Why surgeons should behave like comrades

How do doctors respond to the failure of other doctors? A debate with a lawyer friend about what to do when a client seeks second opinion after a botched up first had the answer.

If a surgeon, known or not known to you, messed up a patient’s case, and you learnt of it, would you tell the patient or take a neutral stand and protect the surgeon?” a lawyer friend asked curiously.

“Are you asking me as friend or lawyer?” I enquired.

“Stop behaving like a lawyer. Answer the question!” she interjected.

Maybe that was her forte, I thought, but I also sensed the need for a heart-to-heart. Lawyers are tricky but important friends for doctors to have in this day and age, where every patient is a potential litigant.

“To me, the answer is simple. I would always protect the surgeon.”

“Even if the patient was a relative or close family friend?” she asked after an uneasy silence.

“Yes,” I said with conviction, subconsciously hoping that other surgeons would do the same if someone whose condition I had worsened came to them for a second opinion.

“But the patient will never know the truth. How does one find closure over a loved one they have lost or was left debilitated after an operation?” she continued, suggesting I lacked empathy and morals.

“I wouldn’t know the truth either,” I said. “It’s unfair and inappropriate to assume what might have transpired during someone else’s surgery, or the exact nature of the problem and corrective measures taken…I have no knowledge of the pre-operative discussion with the family, the intra-operative sequence of events, or the post-operative details.

There are innumerable possibilities, and the story of the hurt family is likely to be tipped in the patient’s favour. No surgeon in the world would operate on someone with the intention to harm. Complications are an unfortunate, sometimes unavoidable part of surgery.”

I offered a legal parallel to make my point stronger. “Don’t you send someone to jail for a crime they didn’t commit, and sometimes, acquit a person 20 years later because of lack of evidence? Is that any less of a mess up?”

“I don’t practice criminal law, so, stop lecturing me!” she shot back, “I’m asking because a client came to me for a second opinion after the first lawyer didn’t spot glaring loopholes in his case, and asked for the wrong relief. As a result, the judgement went against him. Should I tell the client that the lawyer didn’t do justice to his case or leave him believing that the Indian judiciary is ineffective? As lawyers, I believe, we owe the client the truth and must be aware that we are part of a system that people must believe in.”

It was too intense an explanation for me to handle. Lawyers love to lecture.

“You should read a book by neurosurgeon Henry Marsh,” I suggested. “It’s called Do No Harm. In it, he talks of how, despite our best efforts sometimes, in neurosurgery, things don’t always go according to plan. Whether one accepts it or not, some patients will always be part of a surgeon’s learning curve. Neurosurgical disasters can be cruel: A patient can wake up and appear healthy only to die, a few days later, of a stroke or a haemorrhage that’s related, in “some inexplicable way”, to the operation. Nobody other than a neurosurgeon understands what it is like to have to drag yourself up to a ward and see, every day—sometimes for months—a patient whose life has changed for the worse and face his anxious family.”

Do you feel the same way about those wrongly convicted; I wanted to ask her but stayed silent.

Instead, I went on to tell her the story of Mr Raman, an elderly, God-fearing Tamil gentleman who had a tumour encircling and entrenched into his optic nerve. He came to me with declining vision. He could barely count fingers even from close distance. Everything was a blur. At surgery, the tumour was like a rock, stuck to both optic nerves. After toiling for eight hours, I removed it, ensuring I preserved the integrity of both optic nerves. Unfortunately, after the operation, he went blind. The only statement from the pre-operative discussion that the patient and relatives remembered was my telling them that there was a “small” chance of his vision worsening after surgery. Unfortunately, in his case, the small chance was 100 per cent.

I had ‘messed’ up his case. I didn’t need another surgeon to tell me that.

I guess, in law and medicine, where clients rely heavily on the expert’s advice and expertise, we owe them an explanation when things don’t go according to plan, but only one that we can fully vouch for. Every client chooses their lawyer and every patient chooses their doctor. Often, you win. Sometimes, you lose. Often, it’s dharma. Sometimes, it’s also karma.

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