Head, neck, and throat surgeons perform different types of endocrine surgery daily, and not all of those surgeries go as planned. Sometimes, medical malpractice is the result of the operation due to negligence, causing an injury or the death of a patient. Whether the surgery is performed to help control the hormones of an existing ailment, or it is meant to go up as a PubMed for peer review, the operation has standards that need to be met. If someone struggles as a result of a delayed or missed diagnosis, then there may be cause to file a malpractice claim. The best way a patient could know his or her options is by speaking to an experienced malpractice lawyer — one who has successfully dealt with several malpractice claims in the past.
What Is PubMed?
PubMed is a website set up as a way for doctors and specialists to share their knowledge. The goal of PubMed is to improve the working knowledge of doctors around the world. It is run by the United States Department of Health and Human Services, and it serves as a place for all types of specialists to share the procedures they have tried, skills they have perfected, and knowledge of things that do not work. If one doctor on PubMed can discover that when two specific symptoms show up a certain number of hours apart, it always leads to the same diagnosis, then it can help another doctor who is also part of the PubMed community.
All of the pieces on PubMed are accredited and open for peer review. In addition, there are over 30 million unique citations in PubMed, allowing doctors who need help diagnosing a challenging case one place to go to compare journals, books, and websites. Many doctors put the results of their surgeries up on PubMed for others to look over, as it serves as a starting point for conversations to be had. It is just vital for any doctor who may put anything on PubMed to realize that he or she must maintain the same care standards as any other doctor practicing medicine.
What Is the Endocrine System and Why Would It Need Surgery?
According to PubMed, the endocrine system is part of the body responsible for the production and distribution of all essential hormones. These hormones that come out of the different organs of the endocrine system regulate things like:
- The metabolism of the body
- The increase or decrease in blood pressure
- How fertile someone’s body is when it comes to reproduction
- The structure of the bones
- How the body regulates temperature
- How much sleep a person can get
- The overall mood someone has
- How responsive people are cognitively
- How the body digests food
- The rate the heart pulses at
Many different glands make up the endocrine system. PubMed has them listed as:
- The ovaries in women and the testicles in men
- The thymus
- The pituitary gland
- The pancreas
- The thyroid gland
- The adrenal glands
- The parathyroid glands
These aspects of the endocrine system will remove what they need from the blood, alter them chemically within the gland, and secrete whatever the body is lacking or needs at that time. When someone has a hormone level that is too high or too low, it is due to something going on within the endocrine system. In most instances, it is some disease within that system. It could be something more benign, such as an infection or stress. However, it could also signal a part of the body is struggling with a much larger problem.
When talking about endocrine diseases, diabetes is the one most people have heard of most, according to PubMed. In this disease, the body struggles to process the simple sugar called glucose. The body may not be able to handle the glucose because of too much or too little insulin, which is created in the pancreas. To treat diabetes, most people need to take regular medication that helps the body process what glucose it takes in properly. The same goes for other endocrine diseases. Many of them have the ability to be treated with medications, at least when caught early enough.
When these diseases are allowed to progress, then the options often become surgical. One condition that is usually treated through surgery is hypothyroidism. This is a disease of the parathyroid glands, and to address the issue, endocrine surgeons have to go in and perform a parathyroid surgery to remove the malfunctioning glands surgically.
Types of Endocrine Diseases
Aside from the diseases already mentioned, there are several other types of endocrine disorders that all require specific treatment. The earlier the disease is found and diagnosed, the easier it is to treat. Delaying the diagnosis can make a minor problem into a major one. Here are some of the other diseases that can show up as a result of a malfunction in the endocrine system.
- Thyroid cancer is one of the more severe diseases of the endocrine system. It often begins with just a few cells in the thyroid gland changing, and the more those cells grow, the quicker they become cancerous.
- Weight issues that stem from hormones are also a result of a malfunctioning endocrine system. When the signals coming from the endocrine system do not come out correctly, the body may think it needs to store fat instead of burning it even when a person is exercising properly and eating a healthy diet.
