Skeptical Scalpel, MD

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.

If you go to medical school, you will be stressed: bigly

Education

April 6, 2018

Two recent posts highlight the problems facing many medical students today.

The first was by an anonymous rising fourth-year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.”

The second was by another anonymous student who described how miserable he (or she) has been …

The public’s unrealistic expectations about CPR

Skeptical Scalpel, MD

Physician

March 19, 2018

A survey of 1,000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered: a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an …

Unnecessary testing wastes money and can lead to further testing

Skeptical Scalpel, MD

Physician

March 9, 2018

Unnecessary testing wastes money and can lead to further testing. Why does it occur?

Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.

Of 1,580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients.

Nurses …

Patient satisfaction surveys are worthless. Here’s why.

Skeptical Scalpel, MD

Physician

January 17, 2018

For several years, Medicare has tied hospital reimbursement to its definition of quality of care. Poorly performing hospitals can be penalized as much as 2% of their Medicare payments.

As part of Medicare’s assessment of quality, surveys are used to measure patient experience and satisfaction. One of the components of the Medicare survey is pain management, which Medicare describes as follows:

I’m not sure who, if anyone, …

Motivating patients to stop smoking and lose weight before surgery

Skeptical Scalpel, MD

Physician

December 13, 2017

The committee that plans and oversees medical care for the county of Hertfordshire, England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least eight weeks, they will not be allowed to undergo elective surgery.

Patients with a body mass index (BMI) greater than 40 must lose 15 percent of their weight within nine months, and patients with a BMI over 30 …

An argument against public reporting of individual surgeon outcomes

Skeptical Scalpel, MD

Physician

October 9, 2017

Recently, Dr. Ashish K. Jha, a Harvard internist and health policy researcher, published an opinion piece in JAMA, advocating public reporting of individual surgeon outcomes.

I have followed Dr. Jha for many years on Twitter and have enjoyed his blog posts and papers. However, I must respectfully disagree with much of what he wrote this time.

He tries but fails to refute the arguments that critics of individual surgeon reporting …

A surgical resident is held back a year. Finding out who’s right will be difficult.

Skeptical Scalpel, MD

Education

September 24, 2017

A surgical resident is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training.

The St. Louis Post-Dispatch article about this has a link to a 42-page PDF describing the details of the suit. Because I suspect you won’t read that PDF and maybe not even the article, I …

Improving drug adherence will take more than money and technology

Skeptical Scalpel, MD

Meds

September 16, 2017

I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause.

To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information.

Artificial intelligence in health care: Better studies are needed

Skeptical Scalpel, MD

Tech

August 3, 2017

An article in Newsweek magazine says, “Artificial intelligence will cure America’s sick health care system” using data and automation to “drive down the costs of health care while increasing effectiveness.”

According to Newsweek, it will work like this for diabetes. A company called Virta Health has come up with a smartphone app that is like “a live-in doctor and diabetes coach.” Type 2 diabetics who enroll will enter data such as blood sugar …

Don’t blame doctors for medication nonadherence

Skeptical Scalpel, MD

Meds

July 9, 2017

The New York Times says nonadherence to prescribed medications is “an out-of-control epidemic” in the U.S. and quotes a review in Annals of Internal Medicine, which found “20-30% of medication prescriptions are never filled, and approximately 50% of medications for chronic illness are not taken as prescribed.”

For example, “a third of kidney transplant patients don’t take their anti-rejection medications, 41% of heart attack patients don’t take …

Radiologists have an image problem

Skeptical Scalpel, MD

Physician

June 19, 2017

Here’s a question that has been debated for several years: Should radiologists talk to patients about their imaging results?

Citing several issues, I came down solidly on the “no” side in a 2014 blog post.

Two major radiology organizations have committees looking into the concept, and New York Times article said, “they hope to make their case [for it] by demonstrating how some radiologists …

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Radiologists have an image problem

Residents performing surgery: Why can’t we reach a middle ground?

Skeptical Scalpel, MD

Physician

May 25, 2017

A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment.

The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes — …

A medical student fails USMLE Step 1. Can he ever be a surgeon?

Skeptical Scalpel, MD

Physician

May 20, 2017

I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.

I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …

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A medical student fails USMLE Step 1. Can he ever be a surgeon?

Will robots ever be able to perform surgery independently?

Skeptical Scalpel, MD

Physician

April 19, 2017

And if they can, should they?

In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.”

But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots.

The …

Is nonoperative treatment of appendicitis in children safe?

Skeptical Scalpel, MD

Conditions

March 25, 2017

After writing my 21st post about appendicitis back in November, I swore I would not write about it again for the foreseeable future.

Well, the future is now because investigators from the United Kingdom and Canada just published a meta-analysis including ten papers and 413 children about the efficacy and safety of nonoperative treatment for appendicitis in children.

They concluded that nonoperative management is effective in 96 percent …

The malpractice environment doesn’t influence doctors to provide better care

Skeptical Scalpel, MD

Physician

March 1, 2017

A study of over 890,000 Medicare beneficiaries shows that states with malpractice environments unfavorable to physicians do not see improved postoperative outcomes for 11 different types of mostly elective major operations.

States with higher general surgery malpractice insurance premiums had significantly more episodes of postoperative sepsis, pneumonia, acute renal failure, and gastrointestinal bleeding.

Those with higher numbers of paid claims per 100 physicians had more postoperative myocardial infarctions, surgical site …

Caribbean medical schools: It’s not all palm trees and sunsets

Skeptical Scalpel, MD

Education

February 18, 2017

Did you know that several Caribbean medical schools provide postgraduate premed courses so students can complete their science requirements? At least one school’s nearly year-long premed curriculum includes 8 hours per day of classroom work, rudimentary general chemistry and organic labs, and a physics lab with 40-year-old equipment. The fee is more than $30,000 cash, no loans. That’s a lot to pay for courses that are not accredited and credits …

If you go to medical school, you will be stressed. Bigly.

Skeptical Scalpel, MD

Education

February 6, 2017

Two posts on KevinMD highlight the problems facing many medical students today.

The second was by another anonymous student who described how miserable he (or …

Do surgery checklists really work?

Skeptical Scalpel, MD

Physician

January 12, 2017

A before and after study at the University of Vermont Medical Center found that a 24-item operating room checklist did not significantly reduce the incidence of any of nine postoperative adverse outcomes.

More than 12,000 cases were studied, and outcomes included: mortality, death among surgical inpatients with serious treatable complications, sepsis, respiratory failure, wound dehiscence, postoperative venous thromboembolic events (VTE), postoperative hemorrhage or hematoma, transfusion reaction and retained …

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Do surgery checklists really work?

One way to train gritty doctors: Don’t allow them to quit

Skeptical Scalpel, MD

Physician

January 6, 2017

What is grit?

In an article in The Guardian, Angela Duckworth, a psychologist often called the guru of grit, defined it as the commitment to finish what you start, to rise from setbacks, to want to improve and succeed, and to undertake sustained and sometimes unpleasant practice in order to do so.

She said in a paper that grit is perseverance and passion for long-term goals.

I think we’d …