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.

Maybe the reason patients don’t understand us is because we don’t speak in plain English

Peter F. Nichol, MD, PhD

Physician

November 17, 2017

Recently, I was challenged by the mother of a trauma patient. She had read about traumatic spleen injuries online and was concerned about the risk a hematoma presented and wanted the ultrasound to look at the hematoma. I found myself floundering around trying to explain how this study was unnecessary. In frustration, I turned to my nurse practitioner and said, “Heather, can you translate for me?”

This is a common problem. …

It’s time for medicine to share its power

Heather Hansen, JD

Physician

November 15, 2017

In the movie Malice, Alec Baldwin plays Dr. Jed Hill, a surgeon who gives a famous speech during a deposition in a medical malpractice case. “”If you’re looking for God, he was in operating room #2 on November 17th, and he doesn’t like to be second-guessed … I am God.”

No one wants a doctor like that. And yet, maybe we do. We yearn for someone capable of healing all of our …

Physicians: Be nice to your pregnant colleagues

Avani Trivedi, DO

Physician

November 14, 2017

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 …

Let’s get one thing clear: pre-op comments from primary care

Fred N. Pelzman, MD

Physician

November 13, 2017

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 …

For an anesthesiologist, this is the hardest part of medicine

Sasha K. Shillcutt, MD

Physician

November 6, 2017

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 …

I am the “same-same but different”

Dr. Saqib Noor

Physician

November 4, 2017

Phnom Penh is changing at an incalculable rate. It is evolving so quickly that even from my last visit four years ago, I barely recognize the streets I once shuffled my well-worn sandals through. Now, the streets of my old neighborhood are proudly adorned with a new facade of artistic, stylish restaurants and a collection of boutique coffee shops. Bigger buildings and prime real estate positions are now occupied by …

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I am the “same-same but different”

Is assembly line surgery better for the patient?

Thomas D. Guastavino, MD

Physician

November 3, 2017

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 …

Better paid, better utilized physicians can transform the VA

Suvas Vajracharya, PhD

Health Policy

November 2, 2017

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 …

We are all just one diagnosis away from a different reality

Cedrek L. McFadden, MD

Physician

October 29, 2017

“How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and strong. Because someday in your life you will have been all of these.”
—George Washington Carver

Earlier this week, I walked into the exam room and introduced myself to a 48-year-old male. As I generally do, I sat in front of him and asked, …

MKSAP: 72-year-old man with a holosystolic murmur

mksap

Conditions and Diseases

October 28, 2017

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

A 72-year-old man is evaluated during a routine examination. He has no symptoms or significant medical history. He is active and exercises regularly. He does not take any medications.

On physical examination, blood pressure is 135/70 mm Hg, pulse rate is 82/min, and respiration rate is 17/min. Cardiac examination reveals a grade 3/6 …

Why this anesthesiologist says “no” to fentanyl

Karen S. Sibert, MD

Medications

October 26, 2017

No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice.

I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in …

A place for music in the emergency department

Thomas Scary

Medical Education

October 23, 2017

The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical …

Here’s why women doctors need time together

Rekha Chandrabose, MD

Physician

October 20, 2017

The 2nd Annual Women in Anesthesiology Conference is taking place in October. Developing this organization has been a labor of, if not love, then honoring. We are honoring a value system that works to gives women the respect, autonomy, and power they deserve.

There is an amazing power in gathering, shared experiences and decreasing isolation. Nobody has identical life experiences. But part of what informs our identity is shared experiences. As …

Death is certain. How you choose to die isn’t.

Mark McLaughlin, MD

Physician

October 17, 2017

“It is not for me to judge another man’s life. I must judge, I must choose,
I must spurn, purely for myself. For myself, alone.”
-Hermann Hesse, “Siddhartha”

What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But …

Could being vulnerable lead to better health?

Heather Hansen, JD

Physician

October 17, 2017

Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that …

The exact moment this doctor realized the amazing power of women

Sasha K. Shillcutt, MD

Physician

October 11, 2017

I remember the exact moment I realized the amazing power of women; that together, women can accomplish anything they put their minds to.

I grew up in a household of women. I had no brothers to compete with, and my parents always encouraged us to learn and develop leadership skills. However, even growing up in an encouraging environment, I still developed an unconscious bias. In school and in college, I often …

An argument against public reporting of individual surgeon outcomes

Skeptical Scalpel, MD

Physician

October 9, 2017

Recently, Dr. Ashish K. Jha, a Harvard internist and health policy researcher, published an opinion piece in JAMA, advocating public reporting of individual surgeon outcomes.

I have followed Dr. Jha for many years on Twitter and have enjoyed his blog posts and papers. However, I must respectfully disagree with much of what he wrote this time.

He tries but fails to refute the arguments that critics of individual surgeon reporting …

MKSAP: 58-year-old man with hepatitis C-related cirrhosis

mksap

Conditions and Diseases

October 7, 2017

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

A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide.

On physical examination, temperature is 36.8 °C (98.2 …

Please don’t tell me how brave I am

Anonymous

Physician

October 6, 2017

It’s 3 a.m., and I’m wide awake. I’m giddy with excitement and scared. I am 41 years old and tomorrow feels like the first day of school all over again. Only it isn’t. Tomorrow is my first day back at the hospital where I work as a surgeon. Tomorrow is also my first day back at work after chemotherapy.

Two months ago, I was diagnosed with breast cancer. I underwent bilateral …

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Please don’t tell me how brave I am

Face transplantation is the new frontier of plastic surgery

Erez Dayan, MD and Luccie Wo

Conditions and Diseases

October 1, 2017

Replace like with like — that is the basic principle of reconstructive surgery since its conception in the mid-1500s. Borrow from the healthy part of the body to rebuild the damaged part … But what do you do when you have run out of places to borrow? What if there simply isn’t anything like it anywhere else on the body? How do you reconstruct something as complicated as the human …

Surgery

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