ClickCare Café

Complications.

Posted by Lawrence Kerr on Tue, Jun 15, 2010 @ 01:00 AM

As a surgeon, I dread complications.

I think through anything that I could do to avoid them. I worry about alternatives but despite worry and action, they occasionally happen. Not often, but enough to make me worry as I sleep, drive around, and anticipate what needs to be done. And it’s not only me. Fear and dread have driven many of my closest colleagues to retire early.

I have been told to never take on difficult cases: “Don’t try to save the world, Larry.”  My malpractice carrier would prefer I side-step those who are as infirmed with high expectation as they are with cancer. And, as a thoughtful recent article in the New York Times points out, there is the financial and moral question of who pays for the complications once they arise.

So, what does this have to do with ClickCare?  A lot.  While we can try to control infection with a thorough preoperative prep and prophylactic antibiotics. We can share our concerns and have our patients share the risk since most of the time it is indeed, the patient’s complication anyway.  (Not always though, as there are plenty of bad backs, burning necks, AIDS and hepatitis among the practitioners).

We can also make sure that things do not fall through the cracks.  We can be sure that the best minds of our trusted colleagues are made available to the patient.  We can use ClickCare.  Just as we can get complications ourselves from our patients, we can get satisfaction and reinforcement of knowing that we know that we did the right thing, that we tried our best, that we left no stone unturned.  That we truly collaborated on behalf of the patient.

The seeming short-sightedness of the Centers for Medicare and Medicaid Services not wanting to pay for complications (while they also refuse to pay for the tools that would prevent them, such as telemedicine) makes you wonder. While finance catches up with technology, I guess we just have to do the right thing.

For us, the right thing has been to keep taking the hard cases, constantly being vigilant, and taking every opportunity to be leaders in the field of collaboration and proactive care.

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