Surgeons are human, inevitably they will make mistakes that could have been avoided.

One morning at one o’clock, after a  2½ hour operation for a bleeding ulcer, the scrub nurse informed me the count was correct and we closed the abdomen. The patient did well for the first few post-operative days and, despite some nausea, he was discharged home on day seven.

The nausea, however, persisted and a plain abdominal X-ray showed a pack had been left inside the stomach.  During the procedure, in order to control the bleeding, a pack had been placed high within the opened stomach to improve the view.   Subsequent control of the bleeding ulcer was prolonged and difficult and the stomach was closed, followed by the abdomen.   The X-ray revealed the pack remaining inside the stomach.

Errors had occurred at several levels. I should have remembered I had placed the pack and not removed it, the scrub nurse should have detected a pack was missing, and the prolonged post-operative nausea would have warranted an abdominal X-ray in hospital.

When faced with such a circumstance, despite the overwhelming wish not to have to face it, the only honest and reasonable way forward is to tell the absolute truth to patient and/or family. In this particular instance, the patient was grateful the problem had been identified, appreciative of our effort two weeks earlier to save his life and remarkably held no resentment for the complication we had caused. Fortunately, the pack was able to be removed without open surgery and the patient was discharged the next day without nausea.

Until recently, it was not uncommon in some European countries to tell patients that all was well, even after major surgery for cancer had failed. Just how the eventual decline was explained to the patient and family remains something I have never understood.

Patients do need to be given the truth as soon as it is known. If this is done it is usually not only appreciated but removes doubts and suspicions that will eventually follow if the patient later learns information was withheld. A truly negligent act may warrant compensation to the patient. Fortunately, most can be managed without long-term adverse outcomes.

Similarly, families who don’t want the diagnosis (usually cancer) discussed with the patient are probably no longer to be supported. The patient needs to know the situation and the options: it is then up to the family to support and advise, not restrict and ignore.

If patients and staff know that an open approach is always followed with regard to complications and diagnosis, it removes all misinformation and confusion and ensures the best quality health care is delivered.

Guy Maddern is professor of surgery at the University of Adelaide. St Anywhere is fictitious, but the events and issues are real

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Peter Fray

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