The (commercialised) experience of operating: Embodied preferences, ambiguous variations and explaining widespread patient harm

Abstract

This article provides a detailed account of how surgeons perceived and used a device-procedure that caused widespread patient harm: transvaginal mesh for the treatment of pelvic floor disorders in women. Drawing from interviews with 27 surgeons in Canada, the UK, the United States and France and observations of major international medical conferences in North America and Europe between 2015 and 2018, we describe the commercially driven array of operative variations in the use of transvaginal mesh and show that surgeons' understanding of their hands-on, sensory experience with these variations is central to explaining patient harm. Surgeons often developed preferences for how to manage actual and anticipated dangers of transvaginal mesh procedures through embodied operative adjust ments, but collectively the meaning of these preferences was fragmented, contested and deferred. We critically reflect on surgeons' understandings of their operative experience, including the view that such experience is not evidence. The harm in this case poses a challenge to some ways of thinking about uncertainty

Patients’ perspectives on quality and patient safety failures: lessons learned from an inquiry into transvaginal mesh in Australia

“…Ducey and colleagues suggest that variation in clinicians’ performance, perceptions and experiences have direct impacts on what counts as a preventable or non-preventable adverse event [ 14 ]. This, in case of TVM, particularly highlights a weakness of quality and patient safety—only targeting preventable adverse events.…”

“…This hampered changes to clinical governance or guidelines that could have altered clinical practice at a micro level or changed shared understandings of TVM procedures. Critiques of quality and safety have highlighted the power of clinicians to influence what counts as a quality and patient safety issue within all levels of healthcare settings [ 6 , 14 , 15 , 19 ]. This also resonates with the well-recognised history of power imbalance in the construction of knowledge of the female body in medicine and surgery [ 19 ].…”