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Letters to the Editor to:

Scientific Articles:
Christopher W. DiGiovanni, Lana Kang, and Jennifer Manuel
Patient Compliance in Avoiding Wrong-Site Surgery
J Bone Joint Surg Am 2003; 85: 815-819 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read Letter to the Editor] Re: Will literacy ratio affect the incidence of wrong site surgery?
Kirti M Marya   (14 August 2003)
[Read Letter to the Editor] Will literacy ratio affect the incidence of wrong site surgery?
Sukhbir Singh Sangwan, Dr . Soneet Aggarwal(Registrar),Dr. Zile Singh Kundu(Lecturer)   (4 August 2003)

Re: Will literacy ratio affect the incidence of wrong site surgery? 14 August 2003
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Kirti M Marya,
Assistant Professor
Department of Orthopaedic Surgery SSR Medical College, Belle Rive, Mauritius

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Re: Re: Will literacy ratio affect the incidence of wrong site surgery?

dr_marya{at}hotmail.com Kirti M Marya

Dear Sir, The apprehension that high prevalance of illiterate population might have a positive bearing on the incidence of wrong site surgery, as mentioned by Sangwan et al is well founded in the third world. But this is not the real cause of the surgical mis-adventures, so to say! The real root of the problem lies in lack of communication. The time a resident doctor takes to explain to the patient what surgey is to be performed on the patient is the real cause of concern in the third world. Most of the consent work is only on paper, and the illiterate patient is never actually 'explained' the procedure as it is anticipated that he or she will, in any case, not be able to understand what has been explained! Even if this is so, it does not seem unreasonable to suggest to the patient that a wrong surgery might occur if the patient does not follow the instruction. No patient, surely, would not take that seriously enough not to follow what has been told. It is imperative that the communicaion is from the operating surgeon and is with meaningful strong comprehension. It is irrelevant whether the setting is of a developed or developing country. Patients are anyway keen to take initiative and responsibility for the relationship with the doctor. Surgeons worldwide are becoming more mechanical. They have created a long chain of intermediate staff members in between them and the patient. This adds to the chances of errors. I dont find it very hard for the surgeon to have a re-look at the patient prior to anaesthetization. The least we, as surgeons, can do for avoiding these errors, is to communicate with our patients directly and reminding them of the importance and consequencies of their compliance. Expecting a patient, already under mental stress of having to undergo the surgery, to show perfect compliance (pre-op drugs, physiotherapy, wound care, posture, weight-bearing, post-op medication etc) seems to be an unrealistic demand. Reference: 1. Andrew Ellner et al. Can patients get better at working with their doctors? BMJ 2003;327:303–4. 2. Christopher W. DiGiovanni, Lana Kang, and Jennifer Manuel. Patient Compliance in Avoiding Wrong-Site Surgery J Bone Joint Surg Am 2003; 85: 815-819.
Will literacy ratio affect the incidence of wrong site surgery? 4 August 2003
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Sukhbir Singh Sangwan,
Professor and head , Dean
PGIMS, ROHTAK,
Dr . Soneet Aggarwal(Registrar),Dr. Zile Singh Kundu(Lecturer)

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Re: Will literacy ratio affect the incidence of wrong site surgery?

sssangwandeanpgims{at}yahoo.com Sukhbir Singh Sangwan, et al.

Sir, The authors deserve kudos for this study, but we believe that while the surgeon bears much responsiblilty, the patients are also responsible to some extent for wrong site surgery.In India the illiteracy rate is quite high. Wrong site surgery occurs despite the best efforts by the surgeons. There is no documentation of the exact incidence of wrong site surgery among Indians. The authors have rightly said that the patients are totally dependant on the surgeon for "taking care of everything". This article is an eye opener to this part of the world.