- Many issues can lead to high blood pressure. The endocrine system is only one of those issues. When a patient presents with high blood pressure, it is up to the treating physician to run tests to see if a malfunction of the adrenal gland is to blame.
- Growth disorders can stem from a problem within the endocrine system. The hormones are what regulate a person’s growth, so if there are too few hormones, growth can be delayed, and repairs to the body after an injury can also be affected. This is usually the result of an issue within the pituitary gland.
- Some bone disorders are the result of poorly regulated hormones from the endocrine system. The structure of the bone and how dense the bones are can be a direct result of what hormones the body is sending out. It can also lead to problems like osteoporosis.
- Sexual development is also regulated by the endocrine system. When someone has too much or too little testosterone or estrogen, it can impact how the body develops sexually. This can also lead to issues with infertility and impotence in males. Some people with low hormone levels struggle with too little energy, low sex drive, and struggles when muscles need to be repaired.
The best way to test for any of these issues is to perform blood tests or get an endoscopy with a laryngoscope. When a problem with the endocrine system is accurately diagnosed, most primary care physicians send their patients to go and see an endocrinologist. This enables the patient to have the most experienced doctor treating him or her. Some tests can also be performed on a patient’s urine. However, addressing these issues is quite delicate. If the hormones of one part of the body are raised or lowered, it affects the hormones regulating the rest of the body.
How Are Endocrine System Issues Fixed?
The way that an issue gets fixed within the endocrine system depends on what the problem is, to begin with. It also depends on how advanced the disease is. For example, if thyroid disease is causing the malfunction, there are several treatment options, including:
- Thyroidectomy: This can involve simply going in and removing nodules, or it can be more extreme, such as having a total thyroidectomy. A thyroidectomy is when surgeons have to go in and remove either part of the thyroid, or the entire thing.
- Thyroid Lobectomy: This is a procedure where half of the thyroid is surgically removed. This procedure is usually done as a way to look for cancer in the thyroid of a patient.
- Radioactive Treatment: This involves the patient taking some radioactive iodide to see which part or parts of the thyroid are involved in any type of thyroid disease. It also consists of the patient taking additional doses as necessary to stop the cells within the thyroid from creating hormones.
- Medication: This can happen when the issues within the thyroid are still treatable by taking a regular pill.
- Hormone Replacement Therapy: When someone has hypothyroidism, no surgery will help. Instead, the patient needs hormone replacement therapy.
One thing to note is that most doctors will avoid thyroid surgery in most individuals unless they cannot take thyroid medication for some reason, have cancer, or have a huge goiter. There are also two different kinds of surgeons that can work on these cases. Endocrine and otolaryngology surgeons can both perform these types of surgery. The otolaryngologist is a specialist that can handle head, neck, and throat surgeries.
Risk Factors of Thyroid Surgery That Should Be Well-known Before Surgery
During a thyroidectomy, there are many risk factors that every patient should be fully aware of before the procedure begins. These procedures have the potential to alter someone’s life significantly if the surgery does not go as planned or end a person’s life in the worst-case scenario. All doctors must explain these risks before starting the procedure so each patient can make an informed decision. Here are some of the most critical risks associated with thyroid surgery:
- Cutting of the recurrent laryngeal nerve, or RLN: The recurrent laryngeal nerve divides the vagus nerve in half and is what powers the muscles of the larynx. Without this nerve, there is little or no vocal cord function. This could affect only one vocal cord or both of them. In the worst-case scenario, there is full vocal cord paralysis when the recurrent laryngeal nerve is damaged during thyroid surgery. The most dangerous part of this condition is when either vocal cord is paralyzed, it sits partially in the airway and can obstruct a patient’s ability to breathe. There is the option of recurrent laryngeal nerve monitoring, but this is a risky procedure, as well. During recurrent laryngeal nerve monitoring, the vagus nerve and recurrent laryngeal nerve are monitored. However, recurrent laryngeal nerve monitoring is a procedure that has not been proven to improve the outcome odds, and it adds to the overall cost of the procedure.
- All surgeries carry risks, but when surgery is performed in the neck, bleeding is a significant concern. The blood can pool around the neck, making breathing difficult or impossible. In addition, with the pressure of blood moving through the neck, the blood can come out faster than it can be caught, even if a medical professional does pick up on the signs of internal bleeding.
