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.
I am nearing the end of my training at one of the top surgical fellowships in the country. I chose this fellowship not just for the name, but also because the surgeons all seemed like genuine and altruistically motivated individuals. It was two-thirds of the way through fellowship when I found myself in conversation with two male trainees. We were discussing the younger trainee and his girlfriend; he would be …
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There’s no place for locker room talk in the OR
Not once during my eight years of medical school and residency training was I ever asked the converse of the titular question, what was my wife’s opinion of my career choice. Not while scrubbed into a case on my surgery rotations, not in the middle of an overnight call in the neonatal intensive care unit and never once by an attending, fellow or co-resident. Even those who knew me best and …
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What does your husband think about you being a surgeon?
I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.
I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …
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A medical student fails USMLE Step 1. Can he ever be a surgeon?
Women surgeons all over the globe have been recreating the “Operating Theatre” cover of the New Yorker through the #NYerORCoverChallenge. The public recognition of women in what has been a male-dominated field has rallied female surgeons’ spirits everywhere.
Except, perhaps, mine. While I am fiercely proud of my surgical sisters, I also feel a twinge of sadness, because I know so many of the untold …
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Can women be empowered and avoid burnout?
One of the things I most enjoy about being an anesthesiologist is the wide variety of patients that I see. You never know who you’re going to have the privilege to care for on a given day. Although my group is large, I will occasionally be assigned to a patient that I personally know. And occasionally, someone I know will request me as their anesthesiologist.
Last month I took care of …
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When patients personally know their anesthesiologist
We are neurosurgeons, albeit not rocket scientists, but with our insider knowledge, it should be easy for us to understand “narrow networks.” Unfortunately, this is not the case so we can imagine how difficult it is for our patients. Consider the following scenario:
A 52-year-old woman is receiving long-term care for multiple myeloma primarily involving the spine. Well-coordinated neurosurgical and oncological care is provided through a large multispecialty group; however, if …
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Narrow networks have no connection to quality or value
And if they can, should they?
In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.”
But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots.
The …
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Will robots ever be able to perform surgery independently?
And I don’t love it.
When I gained acceptance into medical school, I thought I would one day have one amazing job, or at least one job title where I might get to wear several meaningful hats.
I’m a physician anesthesiologist. It’s my duty to play a role in improving the health and the lives of my patients. I studied and trained for many years to have the privilege of understanding the …
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I’m equal parts doctor, scribe, and mouse jockey
My mind usually starts to wander around the third or fourth hour of retracting a fat flap or holding up a leg during a long operation. I start by guessing how many times the attending has done this particular procedure. Is it his hundredth time doing it? If he was one of the older attendings, perhaps it was his thousandth one.
As a neophyte in the operating room, I still relish …
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Learning surgery one stitch at a time
A few years ago, my colleagues and I started a non-profit called Women in Anesthesiology. I started medical school late and had two children in residency (earning the delightful label of elderly primigravida or, if you prefer, geriatric pregnancy). My co-resident and I noticed few women in our department, and even fewer in leadership. We charged forward, starting a local, then national group. At the same time, a separate Facebook …
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Maybe it’s time for physicians to lean out
“Am I going to die?”
There was a mixture of fear and pain in my patient’s eyes. He was a second grader but had already survived three major heart surgeries. Now he had pneumonia and was struggling to breathe. We were about to intubate him.
“You’re a strong guy,” I whispered to him as his mother held his hand and sobbed. “We’ll get you through this.”
He died two days later.
I drove home …
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I once made a promise to a young boy with half a heart. I could not keep it.
Imagine while driving into work, you drive through a green light. When you look to the right, you see a car barreling through the intersection, and then everything goes black. You vaguely remember being taken into the emergency room of a prestigious hospital nearby. In the ED, you hear a doctor’s voice yelling at nurses to give you medications, and then everything goes black. You wake up in a hospital …
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What should my doctor look like?
After writing my 21st post about appendicitis back in November, I swore I would not write about it again for the foreseeable future.
Well, the future is now because investigators from the United Kingdom and Canada just published a meta-analysis including ten papers and 413 children about the efficacy and safety of nonoperative treatment for appendicitis in children.
They concluded that nonoperative management is effective in 96 percent …
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Is nonoperative treatment of appendicitis in children safe?
Telemedicine is often in the news and until recently I had only casually glossed over the latest articles. The details I paid little attention to, but the headlines I would remember. “Great for rural areas” I would read! “Extend physician reach!” “Get specialists to greater numbers of patients with unique conditions!”
As a nearly graduated anesthesia resident in a large city with an abundance of doctors, I didn’t think telemedicine would have …
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Will telemedicine take your job?
As a medical student, I had nightmares about my first day in the OR: scrubbing incorrectly, contaminating a sterile field, forgetting the anatomy I had so carefully studied the night before. It seemed like the only thing I could do in that artificially lit room was mess up. After a few cases I came to love the routine and ceremony of each surgery: the timeout; the rhythmic pattern of suture, …
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A resident’s guide to being a medical student: In the OR
Among surgeons, it’s pretty common knowledge that residents and other providers may perform non-critical parts of a patient’s procedure. This not only helps residents and other trainees gain valuable surgical experience, it also gives patients better and faster access to high-demand surgical expertise.
The question is this: How well are surgeons explaining these facts to their patients?
Recent guideline updates by the American College of Surgeons (ACS) underscore the need …
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4 scenarios surgeons need to explain to their patients
A couple years ago, I reached the seven-year mark after my initial board certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam.
Diplomates of the ABA — that’ right, I’m considered a diplomate — in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam …
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A physician’s MOC debacle: Nevermind that $2,100 exam he just passed
It is no secret that physicians are disenchanted with the changes in medicine and can be overheard saying that they do not want their children to go into the profession. Has the practice of medicine deteriorated to the extent we say it has, and are there more appealing options?
According to a Doctors Company survey of 5,000 physicians, 9 out of 10 physician respondents indicated an unwillingness to recommend health care …
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The medical profession has a bad reputation. Here’s why.
