Skeptical Scalpel, MD

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

The benefit of CT scans for the diagnosis of appendicitis

Conditions

November 29, 2012

Amid the mounting concern about radiation exposure and future increases in cancer rates comes a report from Washington State describing the benefits of imaging, particularly CT scanning, for the diagnosis of appendicitis.

The authors collected data from some 55 hospitals of all types and sizes over a six-year period for more than 19,300 patients older than age 15; 91% of patients underwent one or more imaging studies. There were …

Penalizing hospitals for never event infections is ineffective

Skeptical Scalpel, MD

Policy

November 20, 2012

I told you so.

Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be reimbursed. I pointed out that several were in fact not 100% preventable despite any institution’s best efforts, and the rates of many of these occurrences would not fall to zero.

Now …

Is it really fair to penalize hospitals for readmissions?

Skeptical Scalpel, MD

Physician

November 8, 2012

As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%.

Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. …

As I reach the end of my career, I empathize more with my patients

Skeptical Scalpel, MD

Physician

September 20, 2012

As I contemplate retirement from clinical practice as a general surgeon, something I’ve been doing for over 41 years including residency, I’ve been having some unsettling thoughts.

Like many physicians, I’ve tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long.

I have written in a previous blog about the …

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

Physician

August 17, 2012

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

Is the death of Rory Staunton really the result of a simple mistake?

Skeptical Scalpel, MD

Physician

August 8, 2012

If you pay attention at all to news about medicine, you must have heard about the tragic death of a 12-year old boy who was seen and discharged from the emergency department of the prestigious New York University Medical Center. He had developed sepsis from what appears to have been a small cut and the diagnosis was missed. When he eventually returned to the ED and was admitted, it …

Why do we teach surgery the same way we did 40 years ago?

Skeptical Scalpel, MD

Education

July 27, 2012

When I was a surgical residency program director, I often wondered what the establishment, you know those guys who ran surgical education, was thinking. Some may remember the rule that a resident had to see at least 50% of the patients he operated on in the clinic or the private surgeon’s office in order to claim credit for having done the case.

There was the emphasis that still exists today on …

New York should ban junk food and sodas in hospitals instead

Skeptical Scalpel, MD

Physician

June 27, 2012

New York City’s Mayor Bloomberg has proposed a ban on the selling of sugar-containing drinks in containers larger than 16 ounces in all types of eating establishments including street vendors, movie theaters, delicatessens and even stadiums. The purpose is to limit sugar intake and theoretically help people lose weight by saving them from themselves.

The plan has received mixed reviews with some calling it a “nanny state” action. Also since a consumer …

Why more colonoscopies need anesthesiologists

Skeptical Scalpel, MD

Physician

April 2, 2012

Using data from Medicare and private insurers, analysts at the RAND Corporation found that the rate of involvement of anesthesiologists for upper GI endoscopy and colonoscopy in low-risk patients had risen steadily over the last few years and is estimated to add $1.1 billion in what may be unnecessary health care costs. There was wide regional variation in the use of anesthesiologists which suggests that some or most of the …

Did hospital politics lead to physician suicide?

Skeptical Scalpel, MD

Physician

December 17, 2011

What causes a doctor to commit suicide?

A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …

Length of stay differences in the uninsured is less than you think

Skeptical Scalpel, MD

Physician

December 7, 2011

There was a bit of excitement on Twitter recently with a number of tweets about a paper published in the Annals of Family Medicine which shows that uninsured patients are being released from hospitals significantly sooner than insured patients. The numbers don’t lie.

From the abstract: “Across all hospital types, the mean length of stay … was significantly shorter for individuals without insurance (2.77 days) than for those with either private …

Why the future of medicine is not looking too good

Skeptical Scalpel, MD

Physician

November 27, 2011

Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?

a. Feeling of insufficient medical knowledge
b. Health system reform
c. Educational debt
d. Availability of free time
e. Dealing with patients

If you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey performed by …

The shortage of general surgeons demands attention

Skeptical Scalpel, MD

Physician

September 17, 2011

There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.

Demand-side facts

The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.

As baby boomers age, the increase …

New fields in general surgery and the rise of the surgical hospitalist

Skeptical Scalpel, MD

Physician

June 24, 2011

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

Think about medical school tuition debt before becoming a doctor

Skeptical Scalpel, MD

Education

April 7, 2011

Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.

Suppressing the urge to tell him not to even consider …

Appendicitis in children and radiation exposure from CT scans

Skeptical Scalpel, MD

Conditions

December 3, 2010

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.

For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …

Advice for a second year medical student

Skeptical Scalpel, MD

Education

October 16, 2010

A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.

I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai …

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

Physician

September 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Create a family practice mystique in medical school

Skeptical Scalpel, MD

Physician

August 3, 2010

For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of …

Skeptical Scalpel, MD

Skeptical Scalpel, MD

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts