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Editor's Correspondence
Feb 27, 2012

Rhetorical Techniques in Contexts Other Than Cardiac Resynchronization Therapy

Author Affiliations

Author Affiliation: Medical Division, Manchester Medical Association, John Rylands University Library, Manchester, England.

Arch Intern Med. 2012;172(4):372-373. doi:10.1001/archinternmed.2011.770

Rhetorical techniques that emphasize benefits of cardiac resynchronization therapy to the exclusion of acknowledgment of its complications1 have their counterpart in the way laparoscopic cholecystectomy has evolved and become a standard procedure, notwithstanding the fact that, compared with “open” cholecystectomy, the former is a technique with far greater risk of damage to the common bile duct.2 Furthermore, despite the fact that in 1996 a prospective randomized comparison between laparoscopic and small-incision cholecystectomy showed that laparoscopic cholecystectomy took significantly (P < .001) longer to perform than small-incision cholecystectomy and that the laparoscopic procedure did not have any significant advantages in terms of hospital stay or postoperative recovery,3 it rapidly “upstaged” open cholecystectomy and became the standard procedure, being especially promoted on a day-case basis. Arguably, as a result of early discharge of day-case patients and suboptimal monitoring for potential complications, the incidence of litigation subsequently rose steeply, with at least 6-fold increase in 2003 vs 1995. One consequence was that in the 15 years since 1995, the National Health Service Litigation Authority documented 414 claims, of which 303 were settled. Among the complications associated with a delayed diagnosis, bile duct injury accounted for 37% of the cases, which was the single greatest proportion.4 However, only as belatedly as February 2011 have medical professionals begun to acknowledge that “Patients should also be educated on these postoperative symptoms, with this information documented at perioperative consent and contained in patients information leaflets.”5(p347) Lessons learned from the experience of laparoscopic cholecystectomy might mitigate the risk of future harms attributable to cardiac resynchronization therapy.

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