- Voice changes are frequent occurrences even without a recurrent laryngeal nerve injury. This is because the pressure in the neck changes during and after recovery, which means the pressure on the vocal cords also changes.
- After surgery for hypoparathyroidism, it is common to have issues with calcium levels in the blood, called hypocalcemia. That is because the glands responsible for controlling the blood calcium levels are either gone or trying to recover. The good news is, only one-quarter of one of these glands is necessary to control the calcium in a patient’s blood, but it may require special monitoring and long-term calcium supplements.
- There is always a high risk of infection when any type of surgery is performed. It could be an infection at the skin level or an infection within the rest of the gland the doctor was working on. It can also be an infection of the blood. Vitals and temperature must be closely monitored following surgery to ensure there are no signs of infection.
- Seromas can also occur after these types of procedures. These are similar to big blisters under the skin that fill with fluid and can put pressure on the neck. Many of them will disappear on their own, but the larger seromas will require a doctor to drain them.
Famous Specialists Who Have Helped Progress the Field of Endocrinology
Many renowned doctors were endocrinologists. They went out of their way to perfect surgical procedure techniques, make breakthroughs, and even get published in prestigious journals, such as The American Journal of Surgery, or J Surg. Here are a few of the more notable ones and their contributions to this field of medicine:
- Dr. Shabirhusain Abadin has been published on PubMed several times for his work with lymph node metastasis when a patient has thyroid cancer. He has also done extensive work on the role of recurrent laryngeal nerve injuries and how they affect surgery once tumors from the thyroid have begun to spread.
- Dr. Peter Angelos has been published on both J Surg and PubMed for his work in medical ethics, patient rights, and thyroid procedures. He specializes in perfecting minimally invasive techniques to treat thyroid issues.
- Professor Henning Dralle was published on both J Surg and PubMed for his work on intraoperative neuromonitoring for goiter surgery and ways of improving the quality of life after any type of thyroid surgery. Dralle also serves as the Professor of Surgery, plus the Chairman of the Department of Surgery for the University of Halle-Wittenberg in Germany. Dralle has held these roles since 1994. Dralle is the author of more than 600 peer-reviewed articles that have been published and written 189 chapters in books about all types of endocrine surgery.
- Dr. Carsten Sekulla was published on both J Surg and PubMed for his work on intraoperative neuromonitoring as well, along with Professor Dralle, Oliver Thomusch, Gerard Walls, and Andreas Machens. Sekulla has also worked on trying to help those with lost vocal fold function to regain function after surgery and worked on improving surgical outcomes for the obese.
- Dr. Andreas Machens was published on J Surg for his work on intraoperative neuromonitoring. Machens also works diligently on trying to come up with treatments for the rarest of endocrine disorders, such as neoplasia type 2b.
Many of these doctors were able to make great strides when it came to intraoperative neuromonitoring by minimizing the manipulations that could lead to changes in the brains, functionality, and spinal cords of the patients undergoing these surgeries. It has reduced damage taken by patients and increased the quality of the techniques used during this procedure. In addition, they are all working on the future directions that people can take when it comes to endocrinology.
Ways Endocrine Problems Can Become Medical Malpractice
Most doctors who specialize in the endocrine system treat two main issues. They heal those who struggle with diabetes, and they treat those who struggle with thyroid issues of all types. Both of these issues can have systemic effects on the body, from how it fights off viruses to how much energy a person has. It is in treating these issues that people begin to notice mistakes being made due to negligence. Here are some examples of problems that could result in a malpractice claim against one of these doctors:
- Overlooking common symptoms in a rush to diagnose a patient and giving a wrong diagnosis
- Delaying the diagnosis of a patient, resulting in his or her condition worsening during the delay
- Not correctly managing someone’s diabetes. Most of the people who have diabetes do not realize the damage it causes is progressive. If the doctor did not handle it properly or inform the patient of this, then he or she can be liable for the eventual life-altering ramifications that come with diabetes, including amputations, blindness, heart disease, or complete kidney failure.
