Surgery

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

Conditions
December 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

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A neurosurgical resident’s typical day

Education
December 1, 2010

I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.

To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …

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Advice for a second year medical student

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 …

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Should CRNAs practice anesthesiology without physician supervision?

Physician
October 5, 2010

Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …

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Cosmetic foot surgery can have serious downsides

Physician
September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Does a stereotypical surgical personality exist?

Physician
August 28, 2010

by Shawn Vuong

Recently, our class learned and practiced how to correctly ‘scrub’ for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.

I said I didn’t really know yet, although I did find surgery pretty fascinating. With that, they told me that they thought I would make a good surgeon. due …

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When a biopsy cannot completely rule out cancer

Conditions
July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

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Hiatal hernia in women can present with heartburn

Conditions
May 8, 2010

by David Edelman, MD

Heartburn and acid reflux disease are common problems affecting women of all ages. The problem develops when acid in the stomach backs up into the esophagus. There is a muscle known as the diaphragm that separates the chest from the abdominal cavity. When you eat or drink, the food goes from the mouth down the esophagus, through the diaphragm and into the stomach. …

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Issues surrounding videotaping surgeries in the operating room

Physician
December 23, 2009

The rapid advance in digital video and still camera technology has found its way into the operating room.

There is the potential to capture and record just about every minute of every surgical procedure in some way. The newest endoscopic camera systems and operating microscopes have integrated systems to record video footage. Storing all that data is just the press of a button away.

The advantages for surgeons are obvious, like the …

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Steve Jobs received a new liver, and the ethics surrounding his transplant

Conditions
June 22, 2009

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Sharpie for surgery

Uncategorized
October 25, 2008

Surgeons use markers to identify the right body part for procedures. Unfortunately, they care become contaminated with bacteria which can lead to surgical site infections.

Enter the Sharpie: “As it turns out, the ink used in a Sharpie pen has an alcohol base, making it an unexpected germ fighter.”

Who knew? The Sharpie is probably also many times cheaper than the single-use “sterile” pen used …

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Tom Brady and his knee infection

Uncategorized
October 23, 2008

New England Patriots quarterback Tom Brady recently underwent repair of his anterior cruciate ligament at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. His doctor was Neal S. ElAttrache, who’s a renowned orthopedic surgeon and former team physician of an NFL team.

Unfortunately, his post-op course has been complicated by an infection. On his website, TomBrady.com, he acknowledged this and said that the original procedure was …

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My take: What makes a good medical blog?

Uncategorized
May 2, 2008

Maria writes: “I’d like your take on what you think constitutes a ‘good’ medblog . . . I am continually surprised with what people like about medblogs. Some people like brief links, some people like critical discussions, some people like stories.

This ultimately all boils down to opinion, but I’d like to know what traits you like in medblogs.

Can you start by opining that you strongly dislike …

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Physicians: "We are the new factory workers"

Uncategorized
May 16, 2007

This article was from six years ago:

Lots of patients fork over nothing but a co-pay, the mandatory cash outlay that can be as low as $10, or even $2. “What do you value a physician at if you pay $2?” asks Stracher, who says that sometimes, for that amount, patients blithely skip even bringing along money. For two bucks, patients sometimes don’t show up. Or they get the idea …

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A former colleague comments on Dr. Anna Pou

Uncategorized
July 26, 2006

Due to intense interest in the Anna Pou story, the following post will be republished to stay current.

Original post date: 7/19/2006

Waking Up Costs offers his support:

I just learned that a former colleague and friend has been charged with second degree murder in the death of four patients at a New Orleans hospital after Katrina. I worked with Dr. Anna Pou in the operating …

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Tedy Bruschi’s patent foramen ovale (PFO) caused his stroke

Uncategorized
March 15, 2005

It was just reported that Tedy Bruschi is undergoing surgery for a hole in his heart:

New England Patriots linebacker Tedy Bruschi — who once played for the University of Arizona – is back in the hospital tonight, according to sources in Tucson and Boston.

The team isn’t confirming this news yet, but KOLD News 13 has learned Bruschi is undergoing surgery to repair a hole in his heart. …

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Possible causes of Tedy Bruschi’s stroke

Uncategorized
February 17, 2005

As has been reported, Patriots linebacker Tedy Bruschi has been hospitalized with some kind of intracerebral bleed. As one can imagine, this is big news here in New England.

Here’s what we know so far:

Patriots linebacker Tedy Bruschi will remain hospitalized while he undergoes additional tests after suffering a broken blood vessel in his head, a Patriots team source told The Boston Globe on Thursday.

Bruschi, …

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Are testicular biopsies necessary for the diagnosis of testicular cancer?

Uncategorized
February 12, 2005

Man sues over “botched” testicular surgery: Another frivolous lawsuit?
“A man is suing a hospital and one of its surgeons, claiming one of his testicles was wrongly removed during surgery.

Danny Curtis claims the surgeon at Kern Medical Center did not conduct a biopsy before arranging urgent surgery to remove a testicular tumor in July 2004, according to the lawsuit filed in Kern County Superior Court.”

I …

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