The Surgeon had been handicapped by a burr in the plantar aspect of his left foot. All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning. There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp …
The call comes in at 9pm or so. The patient sounds sick as all hell. The Surgeon listens to the random assortment of numbers and vitals the nurse provides and clicks off his cell. He finishes reading a boring Berenstain Bear story to his daughter and tucks her into bed. He looks at the clock and runs some mental numbers. By the time he arrives at Hospital, close to ten. See the …
Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of …
Recently, Kevin Pho wrote about a physician, Alexandra Thran, who was disciplined by both her hospital and the state medical board for writing about a trauma patient she had seen. Although Dr. Thran hadn’t divulged the patient’s name, enough information was conveyed that allowed others in the community to identify the patient in question.
That story really freaked me out. Because, as you know, I sometimes write about my …
A Florida study assessed the rate of needle versus surgical breast biopsies over a period of five years.
What we’re talking about here are non-palpable abnormalities that are identified on screening mammography. A mammogram report will come back that assesses the relative risk of an abnormal collection of calcifications harboring an invasive or pre-invasive cancer (staged on a scale from I-V). With such data, one is obligated, as …
Pauline Chen had a post in the New York Times recently about surgical informed consent. Informed consent is an important part of the surgeon/patient communication transaction.
Surgeon reviews the proposed operation, the rationale behind it, and the possible complications. For example— a patient comes in with biliary colic. We describe the anatomy and pathology. We aver that surgical resection will lead to …
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.
Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …
The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.
One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.
We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …
Lucian Leape MD, a public health professor at Harvard, wants to subject doctors in America to strict random and periodic drug testing to help identify those physicians who are impaired. All in the name of patient safety, of course:
“I’m very much in favor of random testing,” Dr. Leape says. “We have a responsibility to identify problem doctors and bring them into treatment.” And to protect patients in the process.
Ok, I …
Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).
I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …
It’s worth your while to browse through Sid Schwab’s sampler one rainy Saturday afternoon when you get a chance.
The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It’s a shorter post (for him) but very powerful and moving.
He describes what it’s like to enter an abdominal cavity of a patient, with all its …
Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.
In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.
It’s part of the social contract: doctors accept limited salaries in exchange for limited liability; …
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