The technical, visual-spatial and haptic details of this case take years of training to grasp. There is no way that the jury and the judge could have grasped all that with just a few explanations and reports. The demeanor, appearance and speaking style of the plaintiff, experts and lawyers probably determined the outcome of this case.
I can figure out most med mal topics and grasp them pretty well even when outside of my specialty, but this one was a pretty big stretch. Just not things I think about a lot.
I can't image what psychiatric problems the dentist has as a result of his surgery! I worked in a private forensic psychiatry practice for 6 years. If you need material I'm happy to give you the doc's contact info and website
Breathing normally through your nose is definitely something take for granted... I've certainly felt like I might go nuts when my nose gets totally clogged up during a cold!
As physicians I think we expect other physicians to go the extra mile for us. I’ve had good experiences with most of my care. One was bad but I didn’t sue. Luckily the problem was fixed by another orthopedic. Even we can make mistakes choosing the wrong doctor.
Great example (to me) of poor outcomes leading to a patient dissatisfied enough to sue despite being (likely) well counseled as to possible (not probable) outcomes. Also horrifying that an expert would claim that septal perforation is due to a substandard surgery rather than a known complication of surgery, much less claiming that persistent or recurrent sinus disease after surgery is somehow related to a malpractice level event..... Crazy that it is still going on a decade later. Great summary!
Interesting. As to doctors suing doctors, or not…I’m a retired orthopedic surgeon/attorney. I went for a TKR locally, in 2016, thinking a primary total knee, in a healthy person with little deformity but for mild:moderate varus, in a normal wt patient, is about as easy an operation as it gets. I woke up with new patella-femoral symptoms. After about 6/8 weeks, and being blown off by the surgeon’s office, I ordered a CT, which confirmed what I suspected-the patella button was grossly malpositioned. I followed up with the surgeon, who tried to “explain” that I wasn’t seeing what I was obviously seeing! I asked him-did you let the resident put in the patella n close after you left the room-KNOWING your patient was an orthopedic surgeon AND an attorney?! He was embarrassed, apologetic, etc. I did not sue him. Just “lived with it “, despite what imo was an inexcusable fuck up. Because 1. I did not want to sue another doctor, and 2. Notwithstanding this error, my overall knee pain , at the femoral/tibial articulation was strikingly better. That said, my patella femoral ‘joint’, which I had no symptoms from pre op, has continued to be a problem. I guess my point is, no, not all, or even most, doctors are hyper critical of their care.
Anosmia is more of a handicap than people realize. Is my toast burning or my house on fire? Our nose knows. Smell is our early warning system & greatly contributes to sexual attraction & pleasure. Women apparently select mates based on olfactory cues related to HLA type. I saw many head injured patients with anosmia during my career and every single one complained bitterly!
So don't minimize anosmia.
But I got the sense this patient's problem was manageable when he saw the surgeon; he was seeking to optimize it. Yet the surgeon saw him once, started a steroid spray, saw him agsin once shortly thereafter & concluded his condition was pretty much the same. Who was treating this patient's symptoms all those prior years? Did the surgeon recommend surgery based on a brief acquaintance at window in time that happened to represent an exacerbation of his symptoms?
We'll never know .
Surgeons need always remember they are not gods. The less affected a patient is prior to surgery, the more perfect the surgical outcome must be.
The patient's mistake was to ask a surgeon if surgery might help, & to not realize that surgery could also make him worse. Since he was was managing OK, he should have just optimized his MEDICAL management.
Stay away from surgeons when you need medical management.
It's equally likely his symptoms were primarily due to inflammation with or without infection & less so by mechanical obstruction. Was there a degree of poor drainage? Almost certainly so. But by the case history given here, this patient had had the problem for quite a while & was managing OK. He chose to see a surgeon to see if things could be improved. Was he the one unlucky patient who didn't do well? IDK . But in the face of lethal disease a patient will accept nearly any surgical solution & tolerate complications, but a damn near normal patient who has a less than wonderful surgical outcome will think it's a disaster. Incidentally, there are millions of patients with allergic rhinitis & sinusitis in the Ohio Valley who are managed medically without aggressive resection of imaging-proven "obstruction".
