Skeptical Scalpel, MD

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

Why is it so hard to define what professionalism is?

Education

January 9, 2015

A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior.

A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation.

In that post, I said, “‘Professionalism’ is difficult to define, especially when trying to …

Should radiologists discuss results with patients?

Skeptical Scalpel, MD

Physician

December 22, 2014

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Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The idea is that patient anxiety while waiting to find out a test result could be alleviated by an immediate discussion with a radiologist.

That would be very nice, but there are …

Cholecystectomies at night: Are they safe?

Skeptical Scalpel, MD

Conditions

November 18, 2014

A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours.

Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay.

The study, published online in the …

Can surgery residency programs be ranked?

Skeptical Scalpel, MD

Education

November 6, 2014

In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity’s co-founder over the issue and echoed some of the comments I had made about the lack of objectivity and emphasis on reputation.

I wonder if it is even possible to develop a set of valid …

Do electronic devices distract students? Be careful with this study.

Skeptical Scalpel, MD

Tech

October 22, 2014

After listening to a lecture, third-year students at the Harvard School of Dental Medicine were surveyed about distractions by electronic devices and given a 12-question quiz. Although 65% of the students admitted to having been distracted by emails, Facebook, and/or texting during the lecture, distracted students had an average score of 9.85 correct compared to 10.444 students who said they weren’t distracted. The difference was not significant, p = 0.652.

In …

A health care story that you normally don’t see in the media

Skeptical Scalpel, MD

Physician

October 8, 2014

Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue.

Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy.

Because of the concern for aspiration, an ambulance was called and the child was taken to …

The outrageous $117,000 bill from an assistant surgeon

Skeptical Scalpel, MD

Physician

September 29, 2014

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Recently, I wondered why Medicare could not control its costs using the investigative power of the federal government instead of releasing physician payment data and relying on journalists to do the work.

Two stories that appeared within days of each other raise a similar question about the private insurance industry’s methods.

An article in Modern Healthcare described the impending closure of …

Surgery is one of the biggest barriers to space travel

Skeptical Scalpel, MD

Physician

September 23, 2014

The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do?

According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely.

The press release from …

Chance: The difference between an unlucky surgeon and a killer

Skeptical Scalpel, MD

Physician

September 15, 2014

Risk-adjusted 30- to 90-day outcome data for selected types of operations done by specific surgeons and hospitals are now being publicly posted online by England’s National Health Service.

According to the site, “Any hospital or consultant [attending surgeon in the UK] identified as an outlier will be investigated and action taken to improve data quality and/or patient care.”

After cardiac surgery outcomes data were made public in New York, some interesting unexpected consequences were …

Pain as a vital sign has contributed to the opioid epidemic

Skeptical Scalpel, MD

Conditions

September 10, 2014

Contrary to what you may have heard, pain is not the fifth vital sign. It’s not a sign at all.

Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature.

What do those four signs have in common?

They can be measured.

A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers …

Surgeons can’t be responsible for every mistake

Skeptical Scalpel, MD

Physician

August 25, 2014

Several months ago, a post called, “Everything’s my fault: How a surgeon says I’m sorry,” appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else.

She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to …

Selecting grittier surgeons is harder than you think

Skeptical Scalpel, MD

Education

August 19, 2014

In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness.

A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs …

Here’s an easy way for Medicare to save money

Skeptical Scalpel, MD

Physician

August 14, 2014

You may find this story hard to believe, but it’s true.

A 75-year-old non-smoking man with no serious medical problems and a relatively low-risk family history (father, a life-long smoker, died of a stroke at age 76) has been undergoing routine physical examinations by his primary care physician in Florida every 6 months for several years.

The visits include a full battery of laboratory studies, nearly all of which have been completely …

Do surgical checklists work? A closer look at the data.

Skeptical Scalpel, MD

Physician

July 22, 2014

The other day Atul Gawande tweeted the following:

Some still oppose WHO Safe Surgery Checklist because no RCT was done. Well, new RCT finds it cut complications 42% http://t.co/qWacE54NIW

— Atul Gawande (@Atul_Gawande) June 18, 2014

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and …

Radiation risk or timely diagnosis: What would parents choose?

Skeptical Scalpel, MD

Conditions

July 8, 2014

It is so nice to be right.

To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they’ll get an accurate diagnosis.

A recent study validates that opinion.

MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries …

Google Glass has a long way to go in the OR

Skeptical Scalpel, MD

Tech

June 9, 2014

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The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion.

Here is what I thought about the event.

The case started about 30 minutes late, which is similar to what would have happened in any …