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.

A commencement address to anesthesiologist assistants

Karen S. Sibert, MD

Physician

August 16, 2017

A commencement address delivered on August 5, 2017, to the 2017 class of anesthesiologist assistants (AAs), Emory University.

Distinguished faculty, graduates, honored guests:

It is a great pleasure and an honor to be here, and to congratulate all the graduates of the Emory University Class of 2017 on your tremendous accomplishment. Just think about all you have learned in the past two years. You’ve transformed yourselves into real anesthesia professionals, able to …

Physicians should not tolerate racism from patients

Farshad Farnejad, MD

Physician

August 15, 2017

It’s 7 a.m. We sit down around a table in the physician’s lounge to discuss and our patients. I am a general and critical care surgeon. Every fourth week I’m “on service” for the ICU. This is my week. I was off over the weekend. I’m refreshed and ready to go. I’m excited. I enjoy the challenge of taking care of critically ill patients.

I get sign out from my partner. …

Today, I hugged a stranger

Edwin Acevedo, Jr., MD

Physician

August 14, 2017

Today, I hugged a stranger.

And I didn’t know his name.

We had just operated on a young man, probably in his late teens. He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition. When he lost pulses in the trauma bay, we cut his chest open and spread his ribs. His lifeless body laid there as we held his heart in the palm of our …

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Today, I hugged a stranger

For medicine to grow, we need to look at our own biases

Sasha K. Shillcutt, MD

Physician

August 11, 2017

If you had told me I would be writing someday on women’s issues, I would have grabbed a pulse oximeter and placed it on your finger to check your oxygen levels. As a physician scientist, I have spent the majority of my career reading, studying and writing on clinical medicine. Then, something changed.

For years, I have had the pleasure of working with and for some pretty phenomenal men in medicine. …

This is what to remember in health reform: We are all one patient

Sasha K. Shillcutt, MD

Health Policy

August 7, 2017

As a physician, I am often discouraged when I turn on the news and read about the state of health care in our country. I can see all 397 sides of the debate and some truth in all sides. The enormous cost of medicine is overwhelming to comprehend for patients and families and even to those of us in medicine.

I think it is important to know all that goes into …

New health policies must cover our most vulnerable

Bruce Campbell, MD

Physician

August 3, 2017

Cancer treatment delays are sometimes inevitable. Here is a story, though, that haunts me.

Years ago, long before the Affordable Care Act, I was asked to evaluate a very pleasant man with hoarseness in a local free clinic. He struggled to make himself heard. “Things have been getting worse and worse,” he said.

“When did you start losing your voice?” I asked.

“About six weeks ago,” he responded. “When it started getting more …

Deep extubation is a useful technique for any anesthesiologist to master

Karen S. Sibert, MD

Conditions and Diseases

August 1, 2017

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:

Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes! Take a deep breath!”

Or:

Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence …

Does the public shaming of Carmen Puliafito go too far?

Vamsi Aribindi, MD

Physician

August 1, 2017

Recently, the Los Angeles Times broke a story that Dr. Puliafito, former Dean of the Keck School of Medicine of USC, had been abusing drugs and keeping company with a group of younger individuals who engaged in drug use and illicit activity. Much of this activity occurred while he was dean, and it is a shocking story: A 66 year-old titan of the field of ophthalmology, renowned for inventing …

Goodbye to all that paperwork: An orthopedic surgeon leaves practice

Divya Singh, MD

Physician

July 26, 2017

“For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. …

Want to go on a surgical humanitarian trip? Here are 12 things to think about.

Sightsee, MD

Physician

July 17, 2017

Travel is one of our passions. Spending time in unique places, trying new foods, and meeting different people is enjoyable and exciting. We are also passionate about our jobs as otolaryngologists.

Humanitarian trips allow us to combine both of these loves.

During these trips, I have repaired cleft lips/palates, removed cancers, reconstructed facial disfigurations and improved breathing and swallowing. Few things are more gratifying than being able to provide life-changing operations without …

Go ahead and call me bossy. Bossy saves lives.

