Immediate Action Required for Wrong-Site Surgery Prevention
You should immediately tell the surgeon that the diseased kidney is on the left side, not the right side. This is an ethical obligation to ensure patient safety and prevent a serious medical error. 1
Why Speaking Up is Critical
Operating on the wrong kidney would constitute a serious medical error with significant consequences:
- Removal of a healthy kidney instead of the diseased one
- Need for additional surgery to address the actual diseased kidney
- Significantly increased risk of chronic kidney disease
- Potential for acute kidney injury, which negatively affects both short and long-term outcomes 2
Overcoming Barriers to Speaking Up
The guideline is clear that:
- Fear of hierarchy should never prevent speaking up about patient safety
- Assuming someone else will notice is not an acceptable reason for delayed intervention 1
- Patient autonomy and safety are paramount considerations in any surgical procedure
Consequences of Not Speaking Up
Failing to speak up in this situation could lead to:
- Irreversible harm to the patient
- Unnecessary loss of a healthy kidney
- Increased risk of acute kidney injury, which is associated with:
- Higher in-hospital mortality
- Decreased survival for up to 10 years after surgery
- Increased risk for progression to chronic kidney disease and potential need for hemodialysis 3
Proper Surgical Site Verification
This situation represents a breakdown in the proper surgical site verification process, which is a critical safety measure in renal surgery. Even a mild kidney injury from operating on the wrong side could have significant consequences, as research shows that even small changes in serum creatinine (as little as 0.2 mg/dL) are associated with adverse postoperative outcomes 4.
Conclusion on Course of Action
The correct answer is B: Tell the surgeon. When you have information that could prevent harm to a patient, especially in a situation where the wrong surgical site is being prepared, you have an ethical obligation to speak up immediately regardless of your position in the medical hierarchy.