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.

When a breast cancer surgeon gets breast cancer: being on the other side of the scalpel

Anne Peled, MD

Physician

January 26, 2018

Six weeks ago, I was diagnosed with invasive breast cancer.

As a breast cancer and breast plastic surgeon, I see women all the time who are in the exact same place I’ve been since receiving the phone call from the pathologist. Shocked and terrified by the news, overwhelmed by what this is going to mean for their life in both the short- and the long-term, waiting for results from what seems like …

Young surgeons are learning robotic surgery in the shadows

Matt Beane, PhD

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 …

Please show more interest in your health than my looks

Misha Armstrong

Medical Education

January 19, 2018

In 2017, more women than men were accepted into medical school for the first time. 2017 also brought attention to the sexual harassment many women face that often goes ignored. Medicine is not immune to behavior that objectifies women and ignores their complaints. My experiences are mild in comparison to many of my peers, but highlights the comfort both patients and physicians feel discussing the appearance of female trainees.

***

I was …

Please change the culture of surgery

Anonymous

Medical 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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Please change the culture of surgery

The operating room is a sanctuary

Dr. Saqib Noor

Physician

January 5, 2018

Pchum Ben is a national religious festival in Cambodia. It’s a time when families pay their respects to their dearly departed — those relatives that walked the earth before us, those who lived, laughed, cried and prayed in an era when we were not necessarily present.

The ceremony involves the offering of food from the living to the dead, as the ghosts of bygone relatives temporarily waken from their perceived existence …

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The operating room is a sanctuary

Plastic surgeon quits and couldn’t get a job at Chick-fil-A

Pamela Wible, MD

Physician

January 4, 2018

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. …

Safe pediatric dental anesthesia is the right of every child

Karen S. Sibert, MD

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 …

‘Tis the season for safe anesthesia practice worldwide

Kelly McQueen, MD, MPH

Physician

December 23, 2017

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

When seconds count, physician anesthesiologists make critical split-second decisions during surgery, procedures or emergent situations that save lives, but what happens when there is no physician anesthesiologist? This is the reality for 5 billion people worldwide. That’s not a typo. Five billion people …

Your plumber offers a money-back guarantee. Should your doctor?

Michelle Andrews

Health Policy

December 18, 2017

Linda Radach has had six hip replacement operations since 2006, three on each side. Osteoarthritis was the reason she needed surgery in the first place, but replacing her hips in some ways only worsened her troubles.

Following two of the procedures, the implanted metal socket didn’t integrate with the bone of her own hip socket and was loose, causing excruciating pain. Most recently, the titanium metal ball in her hip corroded.

The …

Motivating patients to stop smoking and lose weight before surgery

Skeptical Scalpel, MD

Physician

December 13, 2017

The committee that plans and oversees medical care for the county of Hertfordshire, England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least eight weeks, they will not be allowed to undergo elective surgery.

Patients with a body mass index (BMI) greater than 40 must lose 15 percent of their weight within nine months, and patients with a BMI over 30 …

Is there a future for robot-assisted surgery?

Peter F. Nichol, MD, PhD

Health Technology

December 12, 2017

Recently, there was a fascinating article in the Wall Street Journal regarding robot-assisted surgery. It reported the results of two articles published in JAMA that demonstrated that robotic-assisted surgery cost more and took longer without achieving superior results to laparoscopic surgery on average.

With this, my LinkedIn account lit up. Here are several of the comments that came through:

“I’ve come to assume that robotic surgery is better …

The demand for preparation: from the playing field to the OR

Scott Magnuson, MD

Physician

December 11, 2017

We often pull comparisons between unexpected resources in any given profession, especially when it comes to adopting tried and true best practices. For example, I always encourage hospital systems and training institutions to look to the hospitality industry for the treatment of patients and guests, among other areas. Last year, as I settled into my seat on a cross-country flight, I witnessed a textbook example of looking outside the box …

It’s important to give patients an idea of what to expect

Kristin Puhl, MD

Medical Education

December 11, 2017

The familiarity that health care professionals develop with complex medical procedures and topics is the result of years upon years of hard work, and over time we become accustomed to the jargon. We use phrases like “lap chole” and “appy” without much thought when talking to each other and (if we have a momentary lapse) with patients. We take the fantastic array of medical specialties, procedures, and knowledge in our …

A first-time case in a 35-year medical career

Hans Duvefelt, MD

Conditions and Diseases

December 8, 2017

A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis.

It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made …

Leonardo Da Vinci and health care: a matter of perspective

Neil Baum, MD

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 …

5 challenges of working in a county hospital

Pranav Sharma, MD

Health 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 …

Medicine isn’t a guessing game. Always ask for help.

Edna Shenvi, MD

Physician

December 3, 2017

Mine was an unusually long hiatus from residency for research training. And in the rough readjustment to clinical environments and work processes, one forgotten element seemed glaringly problematic:

“Have a plan,” said one attending, “If you don’t know, just guess.”

And another, in a teaching session, “Just guess, even if you’re wrong.”

From a chief resident during an awkward pause when a junior was put on the spot: “Just guess; it’s OK.” When …

I never expected to be a patient

Naderge Pierre, MD

Physician

December 3, 2017

As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I’d yearn for my pager to go off.

I was always tired, too — but for a surgical resident, fatigue is a given. Sleep and eat when you can, get your work done and operate like a madwoman: That …

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I never expected to be a patient

Sometimes not doing surgery makes you a better surgeon

Nina Shapiro, MD

Physician

November 28, 2017

Having been surgically trained and surgically-minded, I’ve had expression ingrained in my psyche such as “a chance to cut is a chance to cure,” “when in doubt, cut it out” and “nothing can heal like cold, hard steel.” Indeed, as a surgeon, I see patients in my office and in the hospital with the specific question of whether or not surgery is indicated, what type of surgery and how urgently …

Involve plastic surgeons early in breast cancer treatment

Terry Myckatyn, MD

Conditions and Diseases

November 18, 2017

Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.

Each surgery has its own …

Surgery

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