- Not taking the time to treat hypertension properly. When high blood pressure is not adequately treated, it can put a massive strain on all blood vessels in the body, plus the kidneys, brain, and heart. What the doctor should do is perform an electrophysiologic procedure to monitor the heart according to the International Standards Guideline Statement, then decide on an appropriate treatment plan. If a doctor chose not to treat a patient’s high blood pressure, and he or she has a stroke, for example, the doctor could be held liable.
- When a patient does not have the right bone density due to a glandular issue, then it is up to the doctor to check consistently for problems like osteoporosis. If this is not diagnosed early, the results on the body are intense. There can be pain, fractures, weak joints, and even the total loss of mobility.
- Diseases of the thyroid need to be treated as quickly as possible. If there is a delay in the diagnosis or treatment of one of these diseases, it can lead to congenital disabilities defects or deformities in children, advanced stages of cancer, and chronic infections.
- It is a doctor’s responsibility to inform and educate each patient he or she treats. If the doctor does not do this, it can lead to a rapid decline in the condition of the patient. In the worst-case scenario, it could lead to the death of the patient. The only way for a patient to know how to modify his or her life to compensate for the endocrine issue is with knowledge.
- The medications that these patients used are very exact since any changes in the hormone levels can alter the entire body. If a doctor were to give the wrong medication or the wrong amount, that could easily become malpractice.
- With many endocrine issues, the symptoms are quite similar. If a patient comes in with traditional signs, it is crucial that the doctor looks at these problems first. Once those are ruled out, then the more complex issues should be considered. If a doctor went straight to the complex, it could be malpractice if one of the more traditional ailments was easier to treat and a better fit for the symptoms.
- If a doctor were to perform a surgery that was not necessary on the patient, that could easily be a malpractice case. The same goes if a doctor did not remove all medical equipment before completing the procedure.
- Damaging the RLN so much that recurrent laryngeal nerve palsy occurs, meaning a full paralysis of the voice box, could be malpractice. It depends on what caused the damage – if the injury happened specifically because the thyroid was being taken out, it might not be malpractice. However, if the surgeon was not careful and nicked the nerve, then it may be malpractice.
- A patient’s family medical history is vital to ensuring he or she is diagnosed properly. If the doctor did not take or look through the medical history of the patient, malpractice could also happen.
- Not paying attention to test results or not ordering tests that would make sense with the symptoms a patient presented with could also be negligent malpractice.
Malpractice Litigation Is Incredibly Complex
Understanding the endocrine system is challenging, but maneuvering around a courtroom during malpractice litigation is equally as complex. Endocrine system ailments can lead to imbalanced hormones. Those hormonal imbalances can lead to a wide range of problems, any of which could be prevented with the right treatment. People must understand the ramifications that come with doctors who specialize in the endocrine system. If the doctor does not treat the patient quickly and efficiently, the patient could wind up facing:
- Heart disease
- Failure of the immune system
- Vision loss
- Kidney failure
- Weight loss or gain
- Skin rashes
- Weak bones
- Fatigue that does not go away
- Chronic headaches
- Voice changes
These are only a few of the things that can happen when the hormones do not remain in balance. That list spans the entire human body. Giving an endocrinologist a patient’s trust is putting his or her life in that person’s hands. If that person is negligent, it can alter the rest of the patient’s life or even cause death.
Communication between the endocrinologist and the primary care doctor is vital to ensuring all of the patient’s needs are met, and all of the most critical tests are being performed. Many malpractice cases come down to an issue where someone was not communicating properly, and it left the well-being of the patient hanging in the balance.
To get to the root of what caused the malpractice, the injured party needs to look into hiring a malpractice attorney with extensive experience. The attorney understands the complexity and nuances of the courtroom. This enables the attorney to use that experience to help the injured party get more compensation for the errors that led to the injury.
What Do the Court Want to See to Make a Malpractice Case?
