Dr. Frank had purposefully scheduled Ms. Reed to come into the office at 4:15 PM on a Friday. Despite the fact that his office staff would be trying to make it home as soon as possible, Dr. Frank had imagined that Ms. Reed might need extra time to discuss her biopsy results: there was a chance that the lump on her neck that she’d felt when tying a scarf might be cancerous. Ms. Reed had been in the waiting room for an hour already by the time Dr. Frank called her in, trying to keep an eye on her two young sons, who were tipping over towers of cardboard blocks into the aisles between seats. “Well, Ms. Reed,” Dr Frank started. “I’d hoped that we’d have a clearer answer for you today, but the pathology results from the aspiration of thyroid nodule are unclear. Some of the cells do look concerning for malignancy. We could repeat the aspiration, but I think that we should remove a piece of your thyroid at this point, to be safe.” “Is this a big surgery? Do I have to stay in the hospital?” Ms. Reed asked. With her job as a teacher and her kids, an inpatient stay would be difficult. “No, no. It’s a day surgery, and one I do routinely. The complications we might see are mainly bleeding and infection. We can control bleeding by cauterizing blood vessels or tying them off, and if there are signs of infection, for instance, if the wound becomes red or if you begin to have fever, we will start you on an antibiotic. There is always a slight risk of injuring a nerve to your vocal cord, but I’ve done this surgery many times and that’s very rare. What questions do you have for me about the procedure?” Ms. Reed said, “I’m ready to have this lump gone. Let’s go ahead with the surgery.” “OK, then, visit with the scheduling nurse out front, and set up a time that works for both of us. You might want to schedule it before one of those occasions when your school has a 3-day weekend, like Easter or Memorial Day. The surgery isn’t urgent.” Mrs. Reed scheduled the surgery, and it went as planned. A few days after the surgery, Ms. Reed came in for an emergency appointment with Dr. Frank. It was obvious that she was irate, but her voice could barely be heard above the noise of the clinic. “I thought you said this was rare,” she said, shaking a printout of a journal article on the subject. “My recurrent laryngeal nerve was injured. I’m a teacher, and I have children! I need my voice. I would have never done the surgery if I knew there was a 4 percent risk that I would lose my voice!” (1) What are the main issues in the case? (2) In your opinion, what’s the subject matter in this case? (3) Was Dr. Frank negligent in explaining the risks of surgery to Ms. Reed? (4) Was he required to use precise percentages of risk? (5) After the fact, what are the likely decisions of (a) Ms. Reed [Patient Perspective]; (b) Dr. Frank [Provider Perspective]; and (c) the society [Society Perspective] in this case? (5) What DM model is likely to create the right paths for optimal decisions? Why?
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