Which side ... which organ ... which patient?

“Sir, this patient is for diagnostic laparoscopy for chronic pelvic pain” my resident doctor informed me. She was to perform the laparoscopy and I was to assist her. The patient was already on the operation table. The anesthetists were going through the motions of getting things ready. “What is her name?” I asked. “Show me her papers.” “Her name is Parwati” said the resident as she handed me the indoor papers. “Never rely on the first name alone” I told her. “You must check the full name. Parwati is such a common name that at a given time there could be three or four women with that first name in our ward. You could get a wrong patient on the table if you stick to the first name alone.” Then I checked the patient’s name on the paper. It was Parwati Sarvate. I turned to the patient and asked “Are you Mrs. Parwati Sarvate?” “Yes” she said. “Sir, her name is written on the label put on her OT gown” my resident pointed to a square label on the front of the woman’s gown, below the left shoulder. She had a look of pride on her face, having shown me a fool-proof method of patient identification. “OK. But remember that the label is put by a nurse, and you are relying on her not to make a mistake. You can get in trouble because you are responsible for patient identity, not the nurse.” It was indeed surprising how naïve the residents could be at times. “Are you undergoing laparoscopy for chronic pelvic pain?” I asked the patient. “Yes” she answered. I confirmed all these details myself, though the resident had done all that herself before bringing the patient to the OT. It was my vicarious responsibility, even if the resident was going to perform the operation, because she was not yet qualified. “You cannot be careless in these matters, or you may end up performing a wrong operation on a wrong patient” I warned. “Yes sir,” the anesthetist agreed with me instantly “that day the surgeons took up a patient for repairing a fistula in ano. After giving anesthesia and lithotomy position, they started the operation, but could not find any fistula. After searching frantically for ten minutes, they realized that patient did not have a fistula, and he actually had a hernia. The patient with a fistula was sitting outside the OT, awaiting his turn to undergo an operation. SO they straightened his position and repaired his hernia. Lucky they had not started dissecting his tissues for repairing a fistula.” “Yes, the fellow must have been lucky” I said. “All he lost was ten minutes. Here are reports in the world literature of patients having perfectly sound limbs or organs surgically removed, while the diseased limbs or organs stayed back inside them or inside some other patients. Needless to say, the operating surgeons paid heavily in the form of compensation and disciplinary action. I remember a patient we had operated on when I was a Registrar. One day a Registrar of another unit brought her along and told me that we had performed a laparoscopic sterilization on her while she had actually wanted a diagnostic laparoscopy for finding out why she was not having a baby. She had gone to his outpatient clinic by mistake and he had found this on her discharge summary. I almost went into a shock. Sterilizing a woman by mistake when she actually wanted treatment to get pregnant was a form of criminal negligence not yet reported in the world literature. I immediately took her along to the medical records section and took out her indoor paper. Luckily it showed that she had actually undergone a diagnostic laparoscopy and not a sterilization operation. Someone had given a discharge summary of another patient.” My audience was suitably impressed. I hope they learned the importance of being careful at all stages of operative treatment of any patient.