How to Talk to a Surgeon, Episode 759
February 18, 2012 6:42 PM   Subscribe

I had reconstructive surgery to close a carcinoma wound this week and the surgeon rushed and botched the stitching. I did everything I could think of to have it seen. Now I don't want to see him for my scheduled appointment next week. I also have to keep things open with insurance and other area surgeons for a possible scar correction after a year. More inside.

Five days ago a plastic surgeon rushed my reconstruction after skin cancer. I was out in fifteen minutes after being told it would take about 45. I was his last of the day and he was already two hours late byt the time he reached me.

My sutures—about eight—bled for several hours so I didn’t notice, until I could rinse about 29 hours later, that the stitches are a mess. In the area over the deep Mohs wound there was just a thin, transparent layer of almost-skin and high above, where it should have been easiest to manage, he sutured together the layers beneath the skin resulting in a large, purple bulb of tissue sticking out and sort of strangled between two sutures. This is where the worst pain is now, four days later, and I suspect this is where I’l see the worst scarring. There are two stitches that are well done, where both ends of skin match up and are level, so I know what to compare the others to.

I called his office yesterday. Before I could get anything specific out the nurse stopped me and insisted that everything is normal. She wasn’t interested in any details, just in getting me off the phone. I told her she would have had more credibility if she’d listened to even one detail but she didn’t seem to understand this, just persisted with the railroading effort. Unfortunately it seemed well practiced.

In recent months I’ve learned what can happen when doctors don’t take our concerns seriously. Shortness of breath reported for many months landed me in the hospital for three days with pulmonary emboli, and the skin flap itself was necessary because the same doctor (our family physician for years and retiring soon) froze a tiny lesion without biopsy around the same time. When it failed to heal well he sent me to a derm. who recognized it as skin cancer at first glance. By then it was much larger and deeper. The wound was very disturbing to look at, if you’ve never seen one. It was the doctor’s and nurses in the hospital and since who convinced me that I’d dodged a bullet. They were full of questions about how it could have gotten so far. This is to hopefully ellude any suggestions from fellow MeFites that Im over-reacting.

When the plastic surgeon’s office wouldn’t listen to me I called the Mohs surgeon’s office, explained my concerns and offered to take a photo and post it to a secure page for review. I just wanted a second opinion about how it looks. Eventually someone from his office called and told me to go back to the offending surgeon.

I feel just as I did with the other recent medical issues. I’m going to have to live with this for the rest of my life. That may seem dramatic it is right between and above my eyes, formerly my best feature. I dread seeing the plastic surgeon for my scheduled appointment Tuesday, am tempted to remove the sutures myself (I have some training) and cancel it. I couldn’t bear more of his “I’m an important surgeon and you are nothing” attitude and I don’t want him near me medically. I’m I’m also kicking myself for not trusting my gut at the original “appointment” when we saw him for five seconds. He removed one end of the simple dressing I had and couldn’t put it back. I reached up and did it and he was gone, leaving the nurse/assitant to do everything. She, also, moved very quickly though there were very few people in the office. FYI, he’s established in the community, has been doing this for fifteen years. I did a quick Google search before surgery and there were no reviews.

Since writing this earlier today he's taken me off the antibiotic he gives everyone automatically. Can quitting Cephalexin after 1500mg per day (550 x 3) for four days hurt me? I asked for a substitution, an antibiotic I do very well with, and he said "It's too broad-spectrum and expensive." I know for a fact that he gave it to another patient because she mentioned it in the waiting room.

What would you do at this point?
posted by R2WeTwo to Health & Fitness (12 answers total) 3 users marked this as a favorite
Best answer: Malpractice lawyer, probably.
posted by oceanjesse at 7:08 PM on February 18, 2012 [2 favorites]

Best answer: I would also see someone else since this guy sounds like an ass.
posted by oceanjesse at 7:09 PM on February 18, 2012 [1 favorite]

Best answer: Botched facial reconstruction and the surgeon wasn't listening to my concerns? I'd document the hell out of it and call a lawyer.
posted by zug at 7:15 PM on February 18, 2012 [4 favorites]

Best answer: These are so reassuring, truly. I also wonder how to go about seeing someone else for the stitches, etc. Don't all surgeons going to stick together? The one who referred me certainly did. Too, the practical matter of quitting the antibiotic concerns me.
posted by R2WeTwo at 7:58 PM on February 18, 2012

Best answer: GPs can take out stitches too... Do you have a new one by now? I have been admin staff for a surgeon in the past, and GPs or other surgeons occasionally did follow up for one reason or another. Go somewhere else, get someone else to remove your stitches and provide an opinion on the quality of the work. Please don't take out your own stitches. If you have problems in the future after doing it yourself, your surgeon will surely blame it on you.
posted by snorkmaiden at 8:49 PM on February 18, 2012 [1 favorite]

Best answer: Yeah, DON'T take out your stitches, especially if you intend to sue or ask for reduction in payments. You need the documentation from another medical practitioner and follow thru from same.

