Surgery and surgeons

We owe it to our patients to put on our game faces

Starla Fitch, MD

November 19, 2014Nov 19, 20142

When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area…

When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”

When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”

When you steel yourself …

A ritual to recover the empathy toward bodies we care for

Amrapali Maitra

November 19, 2014Nov 19, 2014

Watching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation.

In the operating room, the …

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Cholecystectomies at night: Are they safe?

Skeptical Scalpel, MD

November 18, 2014Nov 18, 20149

A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours. Nighttime cholecystectomies were converted 11 percent of the…

Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay.

The study, published online in the …

Patients are doubly screwed by the malpractice system

Sid Schwab, MD

November 16, 2014Nov 16, 20145

The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. "Ho hum," says a lawyer who read my first two posts in this series. "Get out the violins." It's as if, because I…

Part 3 of a series. Read part 1 and part 2.

The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. “Ho hum,” says a lawyer who read my first two posts in this series. “Get out the violins.” It’s as if, because I make my living operating on …

What a student learned: Medicine’s hidden curriculum

Bruce Campbell, MD

November 16, 2014Nov 16, 20143

Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile…

Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.”
— Abraham Verghese, MD

The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, …

Giri Venkatraman, MD, MBA

Perioperative team training: Can we learn from basketball?

November 15, 2014Nov 15, 2014

What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, …

When is it right to share our personal struggles with patients?

Alexis Drutchas, MD

November 15, 2014Nov 15, 20144

I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …

Anesthesiologists have to start to truly care for patients

Shirie Leng, MD

November 12, 2014Nov 12, 201417

Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …

Fall in love with medicine again

Fall in love with medicine again

Starla Fitch, MD

November 11, 2014Nov 11, 2014

An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. A doctor’s self-worth can be tied up with a lot of issues. How well can we make a diagnosis? How elegantly can we perform the…

An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.

A doctor’s self-worth can be tied up with a lot of issues.

How well can we make a diagnosis?

How elegantly can we perform the surgery?

How happy are our patients? Our staffs? Our families?

How many articles have we had published or how many lectures have we given?

The list goes on and on, doesn’t it?

For me, …

Read more…

Can surgery residency programs be ranked?

Skeptical Scalpel, MD

November 6, 2014Nov 6, 20143

In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity's co-founder over the issue and…

I wonder if it is even possible to develop a set of valid …

Physician ratings reward doctors in narrow practice

Thomas D. Guastavino, MD

November 4, 2014Nov 4, 201419

Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was the…

Isn’t that the chronic back pain patient who was addicted to painkillers and got mad at me because I wouldn’t renew …

What I wish I knew: Advice for spouses of doctors and residents

Erica McCaleb Camp

November 3, 2014Nov 3, 201437

Residency life. I don't talk about it much, and that's on purpose. Here's why: My life is wonderful. I really love it. Is it perfect? No. Is anyone's life perfect? Definitely not. I would never wish to portray my life…

Residency life.

I don’t talk about it much, and that’s on purpose. Here’s why: My life is wonderful. I really love it. Is it perfect? No. Is anyone’s life perfect? Definitely not. I would never wish to portray my life in a negative fashion and certainly not to wish for sympathy. I would talk about it in an informative way, but even …

The nuances of breast cancer surgery don’t fit in a headline

Pat Whitworth, MD

November 3, 2014Nov 3, 2014

Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies…

This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an …

The problem with wedding planning when you’re a surgeon

Sangeetha Kolluri, DO

October 30, 2014Oct 30, 20146

The other day, I got into an argument with my parents about choosing wedding décor -- and I blame it on my surgical training. My parents had borne the brunt of the work for the previous eleven months. allowing me…

shutterstock_149847554 The other day, I got into an argument with my parents about choosing wedding décor — and I blame it on my surgical training. My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of …

A case that illustrates the good, the bad and the ugly of American medicine

Ira Nash, MD

October 23, 2014Oct 23, 201417

I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today. Here are the basic facts: the man is in…

I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today.

Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a …

What I love about being an anesthesiologist

Edward R. Mariano, MD

October 20, 2014Oct 20, 201412

I wear a lot of hats in my job. Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table. Many days I spend in…

I wear a lot of hats in my job. Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table.

Many days I spend in an administrative leadership role or conducting research studies. These functions support the best interests of my patients as well as the science …

What do you know about breast reconstruction?

David M. Charles, MD

October 15, 2014Oct 15, 20143

Happy BRA Day! October 15 is officially Breast Cancer Reconstruction Awareness Day. It’s a natural time to discuss commonly-asked questions about breast reconstructive surgery. Breast cancer is a devastating diagnosis and the treatment tends to have a direct impact on…

Happy BRA Day! October 15 is officially Breast Cancer Reconstruction Awareness Day. It’s a natural time to discuss commonly-asked questions about breast reconstructive surgery.

Breast cancer is a devastating diagnosis and the treatment tends to have a direct impact on a woman’s self-esteem, especially if there has been a mastectomy or partial mastectomy. Just knowing breast reconstruction is an option is consoling; it offers hope for many patients. Yet physicians and …