The technical, visual-spatial and haptic details of this case take years of training to grasp. There is no way that the jury and the judge could have grasped all that with just a few explanations and reports. The demeanor, appearance and speaking style of the plaintiff, experts and lawyers probably determined the outcome of this case.
I can figure out most med mal topics and grasp them pretty well even when outside of my specialty, but this one was a pretty big stretch. Just not things I think about a lot.
I can't image what psychiatric problems the dentist has as a result of his surgery! I worked in a private forensic psychiatry practice for 6 years. If you need material I'm happy to give you the doc's contact info and website
Breathing normally through your nose is definitely something take for granted... I've certainly felt like I might go nuts when my nose gets totally clogged up during a cold!
As physicians I think we expect other physicians to go the extra mile for us. I’ve had good experiences with most of my care. One was bad but I didn’t sue. Luckily the problem was fixed by another orthopedic. Even we can make mistakes choosing the wrong doctor.
Great example (to me) of poor outcomes leading to a patient dissatisfied enough to sue despite being (likely) well counseled as to possible (not probable) outcomes. Also horrifying that an expert would claim that septal perforation is due to a substandard surgery rather than a known complication of surgery, much less claiming that persistent or recurrent sinus disease after surgery is somehow related to a malpractice level event..... Crazy that it is still going on a decade later. Great summary!
Interesting. As to doctors suing doctors, or not…I’m a retired orthopedic surgeon/attorney. I went for a TKR locally, in 2016, thinking a primary total knee, in a healthy person with little deformity but for mild:moderate varus, in a normal wt patient, is about as easy an operation as it gets. I woke up with new patella-femoral symptoms. After about 6/8 weeks, and being blown off by the surgeon’s office, I ordered a CT, which confirmed what I suspected-the patella button was grossly malpositioned. I followed up with the surgeon, who tried to “explain” that I wasn’t seeing what I was obviously seeing! I asked him-did you let the resident put in the patella n close after you left the room-KNOWING your patient was an orthopedic surgeon AND an attorney?! He was embarrassed, apologetic, etc. I did not sue him. Just “lived with it “, despite what imo was an inexcusable fuck up. Because 1. I did not want to sue another doctor, and 2. Notwithstanding this error, my overall knee pain , at the femoral/tibial articulation was strikingly better. That said, my patella femoral ‘joint’, which I had no symptoms from pre op, has continued to be a problem. I guess my point is, no, not all, or even most, doctors are hyper critical of their care.
Definitely a lot of variation from doctor to doctor!
Anosmia is more of a handicap than people realize. Is my toast burning or my house on fire? Our nose knows. Smell is our early warning system & greatly contributes to sexual attraction & pleasure. Women apparently select mates based on olfactory cues related to HLA type. I saw many head injured patients with anosmia during my career and every single one complained bitterly!
So don't minimize anosmia.
But I got the sense this patient's problem was manageable when he saw the surgeon; he was seeking to optimize it. Yet the surgeon saw him once, started a steroid spray, saw him agsin once shortly thereafter & concluded his condition was pretty much the same. Who was treating this patient's symptoms all those prior years? Did the surgeon recommend surgery based on a brief acquaintance at window in time that happened to represent an exacerbation of his symptoms?
We'll never know .
Surgeons need always remember they are not gods. The less affected a patient is prior to surgery, the more perfect the surgical outcome must be.
The patient's mistake was to ask a surgeon if surgery might help, & to not realize that surgery could also make him worse. Since he was was managing OK, he should have just optimized his MEDICAL management.
Stay away from surgeons when you need medical management.
What's your next medical management? Who's the person that people refer to for medical management of nasal obstruction?
Keep talking out of your ass man.
It's equally likely his symptoms were primarily due to inflammation with or without infection & less so by mechanical obstruction. Was there a degree of poor drainage? Almost certainly so. But by the case history given here, this patient had had the problem for quite a while & was managing OK. He chose to see a surgeon to see if things could be improved. Was he the one unlucky patient who didn't do well? IDK . But in the face of lethal disease a patient will accept nearly any surgical solution & tolerate complications, but a damn near normal patient who has a less than wonderful surgical outcome will think it's a disaster. Incidentally, there are millions of patients with allergic rhinitis & sinusitis in the Ohio Valley who are managed medically without aggressive resection of imaging-proven "obstruction".