Surgery

Surgeons writing on KevinMD about the craft and the culture of surgery: training and who holds the knife, the operating room and its checklists, outcomes and whether the public should see them, the robot and now AI, women surgeons, and what it is like to be sued over an outcome rather than a decision. Three maintained records draw on this archive: Surgeons and surgery: what surgeons say, in their own words, Residency: what residents and attendings say, in their own words, and Medical malpractice: what physicians say, in their own words.

Excellent surgeons are those who are quick to recognize their mistakes

Naeem Rahman, MD

Conditions and Diseases

December 27, 2018

“Dr. Rahman, this is the nurse in OR 12, Dr. H is doing a robotic/laparoscopic hysterectomy. He thinks he’s injured the ureter and is requesting help. Are you available?” I knew what came next was going to be complex — challenging surgically, disruptive to my schedule and potentially risky. I told the nurse that I would be over in about 10 minutes.

Under anesthesia was Michelle C, a 46-year-old African American …

The challenge of no to arthroscopic surgery

Eric Bohm, MD and Ivan Wong, MD

Conditions and Diseases

December 6, 2018

Nearly half of Canadians aged 65 and over experience osteoarthritis in their knees. Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of bones wears down over time leading to pain, stiffness and decreased mobility. It frequently occurs in the hips and knees — and can be quite painful.

To help improve mobility and treat joint pain, it has been …

Physicians sacrifice a lot to deliver care. Technology shouldn’t ask for more.

Erin Palm, MD, MBA

Health Technology

December 4, 2018

I had a great case the other night. Around midnight on a Friday, the hospitalist physician called me to evaluate an incarcerated femoral hernia. I thought this elderly and medically ill patient would likely die no matter what I did. I spent a grim half-hour at bedside explaining the dilemma to the patient and her family. She needed surgery, but surgery would probably kill her.

The patient chose surgery. And she …

A surgeon mistakes a kidney for a tumor. How can this happen?

Skeptical Scalpel, MD

Conditions and Diseases

December 3, 2018

A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred?

The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide …

What a kitten taught me about critical care

Gary A. Lindenbaum, MD

Physician

December 2, 2018

I recently read an article entitled “The family said, ‘Do everything.’” It described the case of an elderly patient at the end-stage of life. The article concluded that “If your loved one has reached an end-stage of life, do the right thing. Let them die peacefully.” While I agree with this author’s intent, recent experience has altered my perspective on the “right thing.”

My father died after complications …

Lead your health care organization toward a culture of sustainability

Isaac L. Wornom, MD

Physician

November 28, 2018

On a recent vacation, I went out to eat at a small, out-of-the-way restaurant we always visit on our trips to the Outer Banks.

There, I spotted a poster on the wall explaining why the cafe no longer uses plastic bags or plastic straws: to keep the material out of the ocean where it never really goes away.

Plastic bags, straws, eating utensils, plates, bowls, and cups are everywhere in hospitals these …

A beloved mentor falls

Dawn Baker, MD

Physician

November 17, 2018

I walk by the closed double doors and frosty windows of the ICU. You’re lying in there, intubated. It feels weird to go to work now. I can’t see you or talk to you, don’t know the drips, don’t know the plan … and it’s killing me. I, along with many others, desperately want to express my love. So many feelings are swirling inside:

Guilt. For having a chill workday that …

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A beloved mentor falls

How urologists can be more sensitive to male patients

Misty Roberts

Patient

November 14, 2018

Most urology practices in the United States do not employ male nurses or assistants, even in larger cities. This is a serious problem because approximately 75 percent of urology patients are male.

Often people wrongly assume that men don’t care about their modesty. In many cases, this is simply not true. Societal norms say men are not supposed to be modest that this is a sign of weakness. From childhood, males …

Are physician wellness programs just another checkbox?

Anonymous

Physician

November 7, 2018

Recently, I saw a photo of a slide from the American College of Surgeons Clinical Congress: “The Program Directors Guide to Implementation of Well-being Programs.” While I applaud the ongoing focus in medicine on wellness for both trainees and faculty, I am troubled by the perceived need to standardize and program wellness, creating a “checkbox” that may not improve actual well-being. As a recent graduate now living my best life …

Why it’s important to determine who’s truly penicillin-allergic

Karen S. Sibert, MD

Conditions and Diseases

November 6, 2018

A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection.

