery) we were told that he probably would have had better results with the "open procedure", but he felt that was too invasive.
Shouldn't he have been obligated to tell us about this other procedure before he performed the surgery? Shouldn't he have given us all information and left that choice to us?
We were self pay and paid for everything prior to surgery. Can I make this Dr. correct his mistake? If this Dr. doesn't perform the "open procedure", can he be responsible for the payment of someone who does?
 


ellencee

Senior Member
Son had surgery with less than desireable results and complications that we were not aware could happen.
--What are you talking about? The pressure was removed from his heart, was it not?

When we returned for his check up and questioned the Dr. about my sons chests appearance (looks worse than before surgery) we were told that he probably would have had better results with the "open procedure", but he felt that was too invasive.
--"better results" refers to physical appearance, doesn't it? You are totally overlooking the obvious and the necessary, that the open procedure was too invasive and your son may have had a better looking chest but more likely than not would have failed to recover from the surgery (died).

Shouldn't he have been obligated to tell us about this other procedure before he performed the surgery? Shouldn't he have given us all information and left that choice to us?
--No. If it were a choice between 2 or more surgical procedures with the same benefits and risks, and other factors, and the surgeon determined it to be in the best interest of the patient, then you should be given the opportunity to decide but even then, it is not required that the surgeon open the decision for a vote.

We were self pay and paid for everything prior to surgery. Can I make this Dr. correct his mistake? If this Dr. doesn't perform the "open procedure", can he be responsible for the payment of someone who does?
--No. You can not make the surgeon operate again and endanger your son's life with a procedure too invasive to anticipate a healthy heart just so that your son's chest's appearance is more pleasing to your eye and the heart of your soul. Be thankful you had a surgeon more interested in cardiac function to support life than in esthetic enhancement of your son's chest.

EC
 

Supmom810

Member
EC,
Thank you for your reply, but maybe I should have been more specific on the procedure and my sons condition. My son had pectus excavatum,and although his sternum was twisted and pressing on his heart, his cardiac function was normal and in no danger, however he did have mild pulmonary restriction from the chest "caving in". We still have not had follow up tests to find out if the surgery was successful as far as that goes. He has yet to get outside to play and see if there is improvement. Other than his spirometer, which he has not yet reached the level in which we were told he needed to be, that is the only excercise his lungs get.
Since the Dr.s statement to me, I have done research on the "open procedure" and in no way would that surgery have put my son in more danger than the surgery performed. Actually, there are less complications, less hospital time, less pain and has been performed for many years to treat this type of deformity. The surgery that was performed is relatively new and is still undergoing modifications and long term results research.
Don't get me wrong, my sons appearance does not effect me one way or another, I would love and except him if he had two heads. But when you have a 13 yr old telling you he hates the way he looks now, embarrassed to take his shirt off while around anyone or to show people what his chest looks like after surgery and tells me, he wants this bar out of his chest, a mother can only look into possibilities.
I am not looking to file a law suit against this Dr.. I am however, in the process of getting a second opinion to see if they can repair my sons chest so that he is happy with himself and to relieve the pulmonary restriction and only wanted to know what obligation this Dr. has, if any, to help make that happen. It was a very expensive surgery and if need be we will pay for it to be done again if it would mean my son would have his self esteem and confidence back, along with his health, which does and will always come first.
 
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ellencee

Senior Member
OK. Talk with additional surgeons about surgical procedures for this condition. I believe you will find that the surgery performed was acceptable and done in accordance with all critera, standards, ethics, etc. Therefore, you will not be able to gain payment from the original surgeon as your son has not been damaged, much less significantly damaged through an act of negligence. You are not a surgeon or a pediatrician, so you are not qualified to decide via searching the web which surgery is medically indicated or medically appropriate.

It would be a great thing indeed if boys and girls of that age had confidence in their body images. Your son is certainly not alone in his concerns about appearance and he has no need to take off his shirt at the beach--which, by the way, contradicts that he can't go outside and play since the operation.

EC
 

Supmom810

Member
You are not a surgeon or a pediatrician, so you are not qualified to decide via searching the web which surgery is medically indicated or medically appropriate
And I never claimed to be, I only stated that I have been researching both surgeries, to try and understand why one procedure was performed over the other. I wouldn't be taking him for a second opinion or willing to pay for it all over again, if I felt qualified, would I?!

It would be a great thing indeed if boys and girls of that age had confidence in their body images.
He had NO problems with the way he looked before surgery, so why should he suffer with it now, when he may of had a chance to have a normal looking chest with the other surgery.

Your son is certainly not alone in his concerns about appearance and he has no need to take off his shirt at the beach--which, by the way, contradicts that he can't go outside and play since the operation.
Lets see, I don't think I said he was swimming, surfing, playing frisbee or running, now did I? Which by the way are his favorite things to do. All he wants to do is stay in his room, so I don't think taking him to his favorite place just to get out of the house is wrong. You know, just sitting at the beach is pretty relaxing, you might want to try it sometime.

