I was not present for the incident in radiology, but I heard all about it. The patient with the swollen ankle watched with increasing puzzlement as the technician prepared to X-ray his other foot.
The patient pointed out that the technician was dealing with the wrong ankle. The technician said she was doing what the doctor had ordered. They went back and forth with increasing animosity until, unfortunately, might triumphed over right and X-rays of the wrong ankle were duly performed.
The results, reported to the doctor, were normal.
That doctor was I. A few days later, the patient provided me with a full account of the disaster and then limped away from my care forever. I couldn't blame him: I was mortified, but I wasn't surprised. I had feared it would happen sooner or later.
I am one of roughly 20 percent of the population to suffer from profound left-right confusion, a quirk of the mind that doesn't really matter until it suddenly matters a lot. Dr. John R. Clarke is a professor of surgery at Drexel University whose research contributed to current protocols that aim to prevent wrong-site surgeries. In January he told the magazine Outpatient Surgery, "Twenty percent of the population has right and left confusion, meaning that they can't immediately tell their right from their left without having to think about it first.
"That means if I say, 'Raise your right hand' to a group of people, 20 percent might raise their left or have to take a few moments to think about it."
Asked to raise my left hand, I may raise my left or right, whichever. Confronted with a patient's ailing extremity, I have to concentrate and perform a complicated, time-consuming mental flip to note it correctly.
Fortunately, I do not work with sharp objects, so the damage I do when I am in a hurry is all on paper. My notes are sometimes inaccurate, and there was that mortifying ankle X-ray, now several decades ago. Since then, I have compulsively, repeatedly double-checked myself, and as far as I know it has never happened again.
Were I a surgeon, I suspect I would live in a state of unremitting panic, and the people around me would, too.
The problem of so-called wrong-side surgery has long dogged medicine -- most likely since the invention of anesthesia removed the patient from active participation in the process. It is one of several related disasters that includes operating on the wrong body part, doing the wrong procedure on the correct body part and doing everything perfectly on the wrong patient.
In modern corporate lingo, these errors are termed "never" events: They should never occur.
They still do, though. They are infrequent but persistent enough that a little more than 10 years ago The Joint Commission, which accredits and certifies health care organizations and programs, issued a protocol intended to eliminate such errors. Right before an operation, surgical teams now repeatedly review who is getting what done to which body part; that part is labeled, if possible. These measures have helped but not completely prevented "never" events.
Statistics cite communication errors as the primary culprits in wrong-side events. No mention is made of how often my form of inherent right-left confusion precipitates or complicates them, but you have to assume it is often a factor. As commentators have pointed out, patients in the operating room may lie face up, face down or on one side; surgical drapes often conceal most of the patient's body; and the operating table may rotate, utterly bamboozling the laterality-challenged.
No one has yet suggested that precautionary protocols for wrong-side events move way, way upstream -- to initial employment interviews, for instance, or applications to medical school, with interviewers demanding, "Do you know your left from your right?"
Would that constitute discrimination, I wonder -- to pejoratively label a significant minority of the applicant pool, or to steer us pre-emptively away from the operating room, or perhaps to ban us from health care completely?
A group of British researchers has taken a small first step down that road. After studying left-right confusion among medical students for some time, they have proposed that students be formally tested for left-right discrimination early in their training so they are at least self-aware enough to plan accordingly.
It sounds reasonable enough, although one wonders where it will end. After all, other neurological tics abound in the applicant pool. Color blindness, for example, is trivial enough, but it may complicate or even destroy a career in pathology, in which the ability to distinguish colors under a microscope is essential.
Eric Chudler, a neuroscientist at the University of Washington in Seattle, researches handedness. He has posted online a quick self-test readers can use to compare how quickly they process left vs. right compared to up vs. down. The quiz is at tinyurl.com/76uamgf.
Celia Storey added information to this report.
ActiveStyle on 08/17/2015