Sasha K. Shillcutt, MD

Physician

July 15, 2017

Since I was a little girl, I have been called a lot of things. Sensitive. Funny. Strong-willed. Outgoing. Take-charge. Friendly. Bossy. Focused. And my favorite — domineering.

I’ve always been a direct person. I’m an extrovert, which means I walk into a room and I am energized by the people around me. I am also a positive person; I assume you are my friend until you prove otherwise. On most days …

The real reason we think plastic surgery is just boob jobs and tummy tucks

Sarah Fraser, MD

Physician

July 14, 2017

Be honest. What’s the first thing you think of when you hear the words “plastic surgery?” Breast implants? Nose jobs? Or maybe you’ll think about one of the numerous television programs out there that have featured the discipline: “Nip/Tuck?” “Botched?” “Grey’s Anatomy?”

If so, you aren’t alone. Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students and the public. Plastic surgeons perform many …

Artificial intelligence in medicine is still a long ways off

Bruce Campbell, MD

Health Technology

July 10, 2017

“Medicine is a science of uncertainty and an art of probability.”
– Sir William Osler

Two people presented to my clinic on the same day with classic symptoms of head and neck cancer.

Each reported several weeks of unilateral throat discomfort, ear pain, and a neck mass. Each was having some trouble swallowing and had changed his diet to accommodate the soreness. When they opened their mouths, each had a mass with a …

Think doctors make too much money? Think again.

Patrick Connolly, MD

Physician

July 9, 2017

Lots of people write about how “doctors work so hard.” But let’s look at it from an economics and value-creation perspective.

I’m a neurosurgeon, so you know I do pretty well financially, but how much value am I adding to society? Here are a few examples:

1. A mail carrier couldn’t work because of a herniated lumbar disc. We’ll figure he makes $50,000/year. I operated on him; he goes back to work. …

None of us should have to choose between MOC and DRexit

Karen S. Sibert, MD

Physician

July 7, 2017

I wish I knew who coined the term “DRexit” so I could send flowers or a bottle of whiskey as a thank you gift. There couldn’t be a more perfect term to describe the growing exodus of physicians from our beloved profession, which is turning into a morass of computer data entry and meaningless regulations thought up by people who never touch a patient.

The one bright note on the horizon …

These physicians are crying. Here’s why.

Christopher Bennett, MD

Physician

July 4, 2017

I cried this morning. It wasn’t because of the patient who coded with a wide-complex tachycardia and died in front of me, and it wasn’t because of the patient who tried to spit on me for not giving her a prescription for narcotics. Nor was it my intoxicated 2 a.m. bar fight patient yelling at my other patients, including one whom I’d recently diagnosed with metastatic cancer. It was because …

Trauma in the OR. From doctors’ bullying.

Anonymous

Physician

July 1, 2017

It’s Friday morning in any operating room, USA. Nurses and techs are scrambling to get everything in place before the surgeon arrives because if not, there will be hell to pay. The first patient arrives late, the second patient needs to use the bathroom, the third patient needs blankets before the IV is started … and here he comes … and we’re not ready. The fear is palpable.

Down the street, …

I’m your anesthesiologist. Let me explain what that means.

Sasha K. Shillcutt, MD

Physician

June 30, 2017

It’s still dark out when I walk into the busy and bustling preoperative area where patients and their family members crowd into small bays. They hand over their personal belongings to the RNs and their trust to me. As I walk in, I grab my patient’s hand, smile and say, “Hello. My name is Dr. Shillcutt. I am a cardiac anesthesiologist, and I am going to take care of you …

Overpowering the glass ceiling will take more than outnumbering men in the field

Lucy Guevara, MD

Physician

June 5, 2017

I was recently on an off-service rotation and one morning as I entered a patient’s room that had been admitted to our service, I overheard the patient quickly tell the person they were talking to on the phone, “Hey, can I call you back? My nurse just walked in to talk with me.”

For a moment I was confused and actually turned around to look for his nurse behind me. Alas, …

Residents performing surgery: Why can’t we reach a middle ground?

Skeptical Scalpel, MD

Physician

May 25, 2017

A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment.

The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes — …

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