Your left or my left? (AP Photo/Paul W. Gillespie)It sounds like something out of a horror movie, but wrong-sided surgery happens more often than you think.
Concerns about surgeons operating on the wrong part of the body made headlines this week after The Providence Journal reported that on three separate occasions this year, surgeons at Rhode Island Hospital operated on the wrong side of a patient’s head. The most recent case happened last Friday, when the chief resident started to cut on the head of an 82-year-old patient. The resident, a doctor in the seventh year of specialty training, realized the error before reaching the skull and closed the wound with a single stitch. The procedure was done on the correct side, “with good results,” according to a statement from the hospital, which was fined $50,000 by the state health department.
On a percentage basis, surgery on the wrong side or area of the body is considered rare. But nonetheless, it affects hundreds of people a year, and hundreds more cases likely go unreported. This month, the Archives of Surgery ran a letter from The Joint Commission, the primary accrediting agency for hospitals in the United States, noting that it receives about nine voluntary reports per month of so-called “wrong-site adverse events” to its Sentinel Event Database. Last September, the same medical journal reported that wrong-site surgery may be underreported by a factor of 20. That study concluded that there are 1,300 to 2,700 wrong-site procedures annually in the United States.
Many mistakes involve near misses, like the recent case in Rhode Island, where the surgeon starts to cut but realizes the mistake before real damage is done. Sometimes the mistake has dire consequences. In one widely publicized Florida case a few years ago, a series of mistakes by medical staff resulted in a doctor amputating the wrong leg. British doctors in 2002 were tried and acquitted for manslaughter when a patient died after they removed the wrong kidney.
In July, another surgeon at Rhode Island Hospital drilled into the wrong side of an 86-year-old patient’s head during an emergency procedure. The doctor realized his mistake and operated in the correct place. However, the patient died a few days later, but a preliminary investigation showed the patient didn’t die as a result of the surgical error, reports The Providence Journal.
The Joint Commission has a set of guidelines for hospitals to follow to prevent wrong-site surgery. They require hospitals to verify the surgical procedure to be performed, mark the surgical site in advance and take a “time out” immediately prior to starting the operation, during which team members verify that they’ve got the right patient, ensure that scan films aren’t reversed and confirm that medical records and scans match the marked surgical site.
Patients who have scheduled surgical procedures can adopt some simple strategies to protect themselves from wrong-site surgery.
Speak directly with the surgeon just prior to your surgery to discuss the specifics of the operation he or she is scheduled to perform. Talk to the surgeon before you are prepped or given any anesthesia.
Don’t let nurses or other surgical staff mark the surgical site. Insist that the surgeon who will be doing the cutting use a permanent marker to mark the incision site. In Canada, surgeons are advised to put their initials on the place to be cut. “It’s very reasonable to ask and participate in the marking of the site,” said Dr. Peter Angood, vice president and chief patient safety officer of the Joint Commission.
As you interact with surgical nurses, anesthesiologists, radiologists and other providers prior to the surgery, confirm they know what procedure you are scheduled for.
Talk to your doctor about what procedures the hospital has in place to prevent medical mistakes like wrong-site surgery, and make sure the hospital where your operation is being performed is accredited by The Joint Commission.
“I think a patient should recognize that they have the ability to prevent this,” said Dr. Angood. “Each time they talk to the surgeon or people involved in the procedure they should verify that it’s the right leg or the left arm. As they move into the procedure area, the patient and patient’s family shouldn’t hesitate to ask, and re-ask, the nurses and the providers, ‘Are you sure we’re doing the correct side?’ ”
The commission lists these tips for patients to help prevent wrong-site surgery. The page also includes a brochure for download called “Help Avoid Mistakes In Your Surgery” that includes a checklist of extra precautions for surgical patients.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 119 Comments
One of my brothers has had surgery on both shoulders. In each instance, he wrote “yes” and “no” on the respective shoulders in marker pen.
Although the doctor laughed when he saw the ‘instructions,’ he agreed it was prudent to have done so.
Ultimately, our care in in our own hands.
— JerrytheKProper marking of the surgical site, by the surgeon who will actually be doing the cutting, is essential. This marking should be observed by another physician and both individuals should sign an affirmation in the patient’s chart that they marked (or observed the other marking) the surgical site and verified that the correct site was marked.
No surgeon should begin cutting in the OR without verifying, aloud, witnessed by another physician (perhaps the anesthesiologist) that the correct surgical site has been marked.
— famdocThose “tips” make it seem like people are in control of what happens to them before surgery, or are willing, or able, or cognizant enough to make their wishes known. Not to mention the fact that it assumes that the surgeon or doctor performing the procedure actually meets with the patient and gives a damn what they say, and that the hospital staff is willing to listen and take orders from a patient, which I have never seen or heard of. Yeah, right.