I'd agitate to have your Mohs surgeon look at it, if possible. If not, see another reconstructive surgeon. Take plenty of pictures, and document the heck out of everything. Right now, go write down what you can remember about all the events.

This is BS. If doctors can give someone an new jaw or rebuild a cleft palate, then this jerk should have been able to correctly reconstruct a Mohs wound. I certainly don't know the extent of your wound, but this website might give you some ideas of what expectations you might have on the quality of a reconstruction. Of course, YMMV because of size, depth, skin type, age, ability to heal, etc., but still...

I'm sorry to hear that this happened to you. Keep on pursuing this till you're satisfied. Good luck.
posted by BlueHorse at 10:54 PM on February 18, 2012 [1 favorite]

Best answer: I can't agree with calling a lawyer or planning for a lawsuit in any way at this point. In my experience wounds can often look worse a few days later than they initially did, with bruising, and swelling and so forth.

I do agree with seeing another surgeon and getting a second opinion on it, preferably from someone who comes well recommended. Surgeons may stick together in the sense that he might not say "yeah, this guy really screwed up! You ought to get a refund!" but he might say something much more gracious like "I can understand your concerns about this wound and that it doesn't look the way you were hoping it would. There is potential it could be improved. I can offer you x, y, z, as possible options for managing it." That's the sort of professional response I would expect.

In the meantime, keep the wound out of sunlight as completely as possible, do not remove your own sutures, and don't worry about the Keflex. It's not a good idea to stop antibiotics mid-course if they were prescribed for an infection, but it sounds like yours were prescribed prophylactically. Not all antibiotics are appropriate for all indications, so it doesn't matter what anyone else got. IANYD.
posted by treehorn+bunny at 12:27 AM on February 19, 2012 [1 favorite]

Best answer: p.s. if it helps ease your mind Keflex is the typical antibiotic used for skin prophylaxis.
posted by treehorn+bunny at 12:29 AM on February 19, 2012

Best answer: Everyone, thank you more than I'd not been thinking of a refund as it's covered completely by insurance. At the same time, I don't want to have to use the same guy for the correction. It's so disheartening to have to think about doing this again, and the intervening year. That website is exactly what I used to get to the surgery. It's great to know they're not Photoshopped.

I will pursue every remedy.
posted by R2WeTwo at 5:45 AM on February 19, 2012

Best answer: One thing you can do right now, if the wound is dry, is to put a scar sheet on it and keep it on for a couple of months. I had something removed from my face, used the sheet, and now the scar is invisible.
posted by procrastination at 7:05 AM on February 19, 2012 [2 favorites]

Response by poster: If, by chance, anyone happens to check back I'd love some help writing the surgeon's office manager to get more treatment. The stitches came put today and my doctor needed steri-strips to keep one part together. I want the surgeon to see it but he makes me very uncomfortable. When I cancelled the appt. With him in favor of my family physician he called and insulted me. They won't let me see the other surgeon on staff, which seems very rigid and arbitrary. What leverage, besides reviews, do I have. If i mention a lawsuit won't they clam up and refer me to their lawyers?
posted by R2WeTwo at 7:34 PM on February 23, 2012

Best answer: This is unbelievable. What an egotist. I'd talk to my family doctor and see if he can recommend another specialist. If you feel you're in good hands with your family doctor and he can provide acceptable after care, then you'd be much better off sticking with him rather than seeing the jerk again. However, if you feel there's something going on that he cant' handle, you really do need to see someone else. A good generalist will be willing to send you to a specialist if there is a problem. Don't put yourself in the hands of someone you aren't comfortable with and don't trust!

Never mention that you're going to sue someone. Just get a lawyer and do it. Threats are useless. I wouldn't bother to write their office except to tell them you don't don't feel they did a proper job, you don't appreciate their lack of professionalism, and you won't be returning. Basically, I'd fire 'em!

Good luck with the healing. This is very stressful for you, I know. Take care of yourself.
posted by BlueHorse at 10:54 PM on February 23, 2012 [3 favorites]

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