Skeptical Scalpel, MD

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

Must a surgeon mention death as a complication?

Physician

June 3, 2014

Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones.

As I stated before, I …

Can appendicitis be managed without surgery?

Skeptical Scalpel, MD

Conditions

May 20, 2014

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery.

The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients.

Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis …

Today’s residents have more to read but less time to learn

Skeptical Scalpel, MD

Education

May 8, 2014

As everyone knows, residents are now restricted to working 80 hours per week. One of the lesser known side effects of this work hours limitation is the drastic loss of educational conference time.

Since at least one third of the residents must now go home after morning rounds, afternoon conferences are no longer possible. Most residency programs now devote part of at least one morning per week to dedicated educational time.

JAMA …

The problems with making oral board recertification universal

Skeptical Scalpel, MD

Education

May 1, 2014

A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren’t all board recertification examinations given orally. She correctly asserts that oral examinations are better because they assess how people think rather than how much they have memorized.

Here’s why it would be difficult to do.

The initial surgery board exam is given in two parts. First a written …

The residency chances of offshore medical school graduates

Skeptical Scalpel, MD

Education

April 24, 2014

A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools.

In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical Education …

Why should practicing medicine be compared to any other occupation?

Skeptical Scalpel, MD

Physician

April 15, 2014

A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things.

This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I …

Don’t shorten medical school: Shorten undergraduate training instead

Skeptical Scalpel, MD

Education

March 27, 2014

Should medical school be shortened to three years?

I say, “no.”

Here’s why.

There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.

I do not see how medical students can choose a career path before they have …

What is the best way to choose residents?

Skeptical Scalpel, MD

Education

March 7, 2014

On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident.

The fact is that we aren’t really sure what the best way to choose residents is.

First, here’s what we really do.

A 2011 Read more…

What is the best way to choose residents?

Email fatigue leads to lost physician productivity

Skeptical Scalpel, MD

Physician

February 21, 2014

A new paper says “metastasis of email at an academic medical center” may cost millions of dollars.

A pediatrician from the Penn State College of Medicine kept track of all of his emails for an academic year and found that 2035 mass distribution emails were received. They originated from the medical center in 1501, the department in 450, and the university in 84.

The emails were about information technology, academic and professional …

As journals proliferate, so do authors

Skeptical Scalpel, MD

Education

February 14, 2014

New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money.

Authoring journal articles is not only enhancing to one’s CV (the old “publish or perish” cliché), it is required by residency review committees as evidence of “scholarly …

Read more…

As journals proliferate, so do authors

Why doctors and hospitals shouldn’t advertise

Skeptical Scalpel, MD

Physician

February 6, 2014

The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise.

Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US Supreme Court ruled that states could not prohibit advertising by lawyers.

This opened the floodgates for all professionals. Soon advertising by doctors and hospitals became common.

I don’t know what it’s like where …

Are white coats obsolete? Not yet, if you look at the evidence

Skeptical Scalpel, MD

Physician

February 4, 2014

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published.

Science Daily led with the headline “New Infection Control Recommendations Could Make White Coats Obsolete,” which is rather misleading since the guidelines say no such thing.

I won’t reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments.

The guidelines say that facilities may consider adopting a …

The problem of fellows in surgical training

Skeptical Scalpel, MD

Education

January 16, 2014

One of my Physician’s Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training.

Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking.

Another commenter said, “We are …

A patient falls off the OR table: Who’s to blame?

Skeptical Scalpel, MD

Physician

January 9, 2014

An anesthetized patient fell to the floor headfirst from an operating room table during a laparoscopic appendectomy in Scotland. The table had been tilted into an extreme head down position to facilitate the operation. Fortunately, no injury occurred.

The Edinburgh Evening News account says that there were 10 staff members in the room at the time the case started, but no one had placed a safety restraint on the patient.

A follow …

Brain death is still misunderstood by the public

Skeptical Scalpel, MD

Conditions

December 30, 2013

On December 9, 2013, 13-year-old Jahi McMath underwent a tonsillectomy at a children’s hospital in Oakland, California. She suffered postoperative hemorrhage and became comatose. She was declared brain dead by doctors at that hospital on December 12th. This was later confirmed by a court-appointed outside consultant.

There are many issues surrounding this case. Was the tonsillectomy indicated? Some stories reported that it was done to improve her obstructive sleep apnea. Why …

Can defensive medicine ever be stopped?

Skeptical Scalpel, MD

Physician

December 25, 2013

You may have missed this when it first appeared.

Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of health care may be wrong.

Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce health care spending.

According to the report from the National Center for Policy …

Read more…

Can defensive medicine ever be stopped?

Does paying people to lose weight work?

Skeptical Scalpel, MD

Conditions

December 3, 2013

A recent study looked at the effect of paying people to lose weight.

The authors randomized 100 people with BMIs ranging from 30 to 39.9 into four groups. Two groups received weight loss education, one group with and one without payment.

The other two groups received education plus behavior modification with again one group receiving financial incentives and the other not. To remain in the study, they were all supposed …

Read more…

Does paying people to lose weight work?

Do safety scalpels reduce the risk of injury?

Skeptical Scalpel, MD

Conditions

November 20, 2013

pro_safety_scalpel

A Twitter follower wrote me this: “Hospital making me use ‘safety scalpel’ w/retractable sheath. I’ve almost cut myself x 2. Do you know of any data about it?”

That got me interested because I like to question things. Was this going to be yet another rule without evidence?

I thought I would have to do an exhaustive search to see if anyone had ever …

Video review of surgeons: Can the logistical issues be overcome?

Skeptical Scalpel, MD

Physician

November 13, 2013

Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes.

Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited …

Skeptical Scalpel, MD

Skeptical Scalpel, MD

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