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.

The family member in the corner may be paying more attention than you think

Karen S. Sibert, MD

Physician

May 3, 2016

Nothing brings out the mama lioness in me more than seeing one of my cubs not being treated as well as I think it should be.

Recently I had the unusual experience of accompanying my oldest daughter into an unfamiliar hospital for a minor surgical procedure. Now, this daughter isn’t exactly a cub; she’s a full-fledged adult, with a master’s degree in health care administration, a husband, and two small boys of …

Conquering guilt as a trauma surgeon mother

Jamie Coleman, MD

Physician

April 30, 2016

Guilt was not a huge part of my vocabulary until I became a mom. I never felt much guilt about how I spent my time. Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out. And so on and so forth.

And then I became a mom. You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could …

Surgical residency hurt the people that mean the most to me

Anonymous

Physician

April 27, 2016

Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there?

I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to …

It’s time for physicians to practice an evidence-based life

Physician on FIRE, MD

Physician Finance

April 20, 2016

Evidence-based medicine is at the heart of what we physicians do. It is the basis for professional decision-making, and a focus of most journal articles we read. Using solid evidence to practice good medicine has been a foundation of clinical practice for decades.

There are consequences for failing to follow evidence-based guidelines. If patient harm results from straying from a more loosely defined “standard of care,” which tends to be evidence-based, …

You should want surgery residents for your operation. Here’s why.

James Wu, MD

Physician

April 19, 2016

A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …

Women surgeons can do it all

Brittany Bankhead-Kendall, MD

Physician

April 9, 2016

“Beautiful girl, you can do hard things.”

I saw that quote on my favorite Facebook group recently, called Physician Moms Group (or PMG). This is a group of women who, like all of us, are just trying to “do” life every day. Because of our integrity and intellect, we are trying to do it better than anyone else. I think that’s from a Type A personality, combined with leadership and wanting …

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Women surgeons can do it all

Want to fix MOC? This is one idea to do it.

Andrea Paul, MD

Physician

April 6, 2016

There has been a significant amount of outrage over the past few months of the maintenance of certification process. The anger has not only been targeted towards the ABIM, but also towards the other specialty boards. Pediatrics, for example, now requires ABP approved quality improvement (QI) projects that have been widely criticized.

While these MOC requirements are a major nuisance for most, the implications may actually run much deeper. A number …

Ask your doctors how they are doing. Please.

Julie Wei, MD

Physician

April 5, 2016

It’s Tuesday around 9 a.m., and I, a pediatric ear, nose, and throat surgeon on my third or fourth patient at a satellite clinic an hour away from home when the abdominal pain started. It feels as if someone is repeatedly stabbing a knife, and twisting it around, right below my breastbone.

I barely got through that encounter, then moved to the next patient. It will stop, it has to. There were 14 …

Patient-centered perioperative checklists to improve surgical care quality

Fred E. Shapiro, DO

Physician

April 4, 2016

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

With the recent expansion of ambulatory surgical centers, the number of outpatient surgical procedures has increased at an exponential rate. Coupled with the rise in volume has been the increasing complexity of procedures and underlying diseases of patients. The convergence of these factors …

Are today’s surgical residents poorly trained?

Skeptical Scalpel, MD

Medical Education

March 29, 2016

A surgical resident writes:

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.

My questions for you:

1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?

2. What should we do differently? I personally don’t feel that “more simulation activities,” which …

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Are today’s surgical residents poorly trained?

The importance of palliative care in surgery

Adrienne Bruce

Medical Education

March 29, 2016

Even as a child, I noticed that many people, especially my Depression-era grandmother, feared aging and the imminence of death. Death was no stranger to me growing up; I lost my then best friend, my Nano, and my uncle as a child, both traumatically. Yet, death was sad, but natural.

Because of this, I never understood our society’s stigma against dying, something that I’ve struggled with even in medical school. In …

5 tips for parenting a future surgeon

Anonymous

Physician

March 18, 2016

Mamas don’t let your babies grow up to be surgeons.

Really. Don’t.

As the mother of a soon-to-be fellowship-trained surgeon, I know what I’m talking about. Listen to me. Ignore Willie Nelson. You don’t want your babies to be doctors; you want them to be cowboys.

Really.

Yeah, yeah, I know, your daughter is a whiz at all things mathematical and/or spatial. And your son is a science prodigy. Their eye-hand coordination is legendary …

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5 tips for parenting a future surgeon

I’m a woman and a plastic surgeon. This is what beauty means to me.

Lara Devgan, MD, MPH

Physician

March 17, 2016

When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work?

The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the …

What’s the best way to evaluate surgery residents?

Skeptical Scalpel, MD

Physician

March 12, 2016

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination.

According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies — medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning …

Why we need to build bridges between primary care and anesthesiology

Karen S. Sibert, MD

Physician

March 7, 2016

The numbers haven’t changed significantly in several years — only five percent of the U.S. population consumes a full 50 percent of annual health care spending, and just one percent is responsible for nearly 23 percent of spending.

Within the top 10 percent of high spenders, most (nearly 80 percent) are age 45 or older. About 42 percent are persistent high consumers year after year, while the majority requires high spending …

A family caught in a vortex of questionable medical care

Elizabeth Kemp Baker and Sujana S. Chandrasekhar, MD

Patient

March 6, 2016

I am an ENT surgeon, a friend of the author, the patient, and their daughter, whose intervention saved his life. This is a smart, loving family caught in a terrible vortex of terrible medical care until they pulled themselves out, and a story that physicians must read, as we struggle to reinstate humanity and humility into our noble profession. Here is Paul’s tale, as told by his wife.

***

On a mid-December …

Not just a tech: Everyone’s important in the OR

Nina Shapiro, MD

Physician

February 29, 2016

The other day, I was operating on a little girl with a congenital ear abnormality. Not life and death stuff, but delicate surgery nonetheless. My surgical scrub technician was someone with whom I hadn’t worked before, and I asked him if he was enrolled in the operating room nurse training program, as many of the new folks are.

“No, I’m just a tech.”

I stopped what I was doing and replied: “You …

The surgeon who gave a teenager a new smile

Bhupesh Vasisht, MD

Physician

February 29, 2016

The brave teenager was sitting in the corner of the hallway away from other children. A long, torn cloth covered his face, more specifically his mouth. After slowly approaching him, I sat down right next to him. He shifted slightly away from me with a sheepish wide asymmetric grin on his face. As I began to converse with him through a translator, it became obvious he did not want to …

Surgeons are human, not superhuman: The agenda behind the FIRST trial

Dr. Eunice J. Minford

Physician

February 28, 2016

The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial randomized American surgical residency programs to one of two arms:

Standard group continued with their current standard restricted hours practice of 80 hours per week with time for breaks/rest and a limit to hours of work at any one time.
“Flexible” hours group removed current restrictions on hours worked at any one time and waived the need for breaks …
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Surgeons are human, not superhuman: The agenda behind the FIRST trial

A tribute to Paul Kalanithi

Tom Peteet, MD, MPH, MEd

Physician

February 19, 2016

There are few aphorisms in medicine that stand up to reality. Here are two: Physicians get the patients they deserve, and we tend to die like we live.

Paul Kalanithi’s posthumous memoir proves both: As a neurosurgery resident at Stanford, he took on the most challenging cases, and when diagnosed with terminal lung cancer, he lived and died pursuing excellence and truth. I read When Breath Becomes Air …

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A tribute to Paul Kalanithi

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