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Let's talk turkey

12 years 11 months ago #7986 by Rosie
Joe, I think we patients make too many excuses for doctors and the medical system and protocols in place. As usual, we need to get it in writing that the surgeon we selected because of their skill alone performs the procedure if that is what we want. I do. I no longer want to acquiesce to the pressure of protocol. I want to name some of the perimeters I will accept. After all, I have been in this for 7 years and exposed myself to much information and updates. I am no longer a novice being led by the nose and my naivety through the system. Although I have to admit I am still very anxious and tense. Knowing too much does cause a point of tension in it's caution. I think about those who had their bladders punctured. Was it really because their skin was too thin or because an intern was not experienced enough with the instrument and the procedure. Makes you pause, doesn’t it? Rosie

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12 years 11 months ago #7985 by Mike
Well it all started with that lawsuit and that hot cup of coffee and has only gotten worse. Not just the hospitals but even Dr's in practice on their own the malpractice insurance they pay is out their butts. People think it easy being a Dr. Let's use a surgeon for example. I know at Penn their day starts b4 6AM they have to make their rounds early, and then the days they are scheduled for surgery, and let's not forget the days they have their office hours. From what I saw at Penn that most of the top dog Dr's seemed to be married to their jobs.

I never saw a consent form like that at Penn although there were a couple of things I read I did not care for but that's life. Like Pat mentioned I asked Dr Malkowicz you are doing my surgery correct and his reply was yes and I even said I want you to close me up also and he said yes to that whether he did or not I will never know. But let's face it folks a surgery of this caliber and the length of it definitely calls for more then one pair of hands here. Joe ;)

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12 years 11 months ago #7984 by Rosie
Pat, I am sure others received that form but didn't read it carefully or don't remember it. It is very standard at teaching hospitals. I do see a need for on the job training for the practice of medicine but I have been a "lesson" 4 times previous. I did my part in helping to train them now I want complete and best attention from the doctor I chose fore his track record using the special type gyrus instrument and lazar near a ureter orifice. Today, I learned from talking to a patient advocate at the teaching hospital that I have the right and option to rescind and to cross out anything on that Consent for Surgery. Particularly the part of someone other than my doctor doing the procedure and my not wanting to be photographed video taped etc and it won't cause any problem. I am now emerging from the quicksand and sanding on the firm dunes. Thanks Ian for the good insights and advice. I think I need to stabilze myself more before proceeding further with the surgery as you advised. Rosie

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12 years 11 months ago #7982 by Patricia
Yep..the lawyers have covered their a...s.....Now if they can just get that form for McDonalds and their hot coffee to get rid of the frivolous lawsuits over there! I've had to sign that form at all hospitals i've been to including Memorial Sloan...actually reading it was enough for me to back out of the surgery!! The one thing i did do was tell my surgeon that i expected him to do the surgery..not an intern...they were welcome to watch, assist, even sew me up, but he was to do the surgery.....Now granted that was more like a handshake agreement but i expected him to honor it.
I read an article in NY Magazines June l8th issue where 5 top doctors were talking about secrets of the trade..to quote..in regard to coronary surgery..."Well, it's like the big coronary surgeons. They have their fellows come in - they open the chest, they set it up, they have the vein from the leg, it's all ready to go...He comes in, he makes one stitch, and then the fellows close him up. So, he did the procedure, but the fellows did all the major stuff that really counts."
Does make you kinda think! Pat

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12 years 11 months ago #7978 by wsilberstein

Is going to a University affiliated medical center really the best place for us to go? Have you really read the document “Consent to Surgery or Medical Procedure” that is given from that type medical practice and hospital? A University affiliated medical center is a Teaching Hospital. We, as the subject, consent to on-the-job training and sign to abstain any and all involved in any problems that may occur during the course being taught at the time. An intern may perform the surgery or procedure rather than your own surgeon. We can be filmed, recorded, our tissue and all other materials can be used as a teaching tool but we have no rights to any of it and it does not become part of our medical record.

Dear Rosie,
I understand what you are saying, but if I had never been allowed to practice on patients when I was a resident, I would have been unqualified to be out in pediatric practice when I finished my residency, and I still would have been getting my experience with living patients. Even the chief honcho who you want to do all your procedures had to go through the same type of training to become qualified to be the top guy he is today. All surgeons practice procedures on cadavers, animals, models, and simulators before ever doing a major procedure on a patient. Even the top guys develop their procedures experimentally on animals, etc., before trying them on people.
When I recently switched urologists, the guy I went to had just finished as chief resident at Harvard. He was the newest, youngest, and probably least experienced member of the group. 20 years from now, when I'm an old man, I trust he'll still be in practice to take care of me.

I feel we are all just a bunch of cattle in the reception and payment area of the doctors office waiting to be roped in and branded. “This 64 year old female presents, with a history of recurrent bladder cancer, now presents herself for a cystoscopy."

Medicalese and the shorthand protocol for patient presentation does sound impersonal, but it dramatically increases the effciency of communication among physicians. It should not be taken to imply that that's how your doctor views you. How he talks to you when it's just him and you is what counts.

-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant...

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12 years 11 months ago #7972 by wendy
Hi Rosie,

Sorry to hear you felt herded and branded instead of 'treated' like a person. I never signed such a form, I go to the cancer center of the Netherlands. Or maybe I just forget, it was 7 yrs ago, that mastectomy.

It sucks to be a guinea pig. I am one myself, having done treatments for 3 yrs of very high doses of a drug that is not used for longer than 6 months in men. My sister and father were also guinea pigs when they fought their cancer battles, but did not do as well as my sister Maureen and I.

Again, my sympathies. And maybe a cancer center instead of university hospital would be more to your taste if you ever need another cysto (and I hope you don't). Keep us posted on the path report, and good luck with it.
Wendy

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