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Gallbladder Dialogues

The Language and Demeanor of Unnecessary Surgery

75% of Gallstone Cases Remain Asymptomatic

Dr. Yelland made two attempts to talk me into unnecessary gallbladder surgery. He began with a false statement about anatomy, claiming that a gallbladder 10-centimeters long is morbidly enlarged.  Yelland said a normal gallbladder should be only 4 centimeters long.

But textbooks published between 1858 (Gray’s Anatomy) and the modern day say normal gallbladders range from 9 to 10 centimeters in length. When challenged with the texts, Yelland shifted strategy: He said the mere presence of gallstones mandates swift surgery. His pressure was remorseless for months.

Gallbladder Dialogue: The first attempt at unnecessary surgery is well-documented. At my request, the radiologist measured several clinical features on my Ultrasound film. A Saskatoon surgeon named Dr. Andreas Kluftinger (who Yelland pressured me into seeing) was also honest: his consultation report concluded that my gallstones were discovered incidentally on ultrasound, were completely asymptomatic, and did not require cholecystectomy (surgery).

I sought independent information as well from the U of S Health Sciences Library, where medical textbooks affirm that 75% of people with gallstones never develop any symptoms and should not undergo this surgery, which carries serious risk.

Gallbladder Dialogue Redux: One year later, Dr. Yelland acted as if that entire written history did not exist, and resurrected the topic of gallbladder surgery, accompanied by surly aggression. The details are instructive as to how MDs think. (Continued below)

Gallbladder Dialogue

Inspect Your Ultrasound Film

My first Ultrasound scan noted gallstones in a ten-centimeter long gallbladder. These were incidental findings: the original purpose of the Ultrasound was to study a nearby structure (my kidneys).  Of gallbladder symptoms, I had none.  The report read in full:

There are numerous small stones in the gallbladder. The gallbladder is quite large, measuring up to 10 cm in length. The liver, biliary tree, pancreas, spleen and kidneys appear normal. [Radiologist Dr. D. Ator]

The report was sent to referring physician Dr. Joel Yelland (my then-GP) who called me to his clinic for follow-up. Dr. Yelland opened the appointment by recommending surgical removal of my enlarged gallbladder.  I asked: What length is standard for a gallbladder? How much is mine enlarged?  Dr. Yelland answered: The normal length of a gallbladder is 4 centimeters.

Dr. Yelland sat at his desk writing in my chart, then turned to face me. He adopted a pleading posture – yet all I had done was ask two questions. Still in his chair, Dr. Yelland leaned forward from the waist; he clasped his hands and straightened his arms downward, inching that V-shape between his knees until his clasped hands nearly met the floor. He tilted his head up to hold my eyes. On his face, a supplicant's smile.

I was taken aback, also impatient. Such a posture was senseless in the circumstances. Then Dr. Yelland opened his mouth to discuss surgery further … and I froze. I saw a waterfall of saliva dripping in a sheet from his upper teeth to his lower teeth.

[Afternote: I can still picture Dr. Yelland's pleading posture and his waterfall of saliva. When a scene so unusual is underway, the brain shuts out all distraction. The scene gets etched in memory. The edges stay sharp if no explanation is found; instinctively you re-examine the memory over months or years to puzzle out the nuances.]

The observation of Yelland's nervousness, plus my own scientific curiosity, prompted me to consult my $10.00 copy of Gray's Anatomy (published 1858), plus a modern textbook on Gastroenterology. These sources listed 10 centimeters and 9 centimeters, respectively, as the normal gallbladder length (not 4 centimeters).

I wrote an inquiry to Saskatoon Associated Radiologists, the center where the Ultrasound was performed. I received an independent opinion: The center exchanged correspondence directly with me (not with my GP). In a polite letter the radiologist said my gallbladder was not pathologically enlarged and there were no stones in the ducts.

After I showed the radiologist's letter to Dr. Yelland, he no longer called my gallbladder morbidly enlarged. He shifted ground, saying: The presence of gallstones mandates swift surgery. You could develop symptoms at any time. This he told me every two weeks during my regular appointments for my autoimmune diseases.

Out of respect for Dr. Yelland, bowing to his relentless pressure, I finally agreed to see laparoscopic surgeon Dr. Kluftinger – who agreed entirely with the data I had acquired. Dr. Kluftinger's report said my gallstones were discovered incidentally on ultrasound, they were completely asymptomatic, and I did not require cholecystectomy.

Textbooks offer statistics and this guideline: Only 25% of patients with stones ever develop gallbladder trouble, thus surgery is never done on a preventive basis.

Gallbladder Dialogue Redux

Patient’s Sweat Equity Prevents Mishap

My own research, plus answers from the radiologist, prevented unnecessary surgery. That did not change Dr. Yelland's attitude, however. A year later, in spring 2001, Yelland ordered a repeat Ultrasound, this time to check my kidneys and gallbladder both. The situation was static: My gallbladder had the same gallstones; the ducts were still intact; I remained symptom-free. The report in full said:

Multiple small mobile gallstones are identified. The gallbladder wall is not thickened. The extra-hepatic bile duct has a normal diameter of 5 mm. The liver, spleen, kidneys, and pancreas are unremarkable. Specifically, no evidence of renal cysts or hydronephrosis.
[Radiologist Dr. M. Beck]

With that benign report in hand, Dr. Yelland sent me a Recall Notice urging me to return to his new clinic in the Pacific Avenue Medical Building. When my appointment began, Dr. Yelland held the Ultrasound report, studied it a moment, then swiveled his black stool in a slow circle to face me and spoke with rising volume: I thought you had your gallbladder out! He shouted the last word, Out!

The gallbladder incidents didn't change Dr. Yelland's view, but they changed mine. The Gallbladder Dialogues are one reason I terminated the doctor-patient contract. My own science knowledge, and just plain sweat equity in researching my health conditions, prevented these, and other, mishaps. To leave his clinic and start with another GP was simply healthier, wiser, and in keeping with my own spirit of optimism.

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
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Dr. Yelland Recall Notice

Dr. Joel Yelland:
Recall Notice sent to Patient
to discuss the second Ultrasound
Re:  Gallbladder imaging

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