[haldujai]

I concur. I often work as a radiologist in the ED setting, while this is anecdotal I can’t imagine that anyone with history of recent hernia repair, purulent discharge, and chills would not get a CT scan at an academic centre in the US (OP stated residents were present.

I can only speak to the centre I’ve worked/rotated at but this seems inconceivable based on the requisitions I get in my career. We do a lot more for a lot less.

The only point I would disagree on is that “time left untreated” can increase complication rate. If this a partially strangulated hernia and there was a microperforation (quite common and often missed) or bacterial translocation in the hernia sac mesh would almost certainly get infected. Even if not strangulated/perforated at time of surgery, if there are dense adhesions from recurrent/intermittent obstructions that may also increase operative complexity and a lysis of adhesions may contaminate the field. That said you could also just not use mesh.

[throwaway742]

In my experience US EDs tend to be very liberal with testing. At times it seems excessive. I have heard complaints from technicians who say they feel like sometimes the doctors just tick every box on their tablet. I think this might have to do with malpractice insurance. Perhaps, and I say this as a proponent single payer, the NHS prefers cost savings to risk reduction.

[vo2maxer]

Remember that in the chronology, the infection occurs after the second surgery, the hernia repair. The mass develops after the first surgery. I agree with you otherwise. Internal Medicine here.

[haldujai]

Yes exactly, perhaps I was unclear.

In my description, it is conceivable that due to chronicity the field was contaminated at the time of second OR and/or a lysis of adhesions resulted in a contaminated field.

If the surgeon implanted mesh in a contaminated field this would be seeded and inevitably get infected.

This is not uncommon and why surgeons often don’t implant mesh in complex LOA or possibly dirty fields.

I’m not saying this is what happened, but delayed diagnosis of a complicated hernia can increase the risk of complications from repair.

[cameronh90]

It's not clear to me exactly why the wound got infected, as currently all the parties involved are blaming each other.

The surgeon who performed the mesh repair did clearly state it was a possibility, but the hernia wasn't suitable for non-mesh repair, which would have been his preference.

There was no indication of infection or contamination at the time of the hernia repair, and the surgeon who performed the mesh believes the infection was most likely caused by poor aftercare, which was handled by the local hospital due to covid travel difficulties. Of course, he could just be saying that to cover his ass.

[haldujai]

This isn’t necessarily covering his ass.

Mesh infection is a known risk, by your description you were appropriately consented for this.

It will be impossible to definitively identify the source of infection (I.e. was there an inadvertent enterotomy intraoperatively? Was it an inguinal hernia repair which is a relatively “dirty” region close to genitalia and a common location for surgical site infection? Did your mom develop a bacteremia for another reason and seed the implant?).

At the end of the day none of this really matters though because you were appropriately consented.

The only apparent angle for malpractice here would be if a reasonable and competent surgeon would disagree with the use of mesh and would have done a primary or two-stage repair (I.e. reduce the hernia under laparoscopy +/- small bowel resection. Bring the patient back several months later to repair the abdominal wall defect.)

If you saw a physician specializing in hernia care, I would assume that they follow best practices and this type of case was not amenable to the options I described.

If this is the case, it is incredibly unfortunate what happened to your mother. However, bad things happen and this is why we consent for complications (especially ones as devastating as mesh infection).

I wish everything I did worked and I never had complications but the only way to have no complications is to never see patients.

[cameronh90]

We aren't particularly bothered by the mesh infection. Complications happen.

We are bothered by the hospital not diagnosing the hernia despite it being painfully obvious there was a hernia, which led to complications, and then ignoring the signs of infection until it got to the point where it nearly killed her.

[haldujai]

I greatly appreciate this response. We’ve come full circle.

When seen by a competent physician who appropriately consents patients understand complications.

Your issue is that your mother was misdiagnosed (at least by what was communicated on this thread) and by your description I agree.

I addressed this in further detail to one of your comments above, but for any readers I would like to also clarify this here.

Your original comment stated:

“There are quite a few incompetent doctors, sadly, and they stick together and support each other. While I'm generally reluctant to bring up identity politics, it does appear that women and people of colour tend to experience this worse than others”

You later clarified:

“Essentially my mum lives on an island nation where there is only a singular local hospital with a fairly poor reputation.”

I explained above why isolated locations such as this island with a singular hospital don’t attract recently trained/high quality physicians which is also obvious. Consequently the percentage of poor/incompetent physicians will be much higher. There are also fewer physicians for phyisican-physician consults and a singular hospital such as yours probably doesn’t have morbidity and mortality rounds and a QA program.

Therefore your experience, in an island nation with one hospital, is not representative of the modern healthcare experience and the physicians there are likely not on par with metropolitan centres.

With that said, you also choose to live in an island nation (irrespective of the reason this is a choice). That comes with the known disadvantage of poor access to quality healthcare just like every other white collar profession.

It is important to not generalize such an atypical practice setting to the general population as this is a heavily biased view.