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The general surgeon and the head

Gross, Ronald Ronald.Gross at baystatehealth.org
Wed Mar 25 20:37:08 GMT 2009

".....before a general  surgeon ventures out to drain an extra-dural hematoma, he or she should consider our University experts and their liasion with the lawyers"

Forgive me, but I must say that before I consider what you have asked me to consider, I will suggest that you, my dear friend, consider what it was that we, as physicians, all have in common, the likes of which our lawyer friends will never know.....it is called that oft-forgotten oath we took as we left the hallowed halls of medical school.  That Hippocratic Oath is what I will consider when a life is on the line......to hell with the lawyers!

OK, I feel better now.

Best to all,

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sanjay Gupta
Sent: Wednesday, March 25, 2009 4:15 PM
To: Trauma & Critical Care mailing list; Mosche Schein
Subject: Re: The general surgeon and the head

The lawyers are a force to reckon in US even if one is operating within one's own speciality, and God forbid, if you operate on an organ that is considered to be someone's else's territory.

I have a mentor - a surgeon who has been in practice for about 25 years and he recently took care of a truama patient with some hand trauma also.  The patient did quite well, but had some minor stiffness in his hand.  He had been very well behaved in the hospital and had also been profusely thankful at the time of discharge, but this surgeon was rudely shocked when he got sued by this same patient.  The patient had been contacted by an ambulance chasing lawyer who had then presented a expert witness - someone who was an orthopedic surgeon in one of our esteemed Universities, who testified that the injury required that a hand surgeon should have been called.  My mentor "won" the case because his lawyer showed that this expert orthopedic surgeon's main livelihood was just this - being an expert in similar cases.  In the year before this case was filed, the EXPERT had earned 70% of his income by being an expert, and not by operating.  So before a general
 surgeon ventures out to drain an extra-dural hematoma, he or she should consider our University experts and their liasion with the lawyers, as well as the jury who would almost never be sympathetic to a "high" earning person such as a surgeon.

The original story was published by "Contemporary Surgery" in 2008 in malpractice minutes.

Sanjay Gupta
Tel: 207 576 3296

--- On Wed, 3/25/09, Christos Giannou <x.giannou at gmail.com> wrote:

> From: Christos Giannou <x.giannou at gmail.com>
> Subject: The general surgeon and the head
> To: trauma-list at trauma.org
> Date: Wednesday, March 25, 2009, 11:48 AM
> The general surgeon and the head
> Can we separate out the surgery from the logistics and the
> lawyers.
> I was taught (old British school of surgery, Bailey and
> Love) that the
> general surgeon should be able to diagnose an extra- or
> subdural haematoma
> and perform a burr hole trepanation in extremis and under
> local anaesthesai
> with i.v. diazepam or pentothal if necessary.
> (Intracerebral haematoma is a
> different beast, requiring the neurosurgeon. In the
> wilderness, without
> possibility of evacuation, the patient is dead.) Intubate
> and bag the
> patient according to condition.
> The wilderness: if you can consult with a neurosurgeon over
> the phone or
> radio, so much the better (Australian outback scenario and
> probably the
> great white north of Canada as well). Anecdote: the ICRC
> had a general
> surgeon in Jenin in the West Bank during the second
> intifada and the
> incursion of Israeli troops in the city back in 2002. He
> was in one hospital
> and the general surgeon in a second hospital had a patient
> with a
> penetrating brain wound. The ICRC surgeon -- for whom this
> was a normal
> often-seen case -- walked the Palestinian surgeon through a
> brain
> debridement over a VHF radio.
> Lawyers (a particular and peculiar American problem,
> although it is now in
> the process of being globalised): How far does one go to
> "save life in
> extremis"?  After consultation with a specialist? When
> you are in the
> "wilderness" of Montana or South Dakota etc. and there is a
> raging snow
> storm and no one can fly and the ambulance is stuck in a
> snow drift?
> Case-by-case basis? And I'll leave it to the American
> colleagues to discuss
> and dissect this one.
> For most general surgeons in the "bush" of rural Africa,
> Asia or Latin
> America, I believe that lawyers are not much of a problem
> and that a
> well-placed burr hole is as valuable an expertise as a
> C-section, although
> the latter is required far more often.
> cheers
> --
> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
> mob: (++30) 69 74 83 28 18
> --
> trauma-list : TRAUMA.ORG
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