I think you are just looking for an argument. This site is for free legal advice, which you are NOT an attorney. I think you need to find something better to do with your time, then to lash out at someone because she has concerns about her childs emotional state which stems from a surgery that could have had a better outcome. Dr.s words, not mine.

Have a nice evening EC and please, find another person to insult, because I'm done explaining my motive for posting to you!! I will one way or another get the answers I'm looking for and from someone qualified to give them to me, unlike yourself. By the way, have you ever dealt with Pectus Excavatum??
 

ellencee

Senior Member
This is a legal site and you received an answer from a medical-legal consulting expert. This is not a support-your-wildest wishes website or a foster-your- delusions website.

I'd really like to take this opportunity and tell you what I think of you. Unfortunately, I will have to refrain. Be assured, I don't have a nice or kind thought or word about you or your stupid wish-it-were-a-problem problem.

EC
 
K

kellya127

Guest
I understood what you meant supmom. You are very right, EC looks to turn advice into arguements and assumes everyone is out for a free lawsuit. You should check out my thread and the response, I mean advice she gave me. It is under workplace injuries, titled "any recourse for poor treatment" (If I remember correctly). Anyway, about YOUR problem, any healthcare professional would support your desire to seek a second opinion. There is nothing wrong or bad about that. Doctors have to make decisions, like what type of surgery would be best, with things in mind that the laymen would not understand. That is why they went to school for half they're life and that is why they get paid the big bucks. That is also why we should research and seek others opinions. We are forced to put a lot of trust in our doctors. They have our lifes in they're hands. Literally. Doctors normally inform patients and families of risks and complications. I don't know if this is an obligation or common sense. Why don't you talk to this same surgeon about your concerns. It sounds like he had your son's best interest in mind. Perhaps he is better off, clinically speaking, and could now tolerate a less neccessary surgery. You could also consult with a plastic surgeon (they are really not just for nose jobs and boob implants). Payer source is no matter regarding this issue. OOOOOOOKKKKKKKKKKKKKK!!!!!!!!!!!!!!! Here is my disclaimer so EC can't scold me. I am not a lawyer or a legal consultant. I am not here to give advice. I am searching the forums just like you. I am a nurse. I am very familiar with the health care profession. Most of all, I am a compassionate mother who would do anything to help my son get the help he needed. Good luck!
 
K

kellya127

Guest
I forgot to add EC told me she is an RN. I would run far and fast from any facility she works in. What state are you in again EC?
 

Supmom810

Member
I'd really like to take this opportunity and tell you what I think of you. Unfortunately, I will have to refrain. Be assured, I don't have a nice or kind thought or word about you
DITTO!!!!!!!!!!!!!!!!


or your stupid wish-it-were-a-problem problem.
Funny you say that, I also have another medical expert who feels his surgery was, how did he put it "a hack job". And I'm positive his expertise in this situation is much more educated than yours. Once again, Do you have any experience with Pectus Excavatum or it's related health problems. I can't imagine that you do by your verbal attacks. Do yourself a favor and do some research and maybe you will understand where I am coming from, but I doubt it.


Kellya27

I actually have an appointment with his Dr. to discuss my concerns. I am hoping that once he sees the depression my son is falling into, he will be more open with us about this and help us figure out a solution. If not then I am prepared to drive to VA to see another Dr.
Thank you for your understanding and answering my questions with an open mind. Hopefully Nurse (EC) Ratchet will back off. I don't think I have read a positive thing from her on this site. She must be a lonely person with nothing better to do with her time, then to try and knock people down. Someone needs to teach her some courtesy.

Thanks again
 

I AM ALWAYS LIABLE

Senior Member
Supmom810 said:
She must be a lonely person with nothing better to do with her time, then to try and knock people down. Someone needs to teach her some courtesy.

My response:

I'm sorry, but I'm confused. Were you talking about me, or Ellencee? People say the same exact thing to me, and when I read it, I immediately became confused about who you might be talking about.

IAAL
 

ellencee

Senior Member
IAAL
Do you have a list of the common insults to those of us who give real answers instead of feel-good, fantasy answers?
sad and lonely life
nothing better to do than insult people
you're not a real attorney (or you're not a real RN)
if you are an attorney, God help your clients
if you are a nurse, you have no compassion, run in fear of EC as an RN...

Oh, the agony of it all... :)

EC
 

Supmom810

Member
IAAL,
No, it was meant for Ellencee. Actually I am sorry that I sunk to her level with the not so kind words.
All I was wondering, is a Dr. obligated to give their patient all the information needed so that the patient has the knowledge to make a decision on what is best based on the information given. Am I confusing you yet ;) Then if it is proven that the information was not given, and a procedure was done when another one would have had a better outcome, is that Dr. liable? and if so, in what way? That's it, nothing more. Just trying to do what is best for my son.