But one of the most commonly reported allergies — to penicillin — often isn’t a true allergy at all. The urgent question that faces physicians every day in emergency rooms and operating rooms is …

What I wish I knew on the residency interview trail

Amanda Xi, MD

Medical Education

October 28, 2018

I still remember the warm, fuzzy feeling of receiving my first few interview invitations. Unlike medical school, I received much more “love” from residency programs. Since I was part of the inaugural class of a new medical school, I interviewed for a lot of programs: 16 anesthesiology, six transitional years, and three preliminary medicine programs. After my first few interviews, it became apparent that most residency interviews tend to be …

Why physicians should embrace failure

Jason Chesney, MD

Physician

October 22, 2018

Failure is a guarantee. “Success” assumes that certain metrics have been set and that the words used to describe those metrics are understood in the exact same way by all parties involved. One patient with parotid cancer and given facial paralysis after surgery was thrilled to be alive. Another is furious about a widened scar.

The brain, primed to act on behalf of the organism, works at times without our input …

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Why physicians should embrace failure

Antibiotics vs. surgery for appendicitis: What one surgeon thinks

Skeptical Scalpel, MD

Conditions and Diseases

October 16, 2018

Here are a few thoughts about the latest chapter in the never-ending debate about antibiotics vs. surgery for the treatment of uncomplicated appendicitis.

You will recall the randomized controlled trial from Finland published in 2015 that found a 27% rate of failure of antibiotics within the first year.

Now that the patients have now been followed for five years, 100 (39%) of the 246 patients treated with antibiotics have experienced persistent …

Surprising and unlikely rewards of social media engagement by physicians

Lisa Chan, MD

Social Media in Medicine

October 15, 2018

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

It is not uncommon for my patients and their family members to ask for my credentials at the end of our preoperative interview. Despite reaching my forties, my Asian genes have allowed me to maintain a youthful appearance – often causing apprehension about …

Live your life the best you can, and don’t spend it all in the hospital

Cory Fawcett, MD

Physician Finance

October 9, 2018

If you have been following my writing, you know I have been out of the surgical workforce for a year and a half. I have settled into a much more relaxing lifestyle as an author who can set his own work schedule. This week I got a flashback of what my old life was like as a general surgeon when I attended a four-day conference called FinCon.

Each morning of the …

What you need to know as a non-medical spouse to a surgeon

Megan N. Brown-Vilson, MPW

Physician

October 7, 2018

Combating loneliness as a non-medical spouse to a surgical resident is my current struggle.

I do not just mean the absence of his physical self — which do not get me wrong is frustrating– but the complete absence of his mind when he gets home from a long day at the hospital.

Absolutely no one gave me the proper and direct heads up that I needed as to what it would feel …

Judges versus coaches in medical education

Muthu Alagappan, MD

Medical Education

October 4, 2018

I flash a smile as I look up from my notes. “Do it again,” I say, encouraged by his progress, “but this time start with the physical exam.” I am the internal medicine resident leading our “twilight” admitting team, and Vikram, a student on the first day of his medicine clerkship, sits across from me. It is his third time practicing the presentation of Ms. R, a 56-year-old woman with …

The myth of compassion in health care

Emelia Sam, MD

Physician

October 4, 2018

I have a confession.

I didn’t enter my profession to help people. I know. It’s shocking.

Don’t get me wrong. I take my professional responsibility extremely seriously. I’m only admitting that the primary reason for choosing my profession was not altruistic. I made a practical decision to go down this path because of a junior high career day event. Otherwise, I had no real connection to any health care profession other than …

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The myth of compassion in health care

Humanity in medicine is in crisis

Farah Karipineni, MD, MPH

Physician

October 1, 2018

“There’s no heartbeat.”

Three words no one ever wants to hear.

Three words no one ever wants to deliver.

And yet, as a community of physicians, we deliver those crushing words on a daily basis. None of us would ever take the task of bearing this piece of news lightly, but for me, it was not until I was on the receiving end of them that I truly grasped how profoundly a physician …

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Humanity in medicine is in crisis

Patient autonomy in times of shortage

Deepak Gupta, MD

Health Policy

September 27, 2018

Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time.

Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? …

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Patient autonomy in times of shortage

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