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[...] After all, who needs a hole in the head? Yet for thousands of years, trepanation -- the act of scraping, cutting, or drilling an opening into the cranium -- was practiced around the world, primarily to treat head trauma, but possibly to quell headaches, seizures and mental illnesses, or even to expel perceived demons.
[...] "In Incan times, the mortality rate was between 17 and 25 percent, and during the Civil War, it was between 46 and 56 percent. That's a big difference. The question is how did the ancient Peruvian surgeons have outcomes that far surpassed those of surgeons during the American Civil War?"
[...] Whatever their methods, ancient Peruvians had plenty of practice. More than 800 prehistoric skulls with evidence of trepanation -- at least one but as many as seven telltale holes -- have been found in the coastal regions and the Andean highlands of Peru, the earliest dating back to about 400 B.C. That's more than the combined total number of prehistoric trepanned skulls found in the rest of the world.
Source: Remarkable skill of ancient Peru's cranial surgeons
(Score: 3, Informative) by JoeMerchant on Monday June 11 2018, @01:55AM (2 children)
Last surgery I was in, the surgeon left a bone chip in... clear as anything on the post-op X-ray. After 6 weeks of therapy at his PT clinic (for a wound that should have healed up in 2), osteomyelitis presented to noone's great surprise and I was offered another surgery (after all, you've probably hit your out of pocket max already right?) and a 6 week course of IV antibiotics and of course much more PT and followup treatment. While in the infection control clinic, I got to know several other of my surgeon's patients who had similar stories.
N of 1 isn't worth much, but I have observed it in practice many other times: physicians aren't incentivized to do the best thing for their patients, they are incentivized to generate business for themselves and the many many people they employ. We know a few good doctors, but they seem to be in the minority these days, especially in the specialist fields.
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(Score: 2) by lentilla on Monday June 11 2018, @05:03AM (1 child)
Surely the surgeon would have corrected that as a matter of professional pride? We all make mistakes - that's understandable - but when a professional makes a mistake he corrects it.
I realise a second operation requires a collection of people. I would have thought that was something covered by the surgeon's insurance? Better for the surgeon's insurance to pay for a second procedure up-front than to deal with a claim for negligence further down the track?
I'm sorry you had to go through that.
(Score: 2) by JoeMerchant on Monday June 11 2018, @11:46AM
Apparently not. When I asked him if that chip was going to re-fuse to the bone he (normally confident and clear spoken) kind of grunted and mumbled "no, no it's not." He sent me off to standard PT knowing that the other shoe would drop, eventually. On that day, that may have been the best possible course, the chip might have worked its way out cleanly, but by week 3 when it was apparent that my circulation was compromised, the dissolving stitches weren't dissolving (involving exquisite pain in their removal), and my healing progress was passing 2 and then 3x the normal time... I really would have expected better monitoring of my progress, but why? We hadn't reached the insurance covered PT cap yet. He did suggest a (not covered by insurance or offered in PT) hot wax bath to help with the circulation - which it did...
At 6 weeks when the green pus started coming out, the PT office finally opened the back door and sent me to see the doctor again. He suggested a second surgery "I can get you in at the end of the day tomorrow" - just like he did for the first surgery, adding my case to the end of a full day. When I declined the additional surgery (which would have involved the whole team including my family to drive me home after anaesthesia which I didn't want in the first place...) he then offered to take care of it then-there in a supply closet with a nurse, and did, and we had a good outcome from that. In reality, that's how the first operation could and probably should have been handled too, but instead we waited 24 hours to assemble the big team, had the big jovial production and managed to screw it up anyway.
Similarly, my wife's last major medical episode involved pre-eclampsia and a practice of 4 OBs who completely overbook themselves on a regular basis. They almost caught it - saw a high blood pressure reading at a regularly scheduled visit and wrote the correct orders for a followup, but then totally screwed up the followup and the final weeks of regularly scheduled visits - directly traceable to overbooking of the practice and lack of access to the doctors. On the first occasion after 2 days of phone calls with no response we presented at the office in person and I had to push past the receptionist and find the doctors back in their private lounge, physically collapsed on the sofas after a long hard day, to get any kind of followup for the high BP reading - one sprang back to life, did a 2 minute exam and declared "everything's great! Go home and reschedule your next visit for later since you've already come in today." That rescheduling was completely screwed up due to the way their office runs, and the recommended 7 day intervals turned to 10, on day 9 we had to present as an emergency case in the morning with blindness due to high BP - this time not even talking to the receptionist just pushing past to grab the first available MD and get the admission rolling. After 2 weeks in ICU and >$30K in bills Mrs. "everything's great!" came out with her other nugget: "At least we had a good outcome." 2 weeks in ICU is a good outcome? If I wore a body-cam (like Russians' dash cams) for that episode, we would have had a slam-dunk case: receptionists painting their nails, picking up the phone and hanging it up without even talking to the patients who are calling... an average of 2 hours wait past scheduled appointment times, many times stretching to 4 hours and occasionally cancelling. Staff terrified to call the on-duty MD to handle followup orders. We could have spent the next years of our lives in court pressing that case and maybe winning, but it would have all been based on personal testimony and a sketchy paper trail sourced mostly from their offices. The situation also involved good friends of my employer and pressing such a case could also have cost us our sole source of income.
Those are the low-points, but they happen, and our acquaintances who spend more time in the medical care system seem to have more of them.
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