In a gynecological surgery today, we nicked the bladder. Urine spilled into the surgical field and, of course, it had to be repaired. After about a 30 minute detour, things were fixed and the surgery went forward as planned.
In this particular surgery, this type of complication is fairly common. The repairs usually work and lasting complications are rare. A worst case scenario would be a fistual formation (an open channel between the bladder and the vagina or rectum) that allows urine to pour out regularly. That’s a bad deal but can also be repaired.
If it had been you under the knife…would you want to know about this?
This surgeon will describe exactly what happened during his surgery to the patient when she wakes up, as is expected in our community. But is this best? Couldn’t he just tell her things went fine and to let him know if there’s a problem? Would you really want to constantly worry that something may not be right?
Full-disclosure – especially about medical issues – is an American ideal that much of the rest of the world does not follow with nearly as much rigor. In many other cultures, withholding certain medical facts is not meant to be paternalistic, but instead to simply provide compassionate, worry-free medical care.
I’d rather not know. If I’m peeing out of my butt, I’ll tell the doc. Otherwise, I just want to believe that things went fine.
secretwave101 
hmmm.. interesting… not sure how i feel about this. thats a good question.
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I’d want to know.
Does the surgeon tell the patient’s doctor what happened during the surgery? If not, and no one but the surgeon knows AND there are complications later because of the error – how would the patient know to say “Well, they nicked my bladder, could that be causing this issue?”
Otherwise, you could end up with a doctor who misses the real problem and later, when they finally figure it out, you coulod wind up with a very angry patient suing the hospital because the surgeon failed to be upfront.
Seems to better to risk some initial anger and worry from the patient and be transparent about the procedure.
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I asked the surgeon later if he was going to notify the patient, and he gave me a freaked out look as if somehow I intended to not tell the patient – as if it were up to me!
“Don’t even THINK about not telling her…” He said, as I guiltily pondered the latest post on my blog.
And yes, in the hypothetical scenario I posed, the surgeon’s dictation would be available to the primary doc.
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The right, ethical thing to do would be to inform the patient.
Worst case scenario – the patient will later develop a complication, or will see this in her medical chart, or another practitioner who sees it in the medical chart will ask about it.
Most of the time, people will forgive a minor, inadvertent error. They’re a lot less forgiving of deliberate coverups. Trust tends to diminish when patients find out they’ve been lied to, and unfortunately this can carry over to future relationships with other doctors.
You guys expect us to be honest with you, right? Then return the favor.
FWIW, something similar happened once with one of my cats – veterinarian accidentally stuck the bladder while getting a urine sample. He informed me right away, and I appreciated it. And he’s still my vet, all these years later.
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I expect full disclosure and would love to see valid statistics associated with any complication. I would also want to see what comorbidities increase the likelihood of a complication. Guess what? I am smart enough to know that what you think you are going to see going into a surgery may not be exactly what you find – as are most reasonable people.
Personally, I get very annoyed when I start reading through my medical records and find that I was not fully informed of various findings that would have informed further decisions. Give me the full information.
Of course, in this society even physicians and nurses don’t really understand the statistics they often spout.
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Yes, I’d definitely want to know, but you have to pick the right time to say it. When I woke up in recovery, you could have told me that aliens invaded a la “Independence Day”, and I would have said “that’s great, doc” and not remembered it at all. So that wouldn’t count as telling me.
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