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.

Is robotic assisted prostatectomy worth the added expense?

Leonard G. Gomella, MD

Conditions and Diseases

November 17, 2015

Since the introduction of the robotically assisted laparoscopic radical prostatectomy (RALP) in 2000, the long-term prostate cancer control has been uncertain. We now have the first long-term cancer control study that compared the results of the earliest RALP with historical open radical retropubic prostatectomy (ORP) outcomes. Diaz and associates from a recognized RALP center of excellence concluded that RALP has similar long term cancer control compared to open …

A surgeon blogs for one year. Here’s what she learned.

Kathryn A. Hughes, MD

Physician

November 16, 2015

“I admire anyone who has the guts to write anything at all.”
– E. B. White

“All you have to do is write one true sentence. Write the truest sentence that you know.”
– Ernest Hemingway

“Writing is easy. All you have to do is cross out the wrong words.”
– Mark Twain

“There is no greater agony than bearing an untold story inside you.”
– Maya Angelou

“There is nothing to writing. All you do is sit down at …

#ILookLikeASurgeon, not an imposter

Dzifa S. Kpodzo, MD

Physician

November 2, 2015

unknown

Born to a family of scientists — my father an engineer and my mother an oral surgeon — I was given a clear message that I could do anything. Case in point: At age nine when I declared my career goal of being “president of the world” nobody batted an eyelash. Their unwavering confidence followed me through college at UC Berkeley and …

Read more…

#ILookLikeASurgeon, not an imposter

Motivate smokers to quit before surgery. It could save lives.

David O. Warner, MD

Conditions and Diseases

November 1, 2015

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

Physicians who care for surgical patients witness the devastating consequences of cigarette smoking almost every day. For example, smoking increases the risk of acute complications such as pneumonia and wound infections, and adds to the burden of smoking-related diseases such as heart disease. As …

Bad data vs. no data: Defending ProPublica

Ashish Jha, MD, MPH

Health Policy

October 28, 2015

In July the investigative journalists at ProPublica released an analysis of 17,000 surgeons and their complication rates. Known as the Surgeon Scorecard, it set off a firestorm. In the months following, the primary objections to the scorecard have become clearer and were best distilled in a terrific piece by Lisa Rosenbaum. As anyone who follows me on Twitter knows, I am a big fan of Lisa — …

Will your anesthesiologist leave the OR? Patients deserve to know.

Karen S. Sibert, MD

Physician

October 27, 2015

“For some must watch, while some must sleep.”
– William Shakespeare, Hamlet

I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under: What can happen if your anesthesiologist leaves the room during an operation.”

It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, one …

Why do never events occur? It’s because of the human factor.

Cornelius Thiels, DO

Physician

October 26, 2015

Wrong procedure, wrong side/site, wrong implant, retained foreign object: big problem. No patient should ever have to undergo these types of events, and they are therefore called never events. However, these events do occur and when they do they not only jeopardize patient safety but they also breach the trust between patient and practitioner, have financial implications, and reflect negatively on the entire health care system.

The good news is never events …

For quality experts, a point of tension with ProPublica

Dr. Saurabh Jha

Physician

October 26, 2015

Recently, I was speaking with a less is more advocate. He used his superior knowledge of statistics — he had an MPH — to debunk randomized controlled trials. We discussed overdiagnosis, overtreatment, and the shakiness of medical sciences.

We spoke about measuring the quality of physicians. I remarked that quality metrics have as much evidence as Garcinia Cambogia — we had just laughed about Dr. Oz. I expected a chuckle. Instead, …

Surgeons are burnt out and the numbers are staggering

Heena P. Santry, MD

Physician

October 23, 2015

Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 U.S. surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60 percent. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger …

What did a surgeon think of the television show, Code Black?

Skeptical Scalpel, MD

Physician

October 19, 2015

A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black.

There is the usual array of standard medical characters — the inexperienced new residents on their first day at work, the savvy nurses, …

A surgeon conquers her anxiety. See how she did it.

