Surgery and surgeons

1,981 articles · Since 2004

Articles, page 48

Rebutting a physician’s plea to declare independence

May 22, 2014May 22, 20145

Writing in the Wall Street Journal, Daniel F. Craviotto Jr. an orthopedist, made a plea to physicians to declare independence from third parties and emancipate themselves from servitude to payers, mandates and electronic health records (EHR). As rants go, this…

Writing in the Wall Street Journal, Daniel F. Craviotto Jr. an orthopedist, made a plea to physicians to declare independence from third parties and emancipate themselves from servitude to payers, mandates and electronic health records (EHR).

As rants go, this was a first class rant. But its effect was that of a Charles de Gaulle’s whisper to Vichy France rather than a Churchillian oratory at the finest hour.

The article went viral (it has …

Conditions and diseases

Can appendicitis be managed without surgery?

Skeptical Scalpel, MD

May 20, 2014May 20, 201412

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery. The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to…

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery.

The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients.

Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis …

Physician voices

For better or worse, doctors are human

Sid Schwab, MD

May 15, 2014May 15, 20144

Speaking only for myself (but guessing I'm not alone), I can say when a patient develops post-op problems, there's a strong tendency to deny it: not to deny there's something wrong; not to dismiss the patient's concerns or symptoms. Just…

Speaking only for myself (but guessing I’m not alone), I can say when a patient develops post-op problems, there’s a strong tendency to deny it: not to deny there’s something wrong; not to dismiss the patient’s concerns or symptoms. Just to grasp first at the less dire set of possible explanations. Maybe it’s just the flu, constipation, drug reaction. That sort of thing. It’s not about blowing it off — …

Read more…

For better or worse, doctors are human

Real physician voices, twice a week

Free, and one click to unsubscribe.

Physician voices

Why the quality measures used in health care are deeply flawed

Karen S. Sibert, MD

May 12, 2014May 12, 20145

Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators…

There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict …

Medical education

Are today’s newly graduated residents ready to practice medicine?

Christopher Johnson, MD

May 8, 2014May 8, 20148

A newly minted physician, one who has just graduated from medical school, is not yet ready (or licensed) to practice medicine. The next phase in medical training is called residency, a 3 to 5 year span of time during which the new doctor is given teaching, supervision, and increasingly allowed to function independently in his or her chosen specialty.

Since 2003 residents have been limited to working 80 hours per week, averaged over …

Physician voices

Sitting with a patient: The least practiced communication skill

Howard Luks, MD

May 3, 2014May 3, 2014

In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park. Only ten minutes earlier, when we…

In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park.

Only ten minutes earlier, when we first met, Mr. A had been weary, his face drawn, and his speech so quiet that the sound of the aortic balloon pump keeping him alive made it nearly impossible to …

Medical education

The problems with making oral board recertification universal

Skeptical Scalpel, MD

May 1, 2014May 1, 20145

A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren't all board recertification examinations given orally. She correctly asserts that oral examinations are better because they…

A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren’t all board recertification examinations given orally. She correctly asserts that oral examinations are better because they assess how people think rather than how much they have memorized.

Here’s why it would be difficult to do.

The initial surgery board exam is given in two parts. First a written …

Physician voices

Technology and confidence: Working with surgeons in Kenya

Bruce Campbell, MD

April 18, 2014Apr 18, 2014

Confidence is contagious. So is lack of confidence. -Vince Lombardi “So, can you leave this here with us?" I was part of a group of U.S. surgeons traveling to Eldoret, Kenya, seeing patients and helping the Kenyan ENT surgeons learn…

Confidence is contagious. So is lack of confidence.
-Vince Lombardi

“So, can you leave this here with us?”

I was part of a group of U.S. surgeons traveling to Eldoret, Kenya, seeing patients and helping the Kenyan ENT surgeons learn surgical techniques. Our two week mission allowed us to work across-the-table from Kenyan colleagues, discussing surgical approaches, demonstrating techniques, and reviewing all aspects of surgical care.

“I have never seen such a thing!” my …

Physician voices

Why should practicing medicine be compared to any other occupation?

Skeptical Scalpel, MD

April 15, 2014Apr 15, 201415

A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things. This was met…

A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things.

This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I …

Physician voices

A patient nearly died to save him $1110

Robert Gray, MD

April 15, 2014Apr 15, 201435

Where I’m from, you can have someone killed for $5000. I will do it for $1110. I’m a hand surgeon. I practice (or practiced, by the time you read this) in an area that is what we often refer to…

Where I’m from, you can have someone killed for $5000. I will do it for $1110. I’m a hand surgeon.

I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.” Rather, the area isn’t, but the people I treat are. I work in a large urban referral center that has a very high proportion of Medicaid as well as …

Read more…

A patient nearly died to save him $1110

Medical education

Post-operative check

Shara Yurkiewicz

April 14, 2014Apr 14, 20142

It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery. Do you know where you are right now? Actually, you’re in the…

It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.

Do you know where you are right now?

Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …

Read more…

Post-operative check

Health policy

Why the future of health care can be found in the Cayman Islands

Robert Pearl, MD

April 9, 2014Apr 9, 201413

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status. While it lures many tourists and big banks, it’s…

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status.

While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon.

Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering …

Physician voices

What goes through a surgeon’s mind after a complication

Sid Schwab, MD

April 8, 2014Apr 8, 201436

One of the hardest things about being a surgeon is the inevitability of complications. It's true for any doctor; but with surgery, it's as if they are lit in neon and given a soundtrack. At least to me. Aiming for…

One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …

Health policy

Physician report cards make no difference in referral patterns

David B. Nash, MD, MBA

April 6, 2014Apr 6, 20143

Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing "report cards" that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery. Since that time, the…

Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing “report cards” that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery.

Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals.

Has …

Conditions and diseases

Is nerve block anesthesia better for surgery?

American Society of Anesthesiologists & Susan G. Curling, MD

April 6, 2014Apr 6, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More needles ... who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages.…

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

More needles … who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease your risk of complications.

Pain is a devilish thing. After surgery, it keeps …

Physician voices

Introducing yourself to patients is a patient safety issue

Peter Pronovost, MD, PhD

April 3, 2014Apr 3, 201411

One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …

Medical education

Did the NEJM publish a bad study about checklists?

Josh Herigon, MPH

March 30, 2014Mar 30, 20143

Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on…

Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on the subject, quickly wrote a rebuttal on the Incidental Economist. He writes, “I wish the Ontario study were better,” and I join him in that assessment, but want to take it a step further.

Gawande first criticizes …

Physician voices

Checklists alone do not produce a culture of vigilance

Dr. Saurabh Jha

March 30, 2014Mar 30, 20142

A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after…

As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who …

Physician voices

Can we measure what it takes to be a good doctor?

Ashish Jha, MD, MPH

March 28, 2014Mar 28, 20145

I recently spoke to a quality measures development organization and it got me thinking -- what makes a good doctor, and how do we measure it? In thinking about this, I reflected on how far we have come on quality…

I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?

In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …

Surgery and surgeons

Articles, page 48

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular