By Fritz Hofheinz, MD
We reviewed an interesting case recently that helps shed some light on the real-world issues dogging healthcare. The mother of a seven-year-old girl became worried when sinus surgery was recommended for her daughter’s chronic sinusitis (sinus inflammation). Mom was eager to find out if there were other non-surgical options available, and she asked us to review the case. A national expert otolaryngologist (ear, nose and throat doc) reviewed the case for us, and he pointed out that the patient had yet to undergo several of the simple, low risk steps for evaluating and managing chronic sinusitis (sinus inflammation). Further, because of an unusual anomaly in the girl’s facial bone structure, surgery could pose a real risk of damaging her eye. Mom, not surprisingly, was overjoyed to hear the conclusions and to have a clear path forward for treating her daughter that didn’t involve surgery (mom was not even aware there was a potential risk of eye damage).
Why is any of this important you might say? The answer is that this is not a rare case. These situations arise in healthcare every day. Choices are made about complex situations in the rush of 15-minute visits and high anxiety. There is no built-in review system. Only the vigilance and determination of a protective Mom in this case protected her daughter from a possibly rushed surgery. The case could just as easily have ended with surgical complications and a damaged eyeball, or worse, with complications from anesthesia (rare, but it happens), all for a problem that had a simple, safe solution. The treating physicians involved almost certainly are not bad people but they have their own mindsets and motivations and made recommendations based on what they thought was correct. They were likely wrong in this case. Our national sinus expert strongly felt surgery was the wrong option and there were much simpler and safer options to be considered.
If these types of situations happen all the time in healthcare (and they do), why are we not devoting more “healthcare quality” and “healthcare reform” discussions to understanding why these types of cases occur and seeking ways to improve this situation?
