PakMediNet Discussion Forum : Surgery : Missing gauze -whom to blame
gossipbioma;textiloma; cottonoids;-as they call it; on whom should be blame put for missing gauze in abdomen discovered post operatively; the theatre assistant, circualting nurse who is supposed to count or surgeon whos is the chief of team or the hospital system where no policy procedures are handed over to operating surgeons before they start working in that set up; what are policies/ experiences in your institutions;Dr fiaz maqbool fazili Senior Surgeon and President world association of laparoscopy surgeons; king Fhad hospital Medinah munawarah
Posted by: fiazfaziliPosts: 16 :: 26-05-2005 :: | Reply to this Message
its quite surprising that you apparently / seemingly a relatively senior doctor is asking such a basic question. it is definitely the responsibility of the surgeon to make sure before the closure that the count of all sponges/ instruments is correct and if this cannot be confirmed an x-ray is taken to make sure that it is not left in the patients body 'cos these sponges contain a radio opaque lining.
Even if there is no hospital policy /procedure there , this is the first lesson tought to surgeons first day of training that "you are the man" .
ijaz
quote:
fiazfazili wrote:
gossipbioma;textiloma; cottonoids;-as they call it; on whom should be blame put for missing gauze in abdomen discovered post operatively; the theatre assistant, circualting nurse who is supposed to count or surgeon whos is the chief of team or the hospital system where no policy procedures are handed over to operating surgeons before they start working in that set up; what are policies/ experiences in your institutions;Dr fiaz maqbool fazili Senior Surgeon and President world association of laparoscopy surgeons; king Fhad hospital Medinah munawarah
Posted by: ijazaliPosts: 151 :: 30-05-2005 :: | Reply to this Message
Surgery is a team effort. A surgeon cannot operate alone without the OT nurse, asisstants and other members of the operation team. Putting the entire responsibility of such an unfortunate happening on the surgeon would be inaccurate. I personally believe that in case of such an event, a thorough investigation of the matter should be conducted to evaluate the fault. Definate guidelines should be established by the hospital administration to look into such matters.
Regards.
Posted by: id_9112Posts: 13 :: 29-12-2006 :: | Reply to this Message
Quote of ijazali dated 30-05-2005:- it is definitely the responsibility of the surgeon to make sure before the closure that the count of all sponges/ instruments is correct and if this cannot be confirmed an x-ray is taken to make sure.
Reply:- I agree with ijazali.
Quote of id 9112 dated 29-12-2006:- Surgery is a team effort. A surgeon cannot operate alone without the OT nurse, asisstants and other members of the operation team.
Reply:- No doubt a surgeon is head of the team and so it is responsibility of the head who must be vigilant.
Posted by: HussainA (Guest) :: 04-10-2007 :: | Reply to this Message
no matter who ever you blam, but the final responsible person is the operating surgeon specially working in common pakistani hospital
Posted by: sharif60Posts: 2 :: 12-12-2007 :: | Reply to this Message
This argument seems too idealistic that surgeon is head of team and so responsible for everything going around.Specially in pakistani set up where everything is in shambles . This is also a gross misunderstanding that sponges produced has got any silver lining which can make them radio opaque.I work in one of largest trauma center of pakistan, i have never been fortunate to have such sponges.
In middle of very hectic and struggling night,in emergency in particular, surgeon becomes too much obsessed and egrossed in his job.This is practically never possible for him to keep count of every sponge himself, rather he has to be content with statement of assisting nurse that she has counted all the sponges ,she delivered. Dealing with already very stressed situations both professionally and administratively, making him responsible for even what others can mishandle is just like putting last straw which can break camel's back. Either ppl will stop becoming surgeons or they will always work on gunpoint situations. This is not to absolve them of every responsiblity but rather by very nature of their job, they are already taking enormous care of too many things which sometimes defies human abilities.
this is also fact that there is no defined policy for sponges provision, counting(in terms of defined numbers per pack, i,e multiple of odds etc) or stuff they are made of(with regard to that fictious radio opaque stuff). Even if we accept that we have been trained by instinct right from day one for counting sponges after every operation ourselves then what about paramedics who assist us. they totally seem ignorant about magnitude of problem which can emerge as a result of leaving sponges behind. even when educated and trained about this, they just give a deaf ear to it because they know that their positions are unshakable and they are accountable to none.This is pathetic that in this so called health care chain or system if there is any, Doctors and specially surgeons are most vulnerable link which every body feels so handy to assault and walk away just unscathed even amongst our own ranks.I wonder if people will like to join this field in future if society remains so hostile towards those,they have to depend on in the end.