Courts want to see concrete evidence when it comes to a malpractice case. They want to be able to connect the people involved, see what the standard of care should have been, and see how this standard was not kept up with. Finally, they want to know how that led to the injury. The evidence has to show these things:
- A connection that shows that the plaintiff and the accused knew each other on some professional level before the injury
- What the standard of care should have been: The standard of care is what type of care the plaintiff would have gotten from basically any other medical professional under the same underlying circumstances. This is often proven by asking other doctors in the same field how they would treat a patient with the same symptoms.
- How the care the patient received was below this standard: There needs to be proof that the care the plaintiff received was below what this level of care should have been for the circumstances. This is also usually proven by asking a person who works in the same primary field his or her opinion on the treatment.
- How something the accused did or neglected to do led directly to the injury in question: The injury needs to have happened because the medical provider was negligent in some way. A medical accident that could not be helped is not malpractice.
Finding the Right Attorney to Put in Charge of a Medical Malpractice Case
There are specific things that an injured party needs to look into when finding the right malpractice attorney. If the plaintiff is not comfortable with the attorney right from the start, it could turn into a poor relationship as the case wears on. This could result in the plaintiff getting less compensation than he or she deserves simply because both parties want the case to end. The decision-making process should begin with a few phone calls to local malpractice attorneys who have extensive experience with malpractice claims. From there, the injured party should ask some questions, such as:
- How much experience does this particular attorney have in endocrine system malpractice cases? How have the last few instances come out?
- What type of direction does the attorney believe this will go, based on the preliminary evidence? Is a trial or settlement more likely, in his or her opinion?
- What could be missing from this case that would make it stronger? Are there any detriments to this case that could make it weaker?
- Can the attorney explain back what happened to the injured party as a way of showing he or she understands the circumstances of the case?
- How long has the attorney been actively practicing malpractice law?
- Will the attorney make update calls, or will that be delegated out to an assistant of the attorney?
- Who will be doing the investigating into what happened, the attorney, or someone in his or her network of professionals?
- What type of funds will the injured party need to get together to file the case?
- What are the specific statutes of limitations in the state, and how much time is left to file a claim?
- What is the filing process like? Is there a medical review panel that must look over the facts of the case before the process gets started?
- Will this case require expert testimony? If so, what kind?
- Are there any fees that the firm will cover?
- What types of settlements has this attorney gotten for other clients in the past?
Going into court without an attorney is not wise. It is difficult with the way that the court treats those without experience, plus it is also incredibly stressful. People going into court to prosecute a case on their own are likely to be under so much stress that healing slows down, stops, or even begins to reverse. It is never a good idea. It is much easier to allow someone with experience to do the legal side of the process, and the injured party worries about the healing side of the process.
Can Malpractice Claims Get Damages?
Each state has specific laws set up to limit what type and amount of damages an injured party can go after. Some states have limits on noneconomic damages, like pain and suffering, while other states have it on the books that there is no limit due to how expensive recovery and future health challenges may be. It is best to ask an attorney what the rules and limits are instead of trying to guess.
Those who have been hurt during any type of an endocrine system procedure can go after monetary damages, like:
- Medical expenses for the past, present, and future relating directly to the injury
- Medical equipment or prescriptions the injured party may need as a result of the injury
- Wages to cover time lost at work because of the injury
- Future wages if the injured person is unable to return to his or her former job
In addition, the injured party can go after noneconomic damages, including:
- Anguish, stress, or worry the injury caused
- Reduction of quality of life
- Loss of spouse, companion, parent, child, or close relative if the patient died
- Loss of direction, if the person who died was also guiding the choices of the person who files the suit
- No longer being able to go about a regular daily routine, such as taking out the trash, bathing children, or doing laundry are all things that can be compensated for
When the endocrine system of the body begins to act up, the patient needs to be seen right away. From there, the doctor has a duty to care for that patient quickly and effectively. The doctor must do what is in the best interest of the patient. If he or she did something negligent or neglected to do something necessary, it could become a malpractice case. The injury is not something that should be ignored. Carelessness is never allowable when it comes to someone in the medical field. If anyone sustained an injury due to the negligence of a healthcare professional, then an experienced malpractice lawyer needs to be called to see what can be done. There are compensatory awards that can be provided as a way of allowing healing to take place.