Heather Fork, MD

Physician

October 12, 2015

Can anxiety be severe enough to cause a physician to leave medicine? Absolutely. I know a number of physicians who have left for this reason. In my coaching practice I am increasingly aware of the toll anxiety takes on many doctors and am making it my mission to bring more attention to this problem and to find solutions. The physicians I have talked to are just the tip of the …

Do a cricothyrotomy after a failed Heimlich. But it’s likely to fail.

Skeptical Scalpel, MD

Conditions and Diseases

October 11, 2015

At the end of an otherwise informative article about the nuances of performing a Heimlich maneuver, New York Times science reporter Jane E. Brody recommends that if all else fails, a cricothyrotomy should be attempted.

She goes on to briefly explain how the procedure is done. In the right hands, a cricothyrotomy is safer and easier to perform than a formal tracheostomy. However, for a layperson who has never seen either …

The ProPublica Surgeon Scorecard: When journalists become scientists

Peter Pronovost, MD, PhD

Health Policy

October 9, 2015

Most of us would agree that there aren’t enough valid and meaningful health care quality measures to guide patients’ choices of hospitals and physicians. While the federal government has steadily expanded the number of publicly available measures on its Hospital Compare website, it still falls short of what many patients, payers, and providers would like. This is particularly true in the realm of outcomes such as …

Here’s what doctors can learn from global volunteering

Robert Pearl, MD

Physician

October 3, 2015

Resurge

In the arms of every parent who waited on the long line outside the clinic in Mexico was a child born with a facial deformity, usually a cleft lip or palate. Many of these mothers and fathers had walked long distances, carrying their child. Some families included grandparents, aunts and uncles, and others, just a mother, and her baby. Most of these …

How a neurosurgeon balances life and work

Jeffrey S. Henn, MD

Physician

September 25, 2015

“For Me There Are Mountains.”

This is the title of a poem written by a college friend. It’s been almost 30 years, and I have yet to come across words that better define my life, words that immediately resonated with my soul and “understood” me — understood that for me, mountains symbolize at once life’s challenges and rewards, and understood that “there are” is neither choice nor conviction, there just are.

For …

Do patients contribute to the God complex in surgeons?

Dr. Henry Woo

Physician

September 23, 2015

Medical oncologist, Dr. Ranjana Srivastava wrote on the subject on how doctors treat doctors may be medicine’s secret shame in the Guardian back in February 2015.

About a month later, vascular surgeon Dr. Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession. She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, …

I started singing in the procedure room. And it reshaped my view of professionalism.

Chiduzie Madubata, MD

Physician

September 10, 2015

In medical training, one of the main things that is emphasized is the importance of acting professionally. We encounter patients who have a particular idea of how doctors are supposed to act during the patient-physician encounter, and for the most part, I expected that they would want a doctor who is caring, but serious, at the same time.

In those encounters, we are focusing on the health of patients, a very …

Informed consent defines 21st-century medicine

Sara Scarlet, MD

Physician

September 10, 2015

I walk into a tiny ER room and shut the glass door behind me. The smell is dizzying. I look down and see a frail man lying on a stretcher. A soiled bandage on his left leg is halfway unfurled. He is diaphoretic. He sleepily opens his eyes when I say his name. For me, I have barely begun my assessment, but the writing is on the wall. This man …

As a physician, it is difficult to admit to a lack of control

Jeremy B. Wiygul, MD

Conditions and Diseases

September 9, 2015

“Why aren’t you treating this patient?”

Over the phone, the pediatrician’s voice crackled with disdain. I had just spent the last 5 minutes explaining why I didn’t think surgery was necessary for a patient whom the pediatrician had referred to me (unwillingly, as she pointed out during our conversation — the patient’s insurance wouldn’t cover visits to the much bigger competitor hospital that she normally referred to). I remembered the little …

Antibiotics for appendicitis: 3 unintended consequences

Dr. Saurabh Jha

Conditions and Diseases

September 3, 2015

A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70 percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing. The study has limitations. Finland is not just a land of the Read more…

Antibiotics for appendicitis: 3 unintended consequences

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