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.
As we follow the national opioid epidemic, with its greater than five deaths per hour from opioid overdoses, the focus is shifting to methods for limiting an individual’s exposure to these drugs. For most of us, our first contact with these highly addictive medications is after surgery.
Studies now reveal that 60 percent of pills prescribed for pain after surgery go unused. These opioids often make their way to other family …
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The era of opioid-free surgery has arrived
It was a sunny morning in July, and I was scheduled at the outpatient center with the oral and maxillofacial surgeons for teeth extractions. One of my patients was your son, an athletic teenager, whose only medical history was asthma. According to you and him, he had not experienced any recent asthma attacks and had never been hospitalized or intubated. In terms of breathing, he said he felt “perfectly fine” …
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I’m sorry about what happened to your son under anesthesia
As a third-generation physician, I grew up thinking and dreaming of a being a physician, and 33 years later, I am still living the dream. I dreamt of saving people’s lives. I dreamt of a day like today when I received a LinkedIn request from a young lady on whom, 21 years ago, I performed a living donor liver transplant from her mother.
Today she is graduating from college and hopes …
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A life moment you dare not dream of
While hundreds of doctors have submitted (mostly unfavorable) comments to CMS on the proposed evaluation and management changes, other issues seem to be receiving much less attention than they deserve. And one of those may hit physicians who perform procedures in the wallet.
In 2015, Congress asked CMS to analyze the global period data to ensure procedure weighting accurately reflected the actual work done by physicians. Of course, when Congress asks …
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Are Medicare procedure payments in jeopardy?
Fourteen hours into their shift, the intern headed down to the lobby to pick up the delivery. Today it was Indian food. He struggled to push the elevator button while holding the bags but managed to make it up to the top floor ICU. The rest of the surgeons gathered around the table cluttered with spent pens, journal articles and unused bottles of lidocaine to eat. Someone offered up their …
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Time is a gift in the ER
Since the beginning of a new academic year is fast approaching, here’s some heartfelt advice. You might need it, I hope you read it and heed it. If you’re just beginning your medical school journey, the first line is written specifically for you, but the rest of the piece is pertinent for any doctor, at any age and any stage of their careers.
If this is your first day of med …
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As you enter medical school: tips from a patient
Match Day is the culmination of a medical student’s education: the day all graduating seniors and non-traditional applicants find out where they will spend the next three to seven years to train in a desired specialty. I fell in love with obstetrics and gynecology (OB/GYN) as it was the perfect way to combine my passion for women’s health with medicine and surgery. I also liked that the patients were relatively …
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What’s life like after not matching? A physician’s story.
The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years (“Informed Consent for Babies: When Experts Disagree,” “Informed Consent in Infant Research: Ethical Problems Remain,” “Informed Consent in Comparative Effectiveness Research,” and “The Erosion of Informed Consent in Medical Research”). The latest example is a clinical trial of …
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The erosion of informed consent in medical research
Recent research from Florida Atlantic University and Cleveland State University have found a direct correlation between preventative health care and the number of paid sick leave days a worker gets. Workers with more than 10 paid sick days annually access preventative care more frequently than those without paid sick days.
Preventative care, in turn, leads to better overall mental and physical health. Doctors that are in private practice function …
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Why doctors don’t call in sick when they should
Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and …
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What personality type fits your medical specialty?
In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.
His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.
During …
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There’s a fine line between stupid and clever in medicine
A patient with progressive neurologic disorder had a gastrojejunal tube placed for feeding. In a nursing home, the tube fell out and was replaced with a Foley catheter. He was sent to the hospital for placement of a new tube. When he arrived in the interventional radiology suite, the Foley catheter was not visible. A new gastrojejunal tube was successfully placed, and the patient was sent back to the nursing …
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Why medical errors can never be completely eliminated
My last operative day was October 15, 2009. My last attempt at getting to understand my group disability policy was on May 10, 2018. I’m a disabled anesthesiologist who lost his career when my left median nerve stopped functioning properly. I had two disability policies, a private and a group. My dealings with these two companies have been day and night.
My group insurance carrier hammered my dignity for years. In …
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A physician’s group disability nightmare
During my pediatric surgery training, I could easily point out which was the hardest day for the three fellows that were under training on that specific year. It was late evening when I received a call that one of our patients had coded. I was at home, and the drive usually took me exactly seven minutes.
Due to social reasons, this patient was in the hospital with us for months (at …
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How do you come back after losing a battle?
“Some data is better than no data at all.” Do you believe that?
I heard it frequently when the infamous ProPublica’s Surgeon Scorecard first appeared three years ago. Back then I blogged about it saying “To me, bad data is worse than no data at all.”
A recent study in BJU International confirmed my thoughts about this type of publicly posted data and identified a previously unreported issue. The paper attempted to …
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The risks of publically reported surgical outcomes
Why does she work? It’s a question that she must answer, for it begs itself every time she picks him up from daycare.
She always finds him happy there. And yet that — selfishly? — is part of what tears at her. Shouldn’t she be the one making him happy at 11 months?
It’s more important to her than any other role that she plays – she wants to be everything that …
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Why this mother is still a surgeon
It is a little after 9 a.m. I am about to start the second of a long list of endoscopy cases when my phone rings. I glance briefly at the caller ID to confirm it isn’t my office or the hospital calling about another patient, and am quickly overcome with dread as I see the screen reads, “daycare.”
Intuitively, I know why they are calling. My four-month-old must have a fever. …
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Am I a doctor or a mother first?
It was 5:45 in the morning on a Monday after a full weekend of call. Thoroughly exhausted, I shuffled into the elevator and was met by the stench of stale clothing mixed with cigarette smoke. A painfully thin teenager exited, looking lost. I allowed him to wander out, grateful to be spared his odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have.
Morning …
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Life as a doctor is selfless and selfish at the same time
