Tuesday, October 4, 2011

Doctors You Can Trust

It is difficult to dispute the argument that  if nerves are accidentally severed during surgery, repair should be effected quickly to expedite recovery before the injury deteriorates. The issue is whether the remedial action should be carried out if the patient is still under sedation and prior consent had not been secured. And be honest with him afterwards.

The little girl had a hole in the heart (atrial septal defect) and her parents decided on the AMPLATZER® Septal Occluder because the procedure is less invasive than open-heart surgery. Adults with an uncorrected ASD tend to exhibit symptoms of dyspnea on exertion (shortness of breath with minimal exercise), congestive heart failure, or cerebrovascular accident (stroke). The procedure takes approximately 1-2 hours, and many patients go home within the same day. But the procedure was relatively new in Singapore then, and the surgeon decided to be extra kiasu (cautious).

Amplatzer® occluder launched
One day before the operation, he briefed the parents on his method of approach. He planned to use a balloon catheter to check the actual size of the intracardiac shunt. If the ASD did not exceed a certain diameter, the surgeon may decide not to go through the process, even though the $25K equipment was already paid for. Although the AMPLATZER®  device is made of Nitinol (a wire made from an alloy of nickel and titanium) with polyester fabric inserts designed to provide a foundation for growth of tissue and help close the hole, it is still a foreign object in the human body. The surgeon categorically stated that the parents will have to trust his judgement. Mom was like, all that money down the drain!

Fortunately or unfortunately, depending on one's perspective, the ASD was significant enough to justify the operation. The little girl was home by lunchtime, and playing on the swing, without the telltale scars of a typical open heart surgery.

The doctor whose accreditation was revoked was not penalised for reattaching the severed nerves without the patient's expressed permission. His misdemeanor was instructing  a nurse to edit the consent form to include the unauthorised procedure. Electronic forms used at Tan Tock Seng Hospital prevent alterations or cancellations after they are submitted, but Singapore General Hospital has yet to implement such systems. Computers are not fool-proof, the ultimate insurance is a doctor you can trust your life with.


  1. Trust them,
    they save life.
    Accidentally, they
    may cause hurt
    and misery they
    never intended
    to. There is
    no malicious

  2. The main issue is whether there was negligence or not. Not the intent.