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.
What is a doctor? Technically speaking, a doctor is a person that dedicates his or her knowledge and skills to the prevention and treatment of diseases, while maintaining and even enhancing human health.
The majority of physicians enter into the profession of medicine because they are committed to helping others. It is this mission-driven spirit and dedication that makes us grateful for the opportunity each to care for others during a …
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Here’s what happens when the doctor becomes the patient
We as women have to stop saying “I’m sorry” for things out of our control. When we apologize for things we are not responsible for, we take a step backwards in the advancement of women in the workplace.
I am a cardiac anesthesiologist, which means I care for patients who are undergoing open-heart surgery. I work in an academic medical center and train doctors to become anesthesiologists. The operating room (OR) can …
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Before you say “I’m sorry,” I challenge you to think
A surgical resident is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training.
The St. Louis Post-Dispatch article about this has a link to a 42-page PDF describing the details of the suit. Because I suspect you won’t read that PDF and maybe not even the article, I …
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A surgical resident is held back a year. Finding out who’s right will be difficult.
“Someone call for a body bag.”
These were words that I didn’t expect to hear on my final day of burn surgery at large metropolitan hospital. We had just planned on a routine burn excision and skin grafting. Our patient, Faith, was a seven-year-old girl with third-degree burns to 85 percent of her body from a house fire. We had been caring for her in the ICU for the past three …
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Caring for your own wounds: Lessons from the burn unit
I have a very interesting job: I travel around the country providing neuromonitoring to surgeons in the operating room. I’m also an anesthesiologist assistant, certified and licensed to provide anesthesia. Throughout my ten-year career in the OR, I’ve been the guest of nearly a hundred hospitals in the U.S. and the UK. No two hospitals are the same. My career has allowed me to meet hundreds of incredibly caring doctors, …
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Here’s how your attitude affects patients
Let me start by saying that I am a huge Dave Ramsey fan. When I completed residency and began my current position, The Total Money Makeover was the first personal finance book I read, and pardon the cliché, but it changed my life. It instilled in me a strong foundation in money management and offered me a road map to handle the situation I was in: hundreds of thousands of dollar in …
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Pay off debt, invest, or both: Advice to young physicians
I sat on my floor, surrounded by boxes in various states of organization and disarray, sifting through a pile of papers. I was moving for my surgical fellowship and, of course, put off packing to the last minute. However, in the middle of the hectic and scattered process, a particular stack of papers caught my eye; I felt the need to pause and go through them. They were old and …
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What rejection taught this doctor
In the early epoch of human development, mankind learned to shape and sharpen wood, stone and metal objects to facilitate plunging them deep into other humans’ chests, abdomens, skulls and eyes in the ultimate form of conflict resolution.
Over tens of thousands of years, other less pugilistic and more compassionate humans crudely — but later artfully — insinuated an increasingly sophisticated array of implements into the human corpus to cure diseases, …
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Putting down the scalpel: The aging surgeon
I’ve known that I’ve had tumors in my pancreas since 2009. Until now I’ve done nothing about them.
This might sound like a counter-intuitive, even foolhardy strategy, especially for an oncologist, who should surely know better than to let his disease gain an advantage through his own inaction. But I don’t have the “usual” type of pancreatic cancer, the kind that claimed the life of Patrick Swayze and has sentenced many …
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After 8 years, this doctor is finally treating his pancreatic tumors
Approximately 18 months ago, I was asked to serve as the surgical director for operating room (OR) services at our children’s hospital. The opportunity has been an eye-opening experience in understanding how a hospital functions.
ORs are like the economic engine room in a large ocean-going vessel. Without them functioning optimally, the boat stops moving, and is batted about by of waves economic disruption. If surgical admissions drop below a certain …
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Medical device companies will soon face hard audits
My first year after completing surgical residency was an exhilarating and exhausting experience that most physicians will recall as part of their training. The American medical culture has imagined that the nation’s doctors — no matter their workload — simply don’t reach physical or emotional exhaustion in their work. But they do, and as we debate the future of healthcare in our country, we need to address this problem and quickly get to solutions, …
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The hidden crisis within the health care crisis
I work in a male-dominated field. As a cardiac anesthesiologist, I work with mostly male cardiac surgeons in a department where the majority of my fellow anesthesiologists are male. I work with some fantastic male colleagues. They are caring, skilled doctors, and I consider many of them to be friends.
While most of them know how to handle emergencies, trauma and difficult work situations, many times they clam up when we …
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15 tips for working with women
I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, …
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4 times a bedside ultrasound made a difference this week
When I finished my medical training almost sixty years ago, I was like many new graduates: I thought I knew it all.
I opened a private office in Los Angeles and paid courtesy calls on the local physicians to let them know my qualifications and my availability for consultation, as both an internist and a nephrologist. (The treatment of kidney disease was then in its infancy, and I was the area’s …
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Good clinical care takes more than medical acumen
“F*ck!”
I pried my eyes open and had the realization of exactly what time it was. I was going to be late — again. I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes …
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A surgeon makes a mistake, and couldn’t stop crying
Approximately 12 years ago, I hired my first physician in recovery. He had temporarily lost his license following a bout with alcohol. After a stint in a rehabilitation clinic, he was ultimately reinstated. My journey to hire this physician was arduous at best. During the interviewing process, I narrowed the field down to two candidates: one with a past and one without. I wrestled with the “in recovery” situation and …
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Help me help doctors in recovery
Medical and surgical research is breaking boundaries at an astounding pace. From genetic modification and stem cell therapy to robotic and 3-D printing technology, scientific advancement is finding novel, unique and unprecedented solutions to complex, challenging diseases. Indeed, such is the rate of change that I am certain the last eight years of my surgical training in the UK will likely be rendered obsolete within the next twenty years of …
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This frontier of medicine and surgery has been largely ignored for many years
When I was a medical student, trying to forge my path on the clinical wards as a third year, there was a lot to turn me off the idea of a career in medicine entirely — sleep deprivation, early mornings, late nights, standing for hours on rounds, subsisting on diets of hospital graham crackers and off-brand peanut butter. However, what frosted me the most was constantly playing 6 degrees of …
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Stop the abuse of hierarchy with these 5 tips
We sat in the office of the intensive care unit under fluorescent lights, both staring at computer screens covered in vital signs and labs. It was the summer of my second year of residency, and I spent it entirely in the intensive care unit. There were two of us on call at night. Half the nights we would spend shooting the shit about life, and the other half we spent …
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Physicians put up walls. But they feel everything.
