Skeptical Scalpel, MD

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

Here’s why you can’t believe “top hospitals” lists

Physician

April 14, 2016

At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor.

Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data.

Leapfrog’s top 98 included 62 urban, 24 rural, and …

Are today’s surgical residents poorly trained?

Skeptical Scalpel, MD

Education

March 29, 2016

A surgical resident writes:

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.

My questions for you:

1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?

2. What should we do differently? I personally don’t feel that “more simulation activities,” which …

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Are today’s surgical residents poorly trained?

What’s the best way to evaluate surgery residents?

Skeptical Scalpel, MD

Physician

March 12, 2016

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination.

According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies — medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning …

Who is responsible for OR delays? And what can we do about them?

Skeptical Scalpel, MD

Physician

February 17, 2016

Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda.

In my nearly …

The problem with shared decision-making in appendicitis

Skeptical Scalpel, MD

Conditions

January 6, 2016

A JAMA Surgery Viewpoint recently suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study that found that simple appendicitis could be treated successfully with antibiotics in almost 75 percent of patients.

I respect the authors of the JAMA Surgery article and am happy they Read more…

The problem with shared decision-making in appendicitis

If surgery is a team sport, should surgeons bear sole responsibility for errors?

Skeptical Scalpel, MD

Physician

December 25, 2015

A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patient’s abdomen.

According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure.

An insufflator valve had been sterilized and was apparently still …

Incident reports aren’t very helpful. Why are they still being filed in hospitals?

Skeptical Scalpel, MD

Physician

December 10, 2015

Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have.

Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all.

In fact, I don’t even know where they went or who dealt with them. When I was a department …

What did a surgeon think of the television show, Code Black?

Skeptical Scalpel, MD

Physician

October 19, 2015

A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black.

There is the usual array of standard medical characters — the inexperienced new residents on their first day at work, the savvy nurses, …

Do a cricothyrotomy after a failed Heimlich. But it’s likely to fail.

Skeptical Scalpel, MD

Conditions

October 11, 2015

At the end of an otherwise informative article about the nuances of performing a Heimlich maneuver, New York Times science reporter Jane E. Brody recommends that if all else fails, a cricothyrotomy should be attempted.

She goes on to briefly explain how the procedure is done. In the right hands, a cricothyrotomy is safer and easier to perform than a formal tracheostomy. However, for a layperson who has never seen either …

Defining obesity: Disability or disease? Or neither?

Skeptical Scalpel, MD

Conditions

September 29, 2015

In 2013, the American Medical Association recognized obesity as a disease. Dr. Peter Ubel, writing in his blog on the Forbes website, thought this was a bad idea. He feared that calling obesity a disease will result in people having less motivation to lose weight and cited a study which found that people who were told that obesity is a disease tended to be less concerned about their …

Antibiotics for appendicitis? Not for this surgeon. Here’s why.

Skeptical Scalpel, MD

Conditions

July 20, 2015

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The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73 percent of patients were successfully treated with antibiotics or 27 percent of patients failed antibiotics and needed surgery.

The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to …

Can a surgeon operate while sitting down?

Skeptical Scalpel, MD

Physician

June 30, 2015

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A loyal reader alerted me to news of a lawsuit brought by an obstetrician in South Carolina who is suing a hospital for suspending his privileges. He had performed a cesarean section while sitting on a stool because he had a foot fracture secondary to diabetes. Several witnesses said that the doctor “had been unable to properly view the surgical field, …

The self-doubt that every new surgeon faces

Skeptical Scalpel, MD

Physician

June 2, 2015

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A chief resident about to graduate wrote the following to me:

I just read — twice — the New Yorker’s review of Henry Marsh’s memoir you tweeted about. Wow.

It seems like he is grappling with so many of the things I’m feeling now, as I’m trying to sort out if I’m trained “enough” to head out into the world. Of …

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The self-doubt that every new surgeon faces

Can a robot draw your blood?

Skeptical Scalpel, MD

Tech

May 13, 2015

A company has produced prototype robots that can draw blood from human arms. The video above is a 48-second video showing one of them in action.

Using an infrared camera, the robot identifies a suitable vein and accesses the vein with ultrasound guidance.

A second video, not embedded in this post, explains that the robot is about 83 percent successful at drawing blood that compares favorably to the success …

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Can a robot draw your blood?

The downsides of automating health care

Skeptical Scalpel, MD

Physician

May 2, 2015

If you are a doctor, nurse, patient, or just someone interested in patient safety, you should read a five-part story called “The Overdose: Harm in a Wired Hospital” excerpted from a book The Digital Doctor by Dr. Robert Wachter.

Dr. Wachter and the hospital are to be commended for publicizing this incident so others may learn from it. The hospital staff, the patient, and his mother, also deserve credit for allowing their …

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The downsides of automating health care

IMGs matching into surgery: What are the chances?

Skeptical Scalpel, MD

Education

April 25, 2015

Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about.

If the school won’t give you any names, use caution, and …

Why safe harbors for medical malpractice are DOA

Skeptical Scalpel, MD

Physician

April 21, 2015

Several months ago, Physician’s Weekly featured an article describing a bill that was introduced into the House of Representatives called H.R. 1406: The Saving Lives, Saving Costs Act. It would create a “safe harbor” for physicians who could show that they followed best practice guidelines when faced with a malpractice suit. At the end of the piece, a question was asked, “Do you think this bill will help safeguard physicians against …

The Match 2015: A grim prognosis for international medical graduates

Skeptical Scalpel, MD

Education

April 7, 2015

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every U.S. medical school because 93.9 percent of the 18,025 graduates of U.S. allopathic medical schools matched in a specialty.

But for the 1,093 (6.1 percent) U.S. graduates who didn’t match things were not so bright. …

Do not talk or chew for 10 days

Skeptical Scalpel, MD

Physician

March 27, 2015

The other day some cardiologists on Twitter were discussing whether a patient should be blamed if a permanent pacemaker lead became displaced. The consensus seemed to be that it was probably poor placement (i.e., operator error), rather than patient behavior that caused leads to dislodge.

The discussion reminded me of an attending plastic surgeon of mine during my resident days. He was one of the most obsessive-compulsive people I ever met. …

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Do not talk or chew for 10 days

The best doctors expect the unexpected

Skeptical Scalpel, MD

Physician

January 30, 2015

The following is based on an actual case that occurred a long time ago in a galaxy far, far away.

A 65-year-old man arrived in the emergency department by ambulance after being found unresponsive. His respiratory rate was 40 per minute, heart rate was 170 per minute, and temperature was 102.2°. He did not respond to Narcan or an ampule of 50 percent dextrose. Blood sugar was 600 mg/dL. The diagnosis …

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The best doctors expect the unexpected