Blow Out!

An 88 yo female with multiple chronic medical problems, after a fall, was found on X-ray to have a so-called blow-out fracture of the left orbital floor below her eye. She was referred to a busy surgeon who never even saw her at the appointment. She was seen by the office nurse (not a nurse practitioner), after which the doctor scheduled her for surgery with no explanation to the patient of why and how and/or what she should expect. Fortunately, she had enough sense to know this wasn't right. She went to her ophthalmologist who looked at the X-rays, noted that the problem was very mild and that she had no associated symptoms of pain or double vision. She certainly didn't need any surgery especially at her age and with the multiple medical problems that she had.

What went wrong here? Things that may be considered routine are not necessarily routine because patients are always unique. Major medical decisions have to be made by the professionals with the proper qualifications after careful consideration of all the mitigating factors and the context in which the decisions are made. That doesn't mean that nurses can't make medical decisions. They can make decisions for the ones they are qualified to make. This particular decision should have been made by the surgeon after seeing the patient, discussing it with her carefully and understanding the context of her age, other medical problems and the absence of symptoms.

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