Tuesday, December 24, 2013

Did a "botched" vasectomy cause a man to shoot his doctors?"

Last week, I blogged about a Forbes post criticizing surgeons for making too many errors. I pointed out that all complications are not caused by errors, and some complications cannot be prevented. My plea was that if one is going to criticize, at least one should get the facts straight.

The day after I posted that on Physician's Weekly, a man with a shotgun walked into a urology office in Reno, Nevada fatally shooting one doctor and critically wounded another before taking his own life.

Nearly every tweet and media headline about this incident stated that the shooter was upset about "botched" surgery that had been performed on him three years before.

Fox News: "Neighbors say Nevada gunman had botched vasectomy"
CBS News: "Neighbors: Hospital shooter in pain from botched vasectomy"
Huffington Post: "Botched vasectomy might have prompted shooting in Nevada urologist's office"
The Australian: "Gunman had botched vasectomy: Neighbors"

Even after I tried to correct people, they continued to tweet these headlines for a week.

USAToday reported that the shooter's friend said "complications from a vasectomy left the man so sick and weak that he could barely move" and that he "was dying from this."

The last paragraph of the story quoted a professor of urology from the University of California, San Francisco, who said that "many very large studies … show that a vasectomy is not a risk factor for any longer-term health problems, and that's very clear."

The American Urologic Association says that 1 to 2% of vasectomy patients may have chronic pain.

There is no evidence whatsoever that symptoms like being weak and sick were the result of a vasectomy, botched or not. Since chronic pain can occur after surgery that was done correctly, the use of the term "botched" in this case is inappropriate.

And only a couple of stories mentioned the fact that the shooter had a history of depression since the 1990s for which he had been taking Prozac on and off and had also been talked out of committing suicide well before before he had the vasectomy.

Not only are the headlines misleading, but they insult the competence of both of the unfortunate urologists who were victims of a senseless crime.

But I guess the article gets more clicks if "botched" surgery is involved.

As Mark Twain said, "Never let the truth get in the way of a good story."


pamchenko said...

I read some of the comments in the forbes guest blog and its very frustrating. as a surgeon I often find myself telling patients I have a bad option in one hand, and a worse option in another. I try to set the bar very low. or one could say that I'm trying to setup reasonable expectations / possible outcomes. in our culture, cancer is seen as something truly terrible (agreeably so) and when operating for cancer, patients are more accepting of complications/side effects. this is not limited to surgery, but also to the effects of chemotherapy or radiation. they are more understanding that the cost of potential cure requires taking drastic measures that involve various pitfalls.
for pain or infection or non-life threatening issues, I really try to give patients more pause before embarking on a surgical course of management. an example would be operating electively for diverticulitis (risk of infection) or an operation of anal fissure (risk of incontinence). Patients have to accept that the true cost of the operation for diverticulitis is a 15% or so risk of infection postop and 3% risk of leak. Otherwise, they accept the risk of recurrent hospitalizations and disability. Needless to say, I have a very cautious hand before operating on diverticulitis. This was given to me by very senior/cautious surgeons who don't operate to pay bills, but operate when it is necessary. Operating for fissures is a different story. I ask patients to weigh their pain vs the small risk of incontinence.
In my young career too often I see people doing procedures with soft indications and exposing their patients to unnecessary risk. nonetheless, bad things happen to good people (patients and doctors alike) and I've learned to accept that. It doesn't mean I'll stop trying to be better but I being in the profession gives me a more mature understanding of what its like to choose between bad and worse.

Skeptical Scalpel said...

I agree that complications are tolerated less well if the surgery is perceived to be less involved. I also agree that operating on patients who have minimal indications is a good way to get into trouble.

Anonymous said...

Once again, the only thing "botched" in this story is the media's reporting of it. We must remember, however, that while we were in college, studying for medical school--learning to think critically, our buddies in "journalism", "radio-television", or "communications" majors were in the lobby watching television, playing basketball, or being "bored" with college. We shouldn't expect much of the media. In turn, one should avoid speaking to them as they will always twist the truth.

Skeptical Scalpel said...

Hard to argue with those thoughts. Thanks

choohooo said...

I know what happened with Alan because the same thing is going on with me right now. I've been struggling with chronic pain since my vasectomy 9 months ago. It's consumed my life. Depression is the least of my problems. Fortunately, I'm closer to getting an answer than he was. In my case, they damaged one of the nerves in my cord. The reaction has caused other autonomic disorders. The official diagnosis was Small Fiber Neuropathy with polyneuropathy and dysautomia. Some days I'm so dizzy and my eyes are so blurry I can't even get out of bed. Everything started 36 hours post vasectomy. Doctors tell me it was triggered by the nerve damage.

Skeptical Scalpel said...

Choo, I am sorry that you are suffering. I hope that your condition improves. Good luck.

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