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a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Doctors should put themselves in the shoes of their patients

Q: Thank you so much for reading this. A month ago I had appendectomy through laparoscopy. The nurse at the ER told me that I should not be concerned about surgical scars after the laparoscopy because there will only be three tiny keyholes around my abdomen area.

I am a pretty self-conscious person to begin with and I absolutely dread scars. I was very surprised to find out that after the appendectomy, my navel looked so horrible. The navel is no longer round. There's a cut trough the navel right through a very small part of the abdomen area and the stitching job looks a bit like a railroad.

I cried so much when I saw this. When I asked the surgeon about this, he seemed offended and with a firm but soft tone of voice he reminded me, “I saved your life you know…” as if I have not been grateful for what he did. I expressed my gratitude after the surgery.

Now I am left with this horrible looking navel and I really don't know what to do. I wanted to ask him why instead of having three keyholes do I have two keyholes and a wrecked navel but I was too timid to ask further questions after him reminding me that he had saved my life.

I want to believe that wrecking my navel was a life-saving act so that I can put the regrets to rest, but on the other hand how do I know if the surgeon actually wasn't careful enough thus the horrible looking navel. I wish someone can shed some insight into this. Perhaps I am the one misinformed about laparoscopy facts or the nurse didn't tell me the right thing about the scarring risks.

Thank you in advance for your time and answer.

Kind Regards,

Answer by , MD: One of the best lessons my medical school professors taught was to treat every patient as a brother or sister. If you were my patient, I would have treated you like my sister and endeavored to give you the best possible cosmetic result.

The umbilicus (navel or belly button) is a focal point of the abdomen that is cosmetically significant, especially in women. Any doctor who disputes that needs Summer School or a stat infusion of empathy.

When I was trained in surgery, I was taught to be especially careful with cosmetically significant areas such as the face—especially around the eyes or lips, where a small mistake is very apparent. Your surgeon might argue that navel scars or asymmetry are less significant because the abdomen is usually covered, but when it is exposed, eyes are naturally drawn to the umbilicus.

Your surgeon deserves a pat on the back for saving your life, but he may also deserve a figurative slap on the face for being less careful than he could have been. Without knowing your propensity to scar (something that varies substantially from person to person), I can't say with certainty that your doc could have done better, but it certainly sounds that way.

Careful surgical technique can minimize scarring. I was horrified to discover during medical school that more than a few doctors are unconscionably sloppy about their technique, such as by not making any effort to follow the steps we're taught to produce the best possible results in terms of appearance and wound strength.

If more women were aware of the latter, they would know why “female” (gynecologic) surgery is often followed by so many problems: because gynecologic surgeons too often prefer the quick way, not the right way. I was struck by how docs who chose to work on women often seemed to care little about them.

That said, even the best, most careful surgery can result in poor cosmetic results in some people. As part of my training in plastic surgery, we staffed a clinic where we treated black people with keloids, who are more prone to them—7 times more likely, according to the Henry Ford Health System.

In that clinic, we discussed how to give each patient the best cosmetic result, and the option we usually did NOT choose was repeat surgery even though we could have utilized likely better technique than the initial surgeons, most of whom were not plastic surgeons. However, scar revision is always an option, and one that may help you.

Doctors tend to be very defensive when confronted with any suggestion what they did was subpar. That harmonizes with research I've read showing how almost every professor considers himself/herself to be above average (when statistically only 50% can be), and people in general commonly believe they are above average: all manifestations of illusory superiority.

It's part of what keeps us going. If we knew the cold, hard truth about ourselves, life would be more painful than it is. Self-deception is an emotional band-aid that covers what we don't want to see.

But as pleasant as self-deception can be, it can erase or at least undermine the motivation to change and improve. By squarely facing what was wrong with me, I became a better and more competent person. Perhaps some people care less about genuinely improving than facing their flaws, but doctors should not have the comfort of basking in self-delusion. Because lives matter so much, giving any patient less than 100% is an ethical transgression—that's simply my opinion, not how all doctors feel, as evidenced by how cavalier so many of them are.

In my state, doctors once could be sued even if they gave perfect care. Now the malpractice pendulum has swung too far to the opposite extreme and doctors too often slough off because they know which cases and which patients aren't “worth enough” to justify a malpractice lawsuit. (I put “worth enough” in quotes because that is their cold calculation, not mine; what they're doing is an ethical abomination, in my opinion.)

But ethical people do what is right, not whatever they can get away with or justify via self-deception and trivialization of others. As an ER doctor, I intubated (inserted a breathing tube into) many patients to save their lives. I never chipped any teeth in the process because I was careful to protect them. Sure, I could have said something similar to what your surgeon said (“Hey, I saved your life, so don't blame me for chipping your tooth”) but I knew patients want both life AND their teeth—all of 'em! That's a perfectly reasonable expectation, and one with which all docs would readily agree if they had sufficient empathy to habitually put themselves in the shoes of their patients.

The latter is one of life's best lessons, and one I learned too late. Had I learned it earlier, not only could I have better harmonized with people, I could have made life easier for myself, too. One can charge through life and treat others as if they matter less, or one can routinely put oneself in the shoes of others and treat them how everyone wants to be treated. The Golden Rule ethic of reciprocity is indeed golden.

Putting oneself in the shoes of others has been shown to result in healthcare providers giving better, more empathetic care. It can also increase harmony between workers and their bosses, husbands and wives, siblings, neighbors, police and the ones they protect—or sometimes brutalize.

“In the shoes of others” is also the instant antidote to racism. The question, “How would you feel if you were black and were mistreated because of it?” immediately makes everyone except sociopaths and young children realize how wrong it is. Although many people are naturally self-centered, most possess enough sense of fairness to realize the iniquity of mistreating or thinking less of others who simply are of another race.

Doctors generally put themselves on a pedestal and think very highly of themselves and too often too little about patients. Oh, sure, we're taught to give lip service to caring or at least pretending we care, but after stripping away the BS, what most docs care about is draining money from patients and maintaining their self-deceptions about how great they are: surely all above average.

This blindness to one's flaws and mistakes perhaps explains the resistance I met when I served on a hospital Quality Assurance committee and it was my job to examine patient records and notify doctors in writing what they did wrong and could have done better. Month after month, I'd see the same mistakes from the same doctors, who weren't stupid but frankly didn't care enough to give better care—only what they could get away with. Let me tell you, doctors get away with too much, and patients suffer as a result.

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