CUTTING REMARKS
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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | F E B R U A R Y 2 0 1 4
need to write 'EXOSTOSIS' instead of 'SPUR'?
q Omitting the words 'ACROMIOPLASTY' when consenting for rotator
cuff repair. Ouch! I've been routinely performing acromioplasty with
my standard cuff repairs for the past 23 years, so I feel dinged when I
hear this. Should I also add 'EXCISION OF BURSA?' Gimme a break!
q Omitting the phrase 'POSSIBLE OPEN' to an arthroscopic procedure.
I've never opened a knee for a routine meniscectomy in my entire
career, so I take umbrage to this criticism. Should I add 'INJECTION OF
PORTALS WITH LIDOCAINE?'
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Catastrophizing.
Again, the truth is always sacred, but I don't believe
we should scare the living daylights out of our patients. Should we
really include 'DEATH, LOSS OF LIMB OR PARALYSIS' to the consent for a
removal of a prominent screw? Do we really need to add the phrase
'OTHER UNPREDICTABLE RISKS'? That could mean anything from lightning
striking the OR to a hangover for the surgeon. Patients shouldn't need
a Valium drip before a lipoma excision. We are healers and patient
advocates, not tormentors of the soul.
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Legalese.
I often joke that practicing in Philadelphia affords me the
opportunity to be sued B.I.D. It's sad that we do so many things not in
the best interests of patients, but merely in the spirit of defense against
litigation. Phrases such as 'including but not limited to…' are normally
not my first choice of words when discussing the reasonable risks of
an operation with a patient. Does this include dengue fever? Not limit-
ed to coma? 'INJURY TO NEARBY ORGANS' would evoke fear in the most
courageous of souls. By the way, what's the closest organ to a bunion?
I've never liked the phrase 'LIKELIHOOD OF ACHIEVING THE GOALS.' What am
I, some surgical odds-maker? How does one define likelihood — does
it mean probable, likely or bet the house on it?
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