Arriving to the board I notice a new surgeons name, Dr J. I inquire who this was, and hear he is a new Cardiothoracic surgeon, fresh off fellowship. I don’t do hearts, so figure I won’t be running into him very much. They said he will be doing robotic hearts, vascular, endovascular, as well as open heart. I found that interesting, most places I have been the doctors become very specialized in one area, spending a fellowship gaining extra skills and experience to hone those skills. I wonder if this is the new way, or if they just want to be able to bill for more procedures.
I notice his first couple of cases, are very simple, amputations, which I find odd for a heart doctor to do, but each case seems to be more chaotic then the next. I find the circulators scrambling in the hall for items and the cases never seem to go smoothly. I wonder if it is just first-time doctor nervous energy, or if we are dealing with a real quack. My curiosity led me to the internet to ensure he was actually a doctor and not some joe Schmoe who put on a white coat and showed up for work. I did track back his medical school and residency, so I know he is legit.
One afternoon I notice he has spent an exceptionally long time on a one vessel open heart bypass. I know the circulator in the room, as he is a fellow traveler I chat with in the break room. I offer to go in and help and find a room that is filled to the brim of chaos. Equipment everywhere, staff scrambling to assist the surgeon, cell saver running the bypass pump. I quickly realize whatever is going on here, I will be of no assistance. I watch the case struggle along from the board, hearing whispers of a transfer to a university hospital nearby. I was absolutely stumped how a heart hospital would need to do a transfer. Which is in fact what happened.
I inquire to my fellow traveler as to why the patient was transferred, instead of the senior surgeons assisting in repairing whatever was going on, to be told the senior doctors refused. I was shocked, this is their hospital, their heart program, their group name on the line. I was informed that when Dr. J started, it was tradition for the senior doctor to scrub in to assist and watch, and that Dr. J had smacked the senior surgeon’s hand away, and appeared unable to learn from anyone else. I was shocked, I cannot imagine coming into a new heart group and slapping someone’s hand away that was attempting to assist. Each of the other heart surgeons had similar experiences in attempting to teach him, with no willingness to learn.
I hear through the grapevine the next day that the patient that transferred to the university had indeed died. This patient was given to him by his partners because it was a “easier” heart. Young marathon runner, decent vessels, now dead. I wondered what the scramble was in the administration offices, I know they were already hearing lawsuit terms from family. I wondered what would be done to Dr J. As the weeks rolled by, nothing appeared to be business as usual. He continued to struggle through the most basic procedures and never seemed to have great outcomes from what I could see.
One particular evening he was struggling with a lung case, attempting to do a lobectomy for cancer. I am assisting the circulator in the room with the specimen, dealing with grouchy pathology who hate to be at the hospital after 4:30. Running the specimen fresh, as I return to the room to help with the closing, as he is confident, he got clean margins he began to close the patient. The phone rings, pathology, stating “no cancer cells identified”. Everyone in the room looks around, the PA shocked, the room is like crickets, Dr J says nothing. Continues to close the patient and walks out the door.
We stand there in shock, what this phone call means, is he must have taken out the wrong lobe. There were no cancer cells in the specimen, and yet he walked out. What was that conversation going to look like with the family? Would he even be honest with family? Or use some lame “metastases” story later on down the road. At this point administration finally intervened. After approximately six months of chaotic cases, poor outcomes that are easily trackable, the cost of another lawsuit finally outweighed the payout of his contract.
His contract being paid out in full to get him to leave. No reports to the medical board, no accountability for the obvious lack of skills in his practice. Imagine going to work and being a painter and doing a sloppy job, and getting paid out anyway. There is no accountability because the cost of attempting to hold these criticisms is too much red tape and cost to facilities. Instead, pay them off, pass them along, and hope the next facility does the right thing. That is the most frustrating part in healthcare, we all came to help heal, we are all learning, but when someone is obviously too egotistical to learn and grow, why do we allow them to continue to hurt people? We allow surgeons to hurt people until the lawsuits outweigh the contracts. The struggle to realize I have no impact on this and can’t garner any change is deeply troubling.