EC,
I apologize for taking the defensive, but it's been alittle emotional around my house the last 7 weeks. I guess sleep deprivation is getting to me.
Have a good night.
 

ellencee

Senior Member
Supmom810

Just for clarification, it is not negligent for a surgeon to use a procedure that is different from a procedure that another surgeon would have chosen. From the information in the OP's original post, the surgeon based his decision on the risks to the child when deciding on the surgery, ie. his statement that the procedure was too invasive for the child's physical condition. The open surgery requires several additional hours of anesthesia; and, in a patient with compromised pulmonary function and cardiac function (even slight compression of the heart is compromising), the less time in the OR and receiving anesthesia, the better the outcome.

It is reasonable for the surgeon to have ruled-out the open procedure as an option and removed it from consideration. Perhaps another surgeon would have said, 'we can do it one of two ways--open or 'closed', here are the risks and the benefits, let's discuss it'. It does not mean that the parents would have had a choice other than the surgeon's way or the doorway and it does not mean the surgeon in question was negligent in not presenting a surgical procedure that was considered medically inappropriate.

None of the surgeries for this condition produce pretty results until the healing is complete, including healing from the removal of support bars, or support wires, or support plates, whichever was used to support the sternum during healing (usually one-year's time).

It is not an admission of negligence for the surgeon to be disappointed in the results, ie. the scar or remaining chest deformity.

The best results for this surgery occur when the surgery is done on a young child, at least two-years old but not much older. It only makes sense that once the ribcage has been malformed for 13 years, it will be more difficult to symetrically shape through surgery.

Seven weeks is too short of an interval in which to evaluate a post-op scar and the effectiveness of reshaping of the ribcage (and thus the chest's appearance).

The goal of this surgery is to protect the lungs and the heart. Secondary goals are to provide a more pleasing appearance of the chest but it is a mistake to consider this surgery as being done for cosmetic purposes.

If you are determined to injure this surgeon who used his best judgment and skills to provide your son with his best chance at longterm survival, then see a medmal attorney and have an expert witness (surgeon) review the records and the outcome. And, it you don't like that attorney's or expert's opinion, then keep shopping for one(s) who meet(s) your needs.

EC
 

Supmom810

Member
Stepnek,
Unfortunatley only one that was recommended. There are a limited number of Dr.s who perform either surgery in Florida and we traveled to see this one.

EC,
Thanks again for your opinions. I have taken the liberty to post information from a UCLA Surgeon and also included his link in case you would like to further educate yourself pertaining to PE deformities and it's correction.

The best results for this surgery occur when the surgery is done on a young child, at least two-years old but not much older. It only makes sense that once the ribcage has been malformed for 13 years, it will be more difficult to symetrically shape through surgery.
What is the best age for operation?

Correction of pectus chest deformities is technically easiest to perform and the recovery is faster in pre-adolescent children; however, patients under the age of 9 years have a high frequency of developing recurrent depression (over 15%) when they begin their adolescent growth spurt. We rarely recommend repair of pectus deformities in children under 9 years of age unless they have a severe deformity and are experiencing symptoms. The optimal age for repair appears to be between 12 and 19 years. During the past few years, a large number of adults over the age of 20 years who have experienced persistent symptoms from the deformity have undergone repair with equally good results as observed with children.

None of the surgeries for this condition produce pretty results until the healing is complete, including healing from the removal of support bars, or support wires, or support plates, whichever was used to support the sternum during healing (usually one-year's time).
How difficult is it to repair pectus deformities?

The surgical technique for repair of both pectus excavatum and carinatum has improved greatly during the past 20 years. The deformed 3 to 6 costal cartilages on each side of the sternum will have a small segment removed medially and laterally while carefully preserving over 90% of the cartilage and the entire covering periosteum. The sternum is elevated to the desired position and is supported by a thin metal bar behind the sternum for excavatum and in front of the sternum for carinatum, which is attached to a rib on each side. The costal cartilages are sutured back to the sternum medially and small chips of the patient’s own cartilage are placed into the perichondrial sheaths laterally to enhance cartilage regeneration. The reconstructed cartilage will become solid in the normal position within 4 to 6 weeks. The average hospital stay is less than 3 days. Blood loss averages 90 ml during the operation. Blood transfusions have not been used during the past 14 years. Most patients return to school or work in less than 2 weeks. Heavy physical activity is limited for 3 months. The sternal support bar is removed on an outpatient basis in 6 months and takes approximately 16 minutes. Thereafter the patient may participate in vigorous physical activities, including body contact sports.

My sons bar will stay in place for a minimum of 3 years. He had the Nuss procedure, 8 days in the hospital, collasped lung, pleural effusion and it has been 7 weeks and he still can not get out of bed without assistance.

If you are determined to injure this surgeon who used his best judgment and skills to provide your son with his best chance at longterm survival,
I am not out to injure this surgeon contrary to your beliefs. I only wanted to know if he had an obligation to inform us on all procedures. I do not question that he used his judgement, but if he felt he would have had better results from the open procedure, which does not seem that it would have put my sons health in jeapardy, then he could have told us and given us the option to do further research and gone else where if need be.

http://www.surgery.medsch.ucla.edu/asp/Clinical.asp?Clinical_Service=Pectus%20Excavatum,%20Pectus%20Carinatum%20and%20Pectus
 

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