Technology and Pain

I am a retired surgeon of more than 50 years experience with similar situations. There is no question the patient deserves a lot of sympathy. During a five-year stint in the Navy during World War II, I frequently removed the appendix on suspicion to prevent an unnecessary procedure at sea. In a series of 1,500 such operations about 30% were not suppurative or associated with pus.

Such a figure is not deemed acceptable in civilian life and for all I know may not be acceptable in the peace time Navy. The advent of the tissue committee, and the efforts of the American College of Surgeons to eliminate so-called “acute remunerative appendicitis” have placed a chilling damper on the courage of the surgeon to proceed in the face of vague and confusing findings.

Tissue committee review, medical legal considerations, medical staff opprobrium, and skeptical advice from insurance companies, the media, and relatives have changed the doctor’s attitude from “What else can it be?” to “What is it?” To pinpoint the diagnosis, he employs high-tech searches and relies on second opinions. There are worse things than the simple removal of a so-called normal appendix by a capable, experienced, considerate surgeon.

MORRIS T. FRIEDELL, MD

Palm Springs