tag:blogger.com,1999:blog-30499448.post8589306746929426228..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: The Rupture, part twoSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-30499448.post-59079401489536010692006-10-23T19:07:00.000-07:002006-10-23T19:07:00.000-07:00I like the way you handled the situation with your...I like the way you handled the situation with your patient. I agree... he lived 70+ years without this information so why add this burden on his shoulders now.<br /><br />Let's just hope he dies a natural death and there is no autopsy... or they have the same feelings as you. The knowledge serves no purpose.Michellehttps://www.blogger.com/profile/15259837057328898125noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-47704873889101128552006-10-19T23:16:00.000-07:002006-10-19T23:16:00.000-07:00I would be very interested to read your comments a...I would be very interested to read your comments about pediatric hernias. A pretty hefty percentage of our preemies end up needing repairs. I have no idea if the percentage is actually higher than in babies born at term or if the apparent increased incidence is because we keep some of them so long and they become evident while they're in the NICU. Maybe you can shed a little light on that.Judyhttps://www.blogger.com/profile/08237756183010257014noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-8817468924740633762006-10-19T07:49:00.000-07:002006-10-19T07:49:00.000-07:00Julia: Thanks. I think I'll post about pediatric h...Julia: Thanks. I think I'll post about pediatric hernias and belly-button hernias before I finish out the series.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-86271780580979672942006-10-18T19:58:00.000-07:002006-10-18T19:58:00.000-07:00such an amazing way you have of telling us somethi...such an amazing way you have of telling us something... <br /><br />Beautifully written, as always my friend. <br /><br />beeEmpress Bee (of the high sea)https://www.blogger.com/profile/08300140506585000934noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-12828895333593517102006-10-18T14:37:00.000-07:002006-10-18T14:37:00.000-07:00This is fascinating. Keep telling stories.This is fascinating. Keep telling stories.Alexandra Lynchhttps://www.blogger.com/profile/18072477348101339042noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-41191765663251003062006-10-18T03:54:00.000-07:002006-10-18T03:54:00.000-07:00I really do understand your decision, Sid. I can a...I really do understand your decision, Sid. I can also tell that it was a long time ago, when paternalism (using the term historically; not perjoratively, and with no offense intended) in medicine was the norm. I'm not even saying that today's ideal of fully informed patients involved in all treatment decisions is *better*. Frankly I agree there was much comfort in leaving certain things to trusted and competent physicians, especially in times of illness.<br /><br />But I did want to point out that a surgeon confronted with this situation doesn't have to go it alone. He can even call the FP and discuss whether or not the patient might be harmed by the disclosure, and/or how to have the discussion himself if he wishes. (I was thinking about how I'd go about having a conversation like that with this patient, and I came up with this opener: "It may seem strange to be discussing this after all these years, but Dr. Schwab discovered why you could never have (biological) children.")#1 Dinosaurhttps://www.blogger.com/profile/01357845504444464397noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-87653818206237008342006-10-17T14:18:00.000-07:002006-10-17T14:18:00.000-07:00The organs came out with the hernia sac. Had he be...The organs came out with the hernia sac. Had he been younger (no formula: just a lot younger) I'd without doubt have told him. Can't argue strongly that not telling him was right. It seemed so at the time. Also, it was quite some time ago. <br />But it was not really bewilderment nor discomfort. At age 75 or so, with no biological heirs and a family who knew him as he was for decades, I made a considered decision. I don't recall what his situation was vis a vis a family doc. Your point is well-taken regarding the two-way street, as a general rule. In a way, the decision not to tell him was a way of accepting more responsibility than the opposite decision.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-24928181289566788762006-10-17T13:27:00.000-07:002006-10-17T13:27:00.000-07:00Impressive hernia; it dwarfs the biggest I saw in ...Impressive hernia; it dwarfs the biggest I saw in training (only about the size of a grapefruit.) Pretty cool listening to bowel sounds in the scrotum, though.<br /><br />About the first patient, though: I'd like to respectfully submit that not saying anything about the vestigial female organs (did you remove them, BTW?) was exactly the wrong thing to do. <br /><br />I completely understand your bewilderment and discomfort at addressing it with him (yes, him: this finding does not constitute sex reassignment) and your analysis of no good coming from the revelation, but he still has a right to know. <br /><br />Here's another option for dealing with it: call me [his family doc] and tell me what you found. Send me a copy of the path report (including the vestigial organs, I hope) and tell the patient to come see me. I'll do the hermaphrodite research for you (including the possible risk of malignancy; is it analogous to testicular feminization?) and tell the patient about the surgical findings as well as the medical implications in a sensitive, respectful manner.<br /><br />Referral works both ways, you know.#1 Dinosaurhttps://www.blogger.com/profile/01357845504444464397noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-52038069905953677222006-10-17T07:55:00.000-07:002006-10-17T07:55:00.000-07:00Do please share more. Hernia repair is something ...Do please share more. Hernia repair is something no general surgeon really seems to want to <i>talk</i> about to the uninitiated--but I find that learning about these simple things (Appendectomy, hernia repair, lap choles) are great ways to become familiar with the nuts and bolts of what really general surgeons start with.Anonymousnoreply@blogger.com