He Sees Patients but Would Rather See Consumers

BALTIMORE — A new car is a huge investment, right? So you take your time, study up, negotiate, see if a trade-in or a private sale of the old jalopy is the best way to go. You view the salesman with some suspicion, if not as a plague-carrying rat. You storm out of the showroom at least twice before getting anywhere near a sale agreement.

Now, think about the last time you went into the hospital. Things probably went a little differently.

“If the average person spent just half the time preparing for surgery as he or she does purchasing a car, we could probably wipe out 80% of the malpractice suits,” Dr. Fred Ernst says. “Scary isn’t it?”

Very. That’s why Ernst and his late colleague, Dr. William G. Pace, wrote a reader-friendly book for medical consumers: “Now They Lay Me Down to Sleep . . .” (E&P; Publications, $12).

The physicians happened upon the need for this primer after years of personal observation and the constantly increasing number of malpractice suits brought against surgeons and anesthesia care providers each year.

“We [patients] assume so much when it comes to surgeons,” Ernst says. “We are intimidated. We assume he’s an expert, which is hardly the truth in far too many cases. They’re not all ‘the best.’ All surgeons are not created equal, and their credentials should be checked out just like we check out the credentials of anyone else doing work for us.”

Ernst’s book is reader-friendly because of the way it’s laid out and the over-the-counter language it uses. Short chapters start with a “key point” to be covered and the text concludes with an “in summary” section.

The book also disdains tactfulness for straightforwardness. For example, regarding foreign medical graduates, Pace, who was a professor of surgery and assistant dean at the Ohio State University School of Medicine, wrote, “While there are many outstanding health professionals from foreign countries now at work in the United States, surgery-anesthesia patients should be extremely vigilant when consulting foreign doctors. The blunt fact is that some of them have been inadequately prepared for careers in medicine at non-board-certified, second-rate medical schools.”

“With that in mind, how would a patient ever come by this information unless he or she started questioning or sought out a second or third opinion?” Ernst asks. “The point is, we can’t continue to be intimidated and simply take the word of another doctor we probably don’t even know.”

Horror stories of botched surgical procedures and anesthesia care abound in the book. Among Ernst’s “favorites” is the one that sees anesthesiologists (M.D.A.s)--physicians with four years of postgraduate training in an anesthesia residency education program--allowed to supervise up to four anesthesia procedures simultaneously.

“This was deemed acceptable for insurance-billing purposes,” Ernst says. “And the worst part is it hasn’t changed, and there are no restrictions or specific guidelines as to what types of procedures take place in the rooms. Nor do the regulations take into account the seriousness of the surgery, its potential complications or the medical condition of the patient.”

In a tongue-in-cheek aside, the doctor adds, “Make no mistake, it’s strictly illegal and unethical for an M.D.A. to supervise simultaneous procedures at geographically separate institutions.”

So, what are people facing surgery going to do for themselves?

Says Ernst: “First, they find out about alternatives, get second opinions. Third opinions. Make sure you get someone truly qualified. Pre-op visit and questioning are easy to set up. Ask a surgeon about his experience and potential problems that might arise during surgery. Ask your anesthesiologist, ‘Are you going to be there throughout the procedure? And if not, why not?’ Don’t be put down or put off by medical personnel.”

The book’s credo is simple: “You’re paying for it, and you have a perfect right to demand the best care available.”