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Tuesday, April 7, 2009

Between sandwich bites: Testicular surgery against a father’s wishes

This is a father's complaint to the Nevada State Board of Medical Examiners:

To whom it may concern, from one who it has concerned greatly:

It is said that the greatest skill of a doctor is their bedside manners. I could agree with this in theory, the theory being predicated on the hope, my hope that the doctor is operating on all cylinders, is integrated, aligned, smart and most importantly honest. A doctor can have a wonderful personality and a wonderful bedside manner and yet, be completely deceptive, dishonest and completely unconcerned with our welfare when compared to standard practices and of course legal liability. It appears in our mostly litigious society doctors are scared of lawsuit and therefore will be most versed in how to avoid lawsuit secondary to their professional skill.

Such is the case with Dr. J.

I met her on what may have been considered a routine pre-surgical consult. The surgery we discussed was an exploratory surgery for my son's ascended right testicle. I asked lots of questions. In my world, this surgery was going to be a simple procedure because I felt a lump on my son's upper right pubic bone, which gave me assurance that his testicle was there and merely required some medical assistance to return it to where it belonged in his scrotum.

It seemed it would be a simple procedure on the doctor’s part as well because she was far more concerned with eating her lunch in either a recently vacated office or an office she has recently moved into. I followed her into this room to continue my line of questioning. I asked her about her rather flippant line where she said his testicle would be removed if it was less than the size of her pinky fingernail, while ceremoniously indicating such with her extended digits.

I asked her- "What if it is exactly the size of your fingernail?"

"I would still remove it," she replied between bites of her sandwich.

"Really? I don't like that idea. If it is the size of your fingernail, then I expect it stays in. In fact, I'd prefer if his testicle is not the size to move, then it is left alone," I said firmly. She nodded in agreement with her mouth full.

Little did I know at this point I should have pursued a more explicit confirmation of my request, as in I should have gotten this confirmation in detailed affirmation, notarized and with a medical examiner witness.

Because as it turned out later, the doctor removed my son's right ascended testicle without actually measuring it at all. To further add insult to injury to my son and to my duty to protect as Father, she claimed that it was a pre-cancerous situation and that the testicle would be tested for cancer cells. This of course was just a ruse and was never carried out. Of course a young struggling testicle will show no signs of cancer. The main problem I learned from my multiple attempts to find a pediatric urological expert witness is that Doctor J. toed the line of medical malpractice liability. If anything atrophic (by her view) is left in the body, then that is a more litigious situation then actually following the patient's parent's request. In fact, the doctor now sanctimoniously hides behind even more medical legalese by claiming that she did what was "clearly in the best interest of the patient."

How does she know what is in the best interest of the patient?

Oh, because she refers to "a multitude of medical research findings" which only gives her a bigger trench to sit with her other than conscious behavior.

I clearly told her what is in the best interest of my son and she affirmed my request. If she was somehow medically bound to complete my son's procedure with a forced removal of his testicle, then she should have told me clearly at our meeting. Because if she told me at our pre-surgical operation meeting that she is required by medical directives to avoid any future lawsuit and to remove my son's testicle I clearly would have opted out of such a railroaded situation and continued my exploration of alternative therapy.

This is the crux of my crucifixion. And this is also where I hope and pray the doctor is nailed for negligence.

There are errors of omission and then there are errors of commission.

And then there are errors of both. Errors of commission are answering a question incorrectly, which she did. Failing to answer a question or to answer a question in full is an error of omission. She did both while gleefully eating her packed lunch. Such contempt.

I choose at this time to abbreviate my letter and my complaint. I'm sure there are things I could have done differently and things I could have said differently, yet clearly someone in the room of pre-surgical consultation was licensed as the professional, yet clearly my curious questioning was indignantly refused. If I asked nothing, I could accept my results. If I refused nothing, I could accept my results. If I clearly asked and directed the doctor and she told me clearly what she was legally required to do, then I would have accepted an entirely different outcome.

The doctor should listen closer to patients, especially parents.

So in fact, bedside manners are very important. Maybe all of this would have been very different had the doctor demonstrated polite, concerned, engaged listening. And I know it would have been a significantly better outcome if the doctor revealed direct honesty of what is medically required in her surgical procedure. She even could have done this between sandwich bites, or preferably after lunch.

Advice to parents: Specify your preferences for your child’s surgery in writing beforehand and have the surgeon sign it.

Read another story about the lack of informed consent for testicular cancer.

Thanks to Bryan Brey for sharing his story.

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