Thursday, May 19, 2005


An extensive protocol is followed in order to prevent medical errors in the operating room. Only after all of the criteria are met and confirmed does the surgeon lay his hand on the scalpel.

The various steps in this procedure involve checking ID bands, having the patient confirm their identity and operation they are to receive, naming their surgeon, and marking the extremity or side of the body that requires the operation. This last step is vital to avoid errors such as amputating the wrong leg or removing the wrong kidney.

I received a page from someone the other day that went like this:

Nurse: Hello Doctor, this is [bleep] in pre-op. I'm calling about Patient E. I saw that you were just here, but you forgot to mark the patient.

[She was referring to marking either the left or right side of the patient with a "yes" to signify which organ I planned to operate on.]

Me: Well, I didn't mark the patient because we're doing a lap chole.

[lap chole = laparascopic cholecystectomy = removing the gallbaldder]

Nurse: Yes, I know. But you still need to mark the patient.

Me: [slightly annoyed] That's ridiculous. There's only one gallbladder. Why would I have to mark the patient if he only has one organ?

Nurse: [robot-like] It's protocol. We can't go back to the OR if the patient is not marked. We have to know which side you're going to operate on.

Which side? There's only one gallbladder in the body and only in the most extremely rarest of rare situations would it lie anywhere else other than under the liver on the patient's right side. This person couldn't think outside of the box. This person couldn't comprehend the ridiculousness of having to mark this particular patient.

In the end, I quit arguing with the nurse and just went back and drew a big X on the poor patient's body. But not before bringing a copy of an anatomy text to educate the nurse on basic organ location.