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.

Video review of surgeons: Can the logistical issues be overcome?

Skeptical Scalpel, MD

Physician

November 13, 2013

Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes.

Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited …

Everything’s my fault: How a surgeon says I’m sorry

Lara Devgan, MD, MPH

Physician

November 9, 2013

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When I started my surgical internship, my chief resident told me some magic words: Whenever something bad happens, stay calm and say, “I assume full responsibility. It won’t happen again.”

As a young surgeon at the bottom of the totem pole, those words were my mantra for the times when someone’s head was going to roll. In those nascent days of my …

The remarkable resiliency of the human body

David Gelber, MD

Conditions and Diseases

November 1, 2013

Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air.

The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents …

Plastic surgery is about more than cosmetic procedures

Lara Devgan, MD, MPH

Physician

October 31, 2013

Halsted once described plastic surgeons as “the surgeon’s surgeons.” Yet in today’s era of media hype about cosmetic surgery, this turn of phrase feels long-forgotten. Despite what reality television may have you believe, the specialty remains at its core about reconstructive surgery, and collaboration is still a key element.

Here, a few points that show those words are as true now as they ever were:

We manage a patient’s expectations. Patients may have …

The memories of my first hospital job remain fresh

Bruce Campbell, MD

Physician

October 31, 2013

You cannot connect the dots looking forward; you can only connect them looking backwards.
-Steve Jobs

“Doesn’t that window open any wider? Bring in another fan!” the surgeon demands.

Beads of sweat gather at the edge of his cloth cap and the circulating nurse steps up periodically to wipe them away. Heat and city noise roll through the open windows and into the operating room. The brief morning rain shower has left the …

How video can reduce medical errors and improve patient care

Robert Wachter, MD

Health Technology

October 28, 2013

About eight years ago I was desperate to improve my golf game. I just couldn’t straighten out my drives or hit my irons crisply. (Yes, I’m fully aware that this is a first world problem). I decided to try golf camp in Palm Springs for a few days.

My sensei, a crusty ex-touring pro named Artie McNickle, watched me hit several dozen balls on the driving range, video recorder running. “So, …

Tales of two nights before hip surgery

Hans Duvefelt, MD

Physician

October 23, 2013

On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order — the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted.

Every step was deliberate, slow and painful. Whenever he …

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Tales of two nights before hip surgery

Insurers should stop paying for robotic hysterectomies

Jennifer Gunter, MD

Physician

October 21, 2013

A new study confirms what previous studies tell us. That a robotic hysterectomy is not a safer or a more efficient way to remove a uterus for non-cancerous (benign) surgery than a traditional laparoscopic approach. This study indicates that there is little difference between the two types of surgery with one glaring exception, a robotic hysterectomy was $2,489 more expensive than a laparoscopic hysterectomy.

Several months ago the American Congress of Obstetricians …

Not all adverse events are preventable

Skeptical Scalpel, MD

Physician

October 16, 2013

Medical errors are a real problem. I won’t deny that.

It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …

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Not all adverse events are preventable

I no longer wanted to be a surgeon

bongi, MD

Physician

October 16, 2013

It was a battle. Looking back I don’t think we ever had a chance, but you don’t just give up on a young man in the prime of his life. We had to try. He was my patient.

He was a foreigner, on a gap year in Africa where he was going to learn all sorts of things about conservation and African wildlife. Up until the accident, all had apparently gone …

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I no longer wanted to be a surgeon

Medical training is a product of willful preparation

David L. Katz, MD

Physician

October 15, 2013

I have been a loyal patron of the Karma Hair Salon in New Haven, Conn. for at least the past 15 years. Whenever my hair looks good, it is thanks to Karma and owner Cheryl McMahon’s expert attention to my unruly head (the thickness of my hair — a good problem, I know! — could give a yak envy; and I have more cowlicks than several small countries). If ever my hair doesn’t look …

A tiny baby on a big table in a huge OR

Sid Schwab, MD

Conditions and Diseases

October 13, 2013

The potential to do dramatic good, as is the case with surgery, means that sitting and staring back at you at the other end of the see-saw is a grinning dysmorphic ogre. He keeps his eyes locked on yours, staring with the smug certainty that you can’t toss him off, up when you’re down; down when you’re up. The ugly little sonovabitch never goes away. It’s an issue for every healthcare provider. Were it …

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A tiny baby on a big table in a huge OR

The OR is not a good place for a prank

Skeptical Scalpel, MD

Social Media in Medicine

October 2, 2013

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”

And if that wasn’t bad enough, a “nursing attendant” took a photograph.

The patient, who said she had to quit her job …

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The OR is not a good place for a prank

The latest salvo in the federal government’s war on physicians

Karen S. Sibert, MD

Physician

September 27, 2013

The latest salvo in the federal government’s war on physicians comes to us courtesy of the Veterans Health Administration (VHA), which is proposing drastic policy changes to expand nursing scope of practice in all veterans’ hospitals.

A new draft VHA Nursing Handbook would eradicate all existing VHA policies concerning physician supervision, and would designate all advanced practice registered nurses (APRNs), including nurse anesthetists, as licensed independent practitioners (LIPs). This means that …

A 77 percent success rate is good enough for a guy without insurance

Andrew T. Gray, PA-C

Patient

September 26, 2013

The doctor was adamant. “This is America, not Sweden,” he told me. “We operate.”

How did this happen to me? I wondered, looking at him across the ER exam room. How could I, a healthcare provider, not have insurance?

I had woken up that morning with a mildly upset stomach. Nonetheless, I’d gone to my job (begun only six weeks earlier) as a physician assistant at a Beverly Hills HIV clinic. I’d seen patients …

3 stories of surgeons that I find disturbing

Skeptical Scalpel, MD

Physician

September 23, 2013

An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.

There is also said to be evidence showing that in one day he was doing as many …

With the patient hemorrhaging, doctors are backed into a corner

Jordan Grumet, MD

Physician

September 23, 2013

We were pretty damn lucky that she was young and healthy.

The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.

It was a routine hysterectomy. None of the pizazz and flare of a gynecology-oncology surgery, but …

The horror and beauty of performing an amputation

Sid Schwab, MD

Physician

September 22, 2013

There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.

Stark and …

Painting in the OR: The evolution of surgical preparation

David Gelber, MD

Physician

September 16, 2013

One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts.

I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and …

Google Glass for medicine: 4 reasons why it could be disastrous

Matthew Katz, MD

Health Technology

September 14, 2013

The buzz is that Google Glass will transform medicine. But unless it’s carefully vetted it could be a disaster for patients, clinicians and hospitals. Until the FDA or research confirms its safety, Google Glass is banned from my clinic as a privacy and medical practice hazard.

Here are four reasons why:

1. Privacy violations. Google Glass make it extremely easy to take pictures or …