Duties are always specified or relegated to specific ppl who are capable of doing that. Of course this is important to identify or train such ppl.But once this is done, this remains primarily their job.Despite somebody being incharge or supervisor, it will be inhuman and oversimplification to expect him present everywhere, all the time.His omnipresence will become a theoretical reality or textbood phenomenon but unlikely to be ever translated into a working reality.(This may be happening in west but at cost of fewer doctors coming to surgery now as a discipline, their growing fear about seeing themselves as potential candidate for gallows after every attempt at saving a human life and thriving lawyers.benficiaries from both sides and burning candles at both ends.) Eventually the person who was entrusted that responsibility must be inquired about it obviously by his immediate supervisor but again with essential proviso that whether he was ever given such or any authorities. While working in this system ,it does no't take too long to know that we are actually not captain of that legendary ship so often referred to.
This is my humble opinion as i have experienced and observed. I don't mean to offend any body.
[Edited by drfarhan on 05-06-2008 at 05:18 PM GMT]
[Edited by drfarhan on 15-06-2008 at 05:51 PM GMT]
Posted by: drfarhanPosts: 93 :: 03-06-2008 :: | Reply to this Message
Well!
A nice fiction!!!
Posted by: shakeelaPosts: 13 :: 15-06-2008 :: | Reply to this Message
perhaps this is high time to differentiate facts from fiction.Let's start sorting it out and stop living in twilight before its too late!
Posted by: drfarhanPosts: 93 :: 15-06-2008 :: | Reply to this Message
After missing the gauze, it is judge of the court (having the authority to put penalty on the surgeon) Who shold be convinced otherwise it requires two third majority in the parliament to defend the innocent surgeon. Opinion of just a few has no importance.
Posted by: shakeelaPosts: 13 :: 16-06-2008 :: | Reply to this Message
you are right. i have already discussed and admitted about hostile behaviour of society against doctors in general and against surgeons in particular. Unfortuantely this is global phenomena. One reason for this negative attitude towards us as community may be disparities amongst our own ranks and since we never took any stand and convey our message across board as fraternity. EVen a merchants union seem better equipped and much more aware about their rights to get their demands acceeded to but we despite being much more needed and indispensable in the end, are just ignored. We perhaps never tried to be noticed. Look what is happening as a result. your legislature is absolutely oblivious of how quacks are shuffling with human lives but they along with those so called judges whose judgement can be moulded and modified at will of some power brokers, are quick to bring the most educated person of their intelligentia to book.This may be difficult and must be requiring lot many efforts for opening a general store or establishing a sugar mill but its easier for any body to claim himself a doctor and set up hospital and start looting community. No eyebrow is raised and your parliament remains lifeless.
See how we are reciprocating as a result, although may not be consciously. Do really we have any sympathy and good will left towards society. Is our behaviour over years not becoming more callous , rude and frustrated.ARe we not transforming into a sheer mercantile. Is today doctor not more insecured in his own hospital or clinic then ever.
You are also right on this account and this is lamentable that either we don't have any opinion or we failed to voice it effectively from some common platform. If such platforms already exist, they could never scale our genuine problems and represent us in true sense. And perhaps foremost problem amongst all others is our own security which is so nakedly and rather legally jeopardized so often and we remain just silent spectators.
anyways as a practising surgeon and being in field for quite some time, i reflected what i saw ,experienced and observed. Sooner or later we shall be in same shoes. I have seen my colleagues suffering and sometimes it really becomes very sad affair. One literally starts resenting the decision of joining this field in first place. If i am not able to convince this hung parliament or this judiciary then at least i should,or rather we should be raising our voices, individually if not collectively to make them all see flip side of coin.This also raises another one million dollar question, did we ever try to convince any body?
Doctors are not exploiter as they always assume to begin with or "guilty" untill proved otherwise. But you don't and can't call it fiction. If you are unable to fathom our problems , at least dont mock them. These problems ,we are hectically facing and all this is as real as your own self. Its just matter of time before you know it.
[Edited by drfarhan on 16-06-2008 at 07:25 PM GMT]
[Edited by drfarhan on 16-06-2008 at 07:53 PM GMT]
Posted by: drfarhanPosts: 93 :: 16-06-2008 :: | Reply to this Message
quote:
it is judge of the court (having the authority to put penalty on the surgeon) Who shold be convinced otherwise it requires two third majority in the parliament to defend the innocent surgeon.
Posted by: zainPosts: 35 :: 22-06-2008 :: | Reply to this Message
i think what pakistan needs is http://www.motioncomputing.com/about/news/case_studies_healthcare.asp
Posted by: motion (Guest) :: 14-09-2008 :: | Reply to this Message