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.

Selecting grittier surgeons is harder than you think

Skeptical Scalpel, MD

Medical Education

August 19, 2014

In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness.

A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs …

A relationship between a surgeon and an intensivist

Sid Schwab, MD

Physician

August 15, 2014

Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists.

(By way of diversion, I’ll add there were only two of them at the time, and they were both my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply …

A primer on the anesthesia care team model

Kraig S. de Lanzac, MD

Physician

August 10, 2014

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

Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist. Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician. Once we get into the discussion, patients are also surprised to learn that …

Rethinking the fix-it model in medicine

Gretchen Schwarze, MD

Physician

July 28, 2014

She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year …

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Rethinking the fix-it model in medicine

3 ways to master the art of teaming in medicine

Della M. Lin, MD

Physician

July 24, 2014

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

As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow my …

Patient education: Simple solutions are the best solutions

Shirie Leng, MD

Physician

July 22, 2014

In another entry for the communication category, here’s a little play I wrote:

Scene: Pre-op area. Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late.

Anesthesiologist (me): Good morning Mrs. Jones. I’m Dr. so-and-so. How are you this morning?

Patient: Oh, doctor, I have the most terrible headache. They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late.

Me: …

Do surgical checklists work? A closer look at the data.

Skeptical Scalpel, MD

Physician

July 22, 2014

The other day Atul Gawande tweeted the following:

Some still oppose WHO Safe Surgery Checklist because no RCT was done. Well, new RCT finds it cut complications 42% http://t.co/qWacE54NIW

— Atul Gawande (@Atul_Gawande) June 18, 2014

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and …

Total knee replacements: A race to the bottom

Clark Venable, MD

Conditions and Diseases

July 6, 2014

A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery.

Anesthetic care has improved dramatically …

Procedure checklists work only if they are used

Christopher Johnson, MD

Physician

July 1, 2014

Complicated medical procedures can be dangerous, even when done by highly skilled and experienced people. Why? Because, irrespective of the procedural risk itself, all of us are human and we can overlook or forget things, no matter how many times we have done the procedure. This was recognized many years ago in the airline industry. Flying an airplane is a complicated and potentially dangerous activity and their are many steps …

A perfect thank you note to an oncologist

James C. Salwitz, MD

Physician

June 26, 2014

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I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery. The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …

Initial steps for physician entrepreneurs

Manan Shah, MD and Arlen Meyers, MD, MBA

Physician

June 25, 2014

Every time I see a GlideScope, I can’t help but lament, “why didn’t I think of that?” To me, the GlideScope exemplifies how physicians can apply their practical knowledge of medicine to create technology that improves patient outcomes.

I had a front-row seat to physician-designed technology prior to my residency, when I worked at an early-stage venture capital fund advising on health care investments. We invested in a number of physician-founded …

8 essential tips for physician entrepreneurs

Elizabeth Chabner Thompson, MD, MPH

Health Technology

June 19, 2014

While there are many creative people who go into medicine, the challenge of turning experience into innovation can be stifling. My classmates at Johns Hopkins, fellow residents at Harvard, and peers came from a wide variety of backgrounds. But medical school, internship, and residency don’t afford students much time to tinker around.

“Free time” in academic medicine means working in a lab with the “publish or perish” dictum hanging over one’s …

Palliative surgery: A surgeon reflects

Sid Schwab, MD

Physician

June 16, 2014

Palliative surgery is tough stuff. Nobody wins much, and it often challenges one’s ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who’s the object of comfort. And yet, when there’s nothing else to do, it’s often just the right thing. I hate it.

To be clear: We’re talking about surgery to relieve some sort of specific problem, …

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Palliative surgery: A surgeon reflects

Watching people die is sometimes the compassionate thing to do

DocBastard, MD

Physician

June 15, 2014

It is unethical not to be compassionate when you are a physician. Treating people or their families poorly isn’t helpful to anyone in a stressful situation. But a big problem exists there – ethics is not taught in medical school. Then again, neither is compassion. So where do you learn them? Can you learn compassion, or is it something you just have?

Or don’t have?

She could have been anyone’s grandmother. White …

4 questions to ask your plastic surgeon before surgery

Patrick Hsu, MD

Physician

June 15, 2014

As the number of people undergoing plastic surgery rises, the number of people who get bad results also increases. Numerous cases of botched plastic surgeries persist to linger the news which continue to put plastic surgery in a bad light. As a doctor specializing in cosmetic and reconstructive surgery myself, I am saddened by the fact that such cases carry on.

With more and more people choosing to undergo plastic surgery, …

Google Glass has a long way to go in the OR

Skeptical Scalpel, MD

Health Technology

June 9, 2014

The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion.

Here is what I thought about the event.

The case started about 30 minutes late, which is similar to what would have happened in any …

Must a surgeon mention death as a complication?

Skeptical Scalpel, MD

Physician

June 3, 2014

Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones.

As I stated before, I …

A surgeon hopelessly disinterested in teaching

Bruce Campbell, MD

Medical Education

June 3, 2014

Whatever we learn to do, we learn by actually doing it; men come to be builders, for instance, by building, and harp players by playing the harp.
-Aristotle

I groaned. “Don’t make me operate with him again! I assisted him in surgery just last week!”

I was low man on the totem pole and there was no point arguing. All of the residents and fellows kept track of the rotation and I knew …

Better outcomes and lower costs: The perioperative surgical home

Jane C.K. Fitch, MD

Health Policy

June 2, 2014

Whether it’s a knee replacement avoided for years or an urgent life-saving tumor removal, when the decision for surgery occurs, too often the patient begins a journey into a complex system of fragmented medical care. Perioperative care, which generally refers to the three phases of surgery — preoperative, intraoperative and postoperative — can be variable and fragmented. …

Reducing the stress of teaching surgical residents

Eve Karkowsky, MD

Medical Education

May 30, 2014

When I graduated from my residency, far from my current professional home, I wanted to write a book called How Not to Get Yelled At in the Operating Room. Or How to Clear the Fear from Your OR.

I had these titles in mind because I struggled so much during my intern year. It was a tough year, full of intense patient care and sleep deprivation, but the challenge that I most wanted help …

Surgery

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