From TPP — In an emergency situation, these tips likely would be impossible to follow. However, the patient undergoing a scheduled procedure is entirely in control of whether they undergo an operation. In fact, they are required to give their consent. I would never let a surgeon operate on me who wasn’t willing to discuss the procedure with me face to face before the surgery. I would love to hear from surgeons on this — but I think they will agree that good surgeons actually meet and talk with their patients. It’s not a lot to ask.
— HillaryThank goodness I’M not a surgeon.
— Mr. Bass-AckwardsAt least my ortho performed surgery on the correct knee.
The wrong surgery, but on the correct knee. He waived the co-pay on the second surgery. Might have been nice to not spend 6 months on crutches and 10 months with a cane between the first and second surgeries, though.
Having a second doc there might have encouraged the ortho to touch the knee and see if the simple test indicated the actual problem before the wrong procedure was performed.
— Dave RWell a Dominican Republic Surgeon managed to put a 6mm screw straight trough the medular canal and central nerve at the L4 level damaging the nerves and nerve roots, resulting in a horendous 6 month period of extreme pain, lucky me I still walk and survived the menengitis this error gave me….
His excuse was that error do happen and that he was sorry. I our country we do not have the luxury to do anything about this. Doctors seem above the law.
— Eric HertsYour worst nightmare.
— RJH de la Hayewhen I had work done on a knee, the dr visited me right before they carted me in. I said “this knee” and pointed to the one the work would be done on. he seemed rather upset that I should have to point it out.
— rogeryeah, they got it right.
Here in Atlanta, at a ‘renowned’ eye clinic, the wrong eyeball was removed. Horrifying to think about. Greatly tragic to the victim.
— Doc Lee in AtlantaIn October 2004, I was being admitted for hysterectomy surgery to Jupiter Hospital in Florida when the woman processing the paperwork looked at me and said, “what a terrible thing to have to lose a breast!” After I got over the shock of her comment - given that my surgery was only a few hours away - I realized she had the wrong patient file. When I told her that I wasn’t that person, she dismissed my concern and said, “oh, well then, this other one must be your file.”
During my recovery, I had an extremely adverse reaction to a pain med I was given after surgery. Even though the entire surgical team knew what scripts I was taking, this med should never have been administered as it had a known adverse interaction with the meds I was on. I spent a month recovering while visiting nurses attended me twice daily. The point is that no matter how diligent the patient is, until proper protocols are developed, established and followed by medical staff each and every time, there is still a lot left to chance — and many opportunities for things to go very wrong.
— LC DwyerI always meet the patient before surgery, mark the site with a permanenet marker, and confirm verally with the patient what will be done. THis is common sense and good medicine. I would not forgive myself (or would likely a patients lawyer!) if I ever performed surgery on the wrong eye.
— SurgeonScrew the hospitals. You can’t trust them. You have to go with do it yourself kits. At least you’ll know what side to cut.
— DallenA few years ago when I was going in for bunion surgery, a friend of mine who had worked as a nurse at VA told me to write in permanent markers on my left and right feet, respectively, “this foot,” and “not this foot!” I laughed. She said, “You think I’m kidding, don’t you?” I stopped laughing and ended up doing it. Have no idea if my surgeon got a chuckle out of it or not, but I have no regrets.
— LaraA “doctor” cut off the wrong part of my body, and I have a terrible scar to prove it, a place that sometimes bleeds and tears during sex. I don’t think circumcision injuries are as rare as the medical profession professes - skin bridges, tags, scars, urethra injuries, glans injuries are common enough - and I did not provide consent. Surgical errors may be tragic, but amputating normal healthy tissue without consent should be a crime.
— John KuehneI had several eye surgeries at a well-known hospital in NYC. Each time, various sets of medical people at each step of the procedure asked me to confirm that it was the right eye which was being operated on. They marked the area above the eye with red tape. Right before the surgery started, the OR nurse asked me - for at least the 6th time - to confirm that they were operating on the right eye. Needless to add, I was quite pleased with the level of questioning. It was clear that they had been prepped to do exactly that.
— LisaThis one is easy to fix. Just make it mandatory that any doctor who operates on the wrong part substitute one of his own parts to make up for it. Operate on the wrong kidney? Give up one of his own.
One guy had a doctor remove his penis by mistake (doc thought it was a sex change operation). So the doc should have to give up his organ to the patient to make up for it.
That should cut down on mistakes fast. LOL
— FjetMy orthopedic surgeon not only consulted me about my knee but, knowing that I’m a massage therapist with a better understanding of anatomy than most of his patients, asked me if I would like to get a local rather than a general anesthetic and help guide him to the right spot during the surgery {we weren’t actually sure what the problem was until he got there}.
