A Patient Has the Right to Know

Every surgery, minor or major, has a percentage of developing complications. The number is different from one surgery to another, depending on how complicated and difficult it is. The percentage is determined individually for every surgery. For example, it is said that the globally acceptable rate for developing complications after open heart surgery is 1-3%; a number calculated after long years of experience in this type of surgeries performed by highly-qualified surgeons from different countries.


The percentage to develop complications after surgery is based on many factors, including the patient’s age, preoperational health status, available health technologies, surgeons’ skill, follow up at the hospital etc.


In Western countries such as the United States, the physician and surgeon explain to the patient the possibility of developing dangerous post operational side effects and even mentions possible consequences such as permanent damage, paralysis, dangerous infections or even going into a coma and death, even if the possibility to have all these side effects combined was less than 0.001%.


In our Arab societies, however, a lot of patients prefer not to hear such possibilities and statistics and croak when they hear it. Certainly, if the possibility to develop post operational side effects was 1%, that means 99% of patients would not have any complications, but 1% of patients would develop these side effects and then the patient and his family are shocked, then they blame the doctor for not telling them how dangerous the operation was, and even claim that if they knew it was that dangerous they wouldn’t have it. They start attacking the doctor and the hospital, and the attacked surgeon might be one of the most skilled doctors with the better rates of developing side effects in his patients than the globally-acceptable rates. This, of course, might lead to losing faith in the doctor, the hospital or even the health system in the country altogether.


One of the funniest stories I heard from one of my colleagues was about a renowned doctor who told his patient about the possibility of developing side effects and he mentioned all of them honestly and accurately, but the patient left afraid and offended by the doctor and the hospital. The next day, the hospital received an official letter from a well-known figure and a senior official in that country. The letter offered the hospital all sorts of financial inducements and confirming the importance of that matter for them. In other words, the letter asked the hospital to tell the patient there was zero chance of developing side effects after the operation, while the globally-accepted percentage in the biggest medical centers in the world is 1%. To guarantee that no side effects whatsoever would develop after the operation is impossible for humans but is only up to God.


A lot of problems that happen in the health sector in our societies involving patients and doctors are the result of the doctor’s failure to explain the surgery details and side effects to the patient, either out of fear that it would be misunderstood and lead to questioning the doctor’s abilities and credentials, or thinking that it is better for the patient’s psychological status, which is a huge mistake that the West has realized and turned it into a law that is taught in the American medical schools. It is the patient’s right to know everything about the surgery and its possible complications, and no one has the right to take away from the patient at all.


When a patient gets used to that, he will not run away from a doctor who sincerely explains and clarifies everything, and will not go to a different doctor that might not be as skilled and experienced except that he hides facts and possibilities from his patients and says “don’t be afraid, everything will be ok, it’s a simple procedure so don’t worry.” As we mentioned, complications do not develop in 99% of the cases, but in 1% of the cases, complications start and trouble begins.


Naturally, some complications can occur due to a mistake by the physician, the surgeon, the nursing staff or the hospital, but the thing which defines this kind of mistakes and distinguishes it from possible side effects is up to experienced and knowledgeable individuals, not society or the patient’s family.


We need to raise health awareness in our society… A big portion if this awareness is the responsibility of the physician… He needs to learn how to explain to the patient the possible complications and side effects in an acceptable way as much as possible, as it is one of the patient’s rights… On the other hand, the patient needs to learn how to listen to these details, and know that mentioning these possibilities before the procedure is not a way of doubting the doctor’s skill and capabilities but a truth that should not be ignored as long as it is within the globally-recognized percentage.


We also need to find a way to allow the patient to know the rates of developing post operational complications for each doctor and each hospital and the number of surgeries performed by the doctor, where the doctor can tell the patient about the number of surgeries he performed, the international percentage of possible complications for the surgery and the rate of occurrences in the ones he personally performed.


A special health system should follow up with the program’s progress, while hospitals and doctors should be obligated to document all side effects and then make reports about each hospital and doctor… This way we can certainly provide the patient with an accurate scientific method so that he can be aware of the situation and judge the doctor objectively, aside from personal interests that could lead to exaggeration and prejudice.


Okaz Newspaper – 14 Safar 1417 AH falling on 30 June 1996 AD