“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”
That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …
Push back on toxic behaviors from other doctors
Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.
Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.
Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, …
Why cataract surgery is more complicated than it should be
When we look back on the last century, the pace and number of advances in our ability to treat disease and injury is truly astonishing. The exponential growth of technology has contributed to this greatly, as we see new advances often come in the form of new technologies. Amazing innovations in the fields of endoscopy, catheterization, robotics, imaging, navigation, 3D printing and more allow us to do things that were …
Is surgical training stuck in the past?
It was mid-afternoon in the ever-bustling surgical intensive care unit (ICU). The nurse, one of those experienced, battle-hardened savants of human symptoms, called me into one of the patient rooms. He was tachypneic on the ventilator with labored breathing and declining oxygen saturations; with each inspiration, his diaphragm would paradoxically elevate, his stomach bulge and the ventilator alarm with the dyssynchrony. Intubated, sedated and unaware, he was fighting for his …
A physician is often the only person that sets the tone of hope, or despair
Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.
Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 …
The truth about plastic surgery chains
4:00 p.m. Right on time.
I am walking down the street with my brother on his first visit to me in residency; I’m only two weeks in.
I turn to him: “Wait a second.”
I place my hand on the cement wall next to us, and I start to heave.
“Um … are you OK?”
“Yeah. No worries. My body’s just adjusting.”
I go on to describe how every day at 4 p.m. after a 24-hour …
Intern year is still universally hard. Intern year is also universally great.
I’m about two-thirds of the way through my 3rd year of medical school, and I have hit my wall. I have become so fed up with the set up of medical school. I think a decent amount of this comes from the fact I am on my 6th week of an eight-week surgery clerkship (an area of medicine that I literally have zero interest in). I’m tired of waking up …
Is apathy needed to survive medical school?
Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.
Even for people who’ve never struggled with drug abuse, studies …
Stop opioid addiction where it starts: in the hospital
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 …
What inspires this medical student
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 …
Young surgeons are learning robotic surgery in the shadows
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 …
Please change the culture of surgery
I just got off the phone with Paul, a highly-sought-after plastic surgeon in New York.
“I don’t want to be a doctor anymore,” Paul says. “What else can I do? I have lots of restaurant experience. I’ve worked in 15 restaurants during my life. It’s not easy, but I could do it. I did research on chains and franchises, and I chose Chick-fil-A. …
Plastic surgeon quits and couldn’t get a job at Chick-fil-A
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 …
Safe pediatric dental anesthesia is the right of every child
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 …
Leonardo Da Vinci and health care: a matter of perspective
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 …
5 challenges of working in a county hospital
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 …
Physicians: Be nice to your pregnant colleagues
Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …
Let’s get one thing clear: pre-op comments from primary care
As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.
Recently I was at a social event and introducing myself to some …
For an anesthesiologist, this is the hardest part of medicine
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 …
Is assembly line surgery better for the patient?
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 …
Better paid, better utilized physicians can transform the VA
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