Surgery

What inspires this medical student

Education
January 28, 2018

Someone who I care about deeply messaged me today: “I think I’m done with surgery.”

This person, a surgeon, feels like his potential is elsewhere. There are more opportunities, different challenges, and fulfilling experiences in other places and he is ready to explore.

I told him that he inspires me.

But I am in medical school. So how could someone leaving the medical field be inspiring to me?

Because inspiration does not come from a job description or a fancy …

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Young surgeons are learning robotic surgery in the shadows

Physician
January 19, 2018

Artificial intelligence and robotics spell massive changes to the world of work. These technologies can automate new tasks, and we are making more of them, faster, better and cheaper than ever before.

Surgery was early to the robotics party: Over a third of U.S. hospitals have at least one surgical robot. Such robots have been in widespread use by a growing variety of surgical disciplines, including urology and …

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Please change the culture of surgery

Education
January 8, 2018

It is December 2017. I have been on the road for the last five months, completing my five months of elective rotations. I am a fourth-year medical student aspiring to specialize in family medicine. I also want to learn procedures, so I did two months of surgery, three months of family practice electives. At the beginning of this process, I had wanted to be a general surgeon, but I ended …

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Safe pediatric dental anesthesia is the right of every child

Physician
December 29, 2017

When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief.

“But they can’t do that,” I’ve been told more than once.

Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the …

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Leonardo Da Vinci and health care: a matter of perspective

Physician
December 6, 2017

Recently, a Leonardo Da Vinci painting, Salvator Mundi (Savior of the World), was sold for $450 million, making it the largest fee for a painting ever sold.  Was it a good investment?  The painting was sold by Leonardo’s heir to King Francis I of France for 4000 gold ducats in 1519, which according to the American Numismatic Society would be equivalent to $575,000 at today’s price of gold at $1277 …

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5 challenges of working in a county hospital

Policy
December 6, 2017

As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas.  After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have …

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Physicians: Be nice to your pregnant colleagues

Physician
November 14, 2017

After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.”  Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”

After it’s told to you over and over again by your male co-residents and even some of my …

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Is assembly line surgery better for the patient?

Physician
November 3, 2017

A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”

Thirty years ago, I moved to a small community to …

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Better paid, better utilized physicians can transform the VA

Policy
November 2, 2017

It’s a tale of two health systems: the VA and Kaiser Permanente.

The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.

Kaiser Permanente …

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Why this anesthesiologist says “no” to fentanyl

Meds
October 26, 2017

No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice.

I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in …

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A place for music in the emergency department

Education
October 23, 2017

The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical …

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Here’s what happens when the doctor becomes the patient

Physician
September 29, 2017

What is a doctor? Technically speaking, a doctor is a person that dedicates his or her knowledge and skills to the prevention and treatment of diseases, while maintaining and even enhancing human health.

The majority of physicians enter into the profession of medicine because they are committed to helping others. It is this mission-driven spirit and dedication that makes us grateful for the opportunity each to care for others during a …

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Before you say “I’m sorry,” I challenge you to think

Physician
September 26, 2017

We as women have to stop saying “I’m sorry” for things out of our control. When we apologize for things we are not responsible for, we take a step backwards in the advancement of women in the workplace.

I am a cardiac anesthesiologist, which means I care for patients who are undergoing open-heart surgery. I work in an academic medical center and train doctors to become anesthesiologists. The operating room (OR) can …

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

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 …

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15 tips for working with women

Physician
August 28, 2017

I work in a male-dominated field. As a cardiac anesthesiologist, I work with mostly male cardiac surgeons in a department where the majority of my fellow anesthesiologists are male. I work with some fantastic male colleagues. They are caring, skilled doctors, and I consider many of them to be friends.

While most of them know how to handle emergencies, trauma and difficult work situations, many times they clam up when we …

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Good clinical care takes more than medical acumen

Physician
August 25, 2017

When I finished my medical training almost sixty years ago, I was like many new graduates: I thought I knew it all.

I opened a private office in Los Angeles and paid courtesy calls on the local physicians to let them know my qualifications and my availability for consultation, as both an internist and a nephrologist. (The treatment of kidney disease was then in its infancy, and I was the area’s …

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A surgeon makes a mistake, and couldn’t stop crying

Physician
August 25, 2017

“F*ck!”

I pried my eyes open and had the realization of exactly what time it was. I was going to be late — again. I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes …

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