Watching your own surgery sounds disgusting but was actually quite fascinating as I watched the arthroscope give me a guided tour of my own knee.
For the record, the patient lived happily ever after.
— StanHaving recently gone through medical school, every surgery I witnessed the surgeon talked to the patient beforehand and confirmed the procedure that was to be done (by saying something like, “just to confirm, we are doing a removal of a lump in your breast today”) and then if there was an issue with side, confirmed this as well and usually had the patient mark the correct side (which was also confirmed by review of chart, radiology, etc). Before the operation was started, there was another review (a sort of “timeout” in which the nurse, surgeon, and anesthesiologist confirmed what they were doing, who the patient was, etc).
The thing is, a lot of patients don’t remember these conversations afterwards whether from anesthesia or from simple anxiety, but it doesn’t mean they don’t happen. Obviously they don’t always happen, and in certain cases the patient isn’t really going to be able to help you (like “which side is your brain tumor on” or some question like that).
— mattI wonder if Dave R’s (comment 5) sterling ortho was the same surgeon who put an overly long rod into my husband’s left leg during that awful winter of ice storms we had in the mid-1990s. When my husband complained of excruciating pain and inability to straighten the leg 1-month postop, the ortho initially dismissed his complaint with talk of a “low pain threshold.” But one glance of the x-ray told all … Foolish us. We allowed the same man to reoperate to correct his error and replace the rod that was projecting into his knee. But my husband had to wait for that small appropriate optimal healing window to have the procedure done. This meant 2 additional months of agony for him. Our consulting opinion, by the way, was from the Yankees’ surgeon, who was right on target! And never before or since have I heard a physician place a phone call to a colleague about his error calling him a name the NYT wouldn’t print.
Elissa S.
— Elissa S.The answer to comment 16 is OK, then there will be no more surgeons. Hope you don’t ever need one. The day you do you’ll be willing to sign every consent form and undergo any risk of complication.
Obviously procedures need to be improved, but for every tragic error, medicine has also saved many lives.
— ptI always ask the patient which body part and side we’re planning to work on prior to any meds being given. I then personally initial the site after the patient has done the same. I’m surprised by some of the looks I get from my patients. Some seem disquieted by my little pre op ritual, but it works. One wise guy patient taped his business card (a malpractice plaintiff’s attorney) to his knee. That was a riot. The patient survived the proceedure.
— 3.0 tennis stud/docI had surgery on my wrist, and when the Doctor put his initials and big X with a Sharpie, I thought it was funny. I was very pleased with the results, and after reading of so many horro stories, I realize, that Doctor new what he was doing. While funny to me, it was no joke to him. The most imoprtant thing one can do before surgery is interview 3-4 docs before having it, that’s what I did, and I wouldn’t have the surgery done by the ones who seemed incompetent, unsure, or ambivalent. Don’t go under the knife unless you know who is holding it!
— jimWhat does it say about the medical profession in this country that the burden of making sure the cut is made in the right place has to be shouldered by the patient? Truly revolting, and about the best argument against tort reform I can think of.
— crhairstonNot to say that there are not some real charlatans out there, but patients are empowered. If you see a doctor and he/she is not willing to share responsibility with you, the patient, then walk. See some one who doesn’t have his/her ego all wrapped up in a white coat. It is just so much easier to blame the doc, blame the mechanic, blame the teacher. Can you imagine the line waiting to blame the preacher come judgment day? Be accountable for yourself! No one promised you anything other than birth and death. The rest is on your time. Be responsible.
— Lambert McLaurinLast week I had my gallbladder removed in an emergency operation. Thanks to the way the stone was blocking a duct, the pain was manifesting in an entirely different place — middle of my chest — than the actual problem spot was located. I couldn’t have told you exactly where the gallbladder was located, period, without glancing over a chart first. It’s not exactly my specialty. It’s theirs. So you’re telling me it’s my responsibility to tell the doctors where to cut, because after years of training and bucketloads of my money, they can’t tell their left from their right?
My surgery, fortunately, went very well. I’m counting my lucky stars.
— JaeTPP responds: No, I don’t think anyone is suggesting that it’s your responsibility to tell your doctor where to cut. It’s your responsibility to talk to your doctor, make sure your doctor and you are in agreement about the procedure being performed, and give your consent. And if you have two of a particular body part, it makes sense to make sure the doctor marks the correct body part. Doctors are human and mistakes happen all along the process. If someone gives the nurse the wrong file or they prep the wrong leg or a technicians hangs the scan up backwards — a doctor walking into that situation could easily make a mistake. When you go into a hospital, you are relying on a number of people with varying levels of skill and experience, so simply stating the obvious — “You are removing my gallbladder right doctor?” is a smart thing to do.