After a skateboard injury, a young man was left with a fairly significant ankle fracture  (a comminuted segmental fibula fracture).  I saw him with his x-rays in my office and we made the decision to treat the fracture surgically.  His surgery was scheduled for the following day.

Upon arriving at the hospital to perform the surgery, I was asked if I had his x-rays.  I asked “Why?”  I was told that it is now hospital policy that the x-ray must be present in the room in order to proceed surgically and that if there were no x-rays available, the case would be canceled by the hospital.  The use of fluoroscopy to take an new picture in the operating room was unacceptable to satisfy this requirement.

There is not a single person in the operating room qualified to evaluate the x-ray besides the treating surgeon.  A decision for appropriate diagnostic evaluation and treatment methods is made by the physician not the hospital.  A choice to “require” the presence of an imaging study in order for a surgeon to proceed is a decision to allow the hospital and its staff to further dictate medical care.  The x-ray of my patient was clearly in my mind I throughout the entire surgical procedure without the need to refer to any picture.  An image on the flouroscope was obtained as needed.

Would it have been good patient care to cancel my patient’s badly needed surgery because the xray images were in my head and not on the wall?  We are already restricted by paperwork, choices of tools and devices used in the operating room, and time to efficiently perform surgeries.

It would be refreshing to put patient care back in the hands of doctors and not administrators who often don’t understand medicine–but are so afraid that we might make a mistake. It is disappointing, although not surprising, that further restrictions are placed on physicians decision-making ability and care for patients, all in the name of improving patient care.  Have we missed the mark on what is truly important, or does the daily introduction of policy upon policy improve our outcomes ?

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