To the editor:

Last spring a Kaiser Permanente general practitioner checked my sore left foot, said “cellulitis” and sent me to radiology in case there was a fracture. The order that reached radiology called for X-rays on my right foot.

“It happens all the time,” said the GP.

After looking at my panoramic X-ray, my dentist once worked on the wrong side of my mouth for several seconds before realizing his error.

Wrong-site surgery results from false information. Because transferring information from the patient to one’s notes or from records back to the patient can introduce errors, site information should remain with the patient. Let the GP mark the trouble spot by drawing a small circle or bull’s-eye (not an X) on the patient’s skin. (To GPs: Repeat site information in your notes if you wish, but distrust what you write.)

Later the specialist or surgeon can, if necessary, X out the GP’s mark and replace it with a mark where he or she thinks it should be.

Peeling back clothing to see the GP’s marks is a small price to pay for having site information on the one medium that cannot be lost, confused with that of another patient or reversed right for left.

I became interested in wrong-site surgery (WSS) when Craig DuMond made his last misplaced operation. Imagining myself in DuMond’s shoes, I hoped something good could result from his personal disaster. Soon I realized that the prime cause of WSS was faulty transfer of information. So do not transfer it. The information starts with the patient, so keep it there – hence the above proposal.

I have been pushing the idea since 2002 and, until last fall, thought I might be making progress with Adirondack Medical Center. Perhaps AMC folk were merely tickling a donor under the chin, but our discussions were rational. I tried out the idea on two Saranac Lake GPs. One, an AMC staff member, replied that he saw no problem. The other, not a staff member, did not reply.

I wanted to present the proposal to the AMC medical staff and respond to the likely objectives, but suddenly I was told that the proposal would have to be read to the staff by Dr. Broderick, its head. When Dr. Broderick was introduced to me, he explained that medicine is now evidence-based and WSS is rare enough that an impossibly large clinical trail of skin marking would be needed to get enough evidence to approve its use – logic that would forbid trying out a vaccine for any rare disease. (Editor’s note: The previous sentence has been corrected.)

I have been told that he presented my proposal, and that there was no discussion, but have been unable to learn the tone in which he presented it. The AMC will no longer discuss the proposal. I believe the doctors’ guild has frightened AMC management into immobility. (Editor’s note: The previous sentence has been corrected.)

Sincerely yours,

Charles W. McCutchen

Bethesda, Maryland