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.

We hide behind vague words for fear of not living up to specific ones

Shara Yurkiewicz

Medical Education

March 4, 2013

“Your hands feel like velvet,” the 94-year-old woman told me as I pushed on her abdomen in the emergency department on a Friday night.

“That’s the nicest thing anyone’s said to me all day,” I told her.

“That’s pretty sad,” she said, and her abdomen quivered as she suppressed a laugh.

I walked out of the curtained room and briefly presented her findings to the resident on call. In return, he showed me …

This is what it’s like to do an operation

Sid Schwab, MD

Physician

February 28, 2013

shutterstock_110842343

First in a continuing series.

With as much detail as is useful, and as descriptively as I can manage, I’d like to relate what it’s like to do an operation, from before laying knife on skin to after placing the bandage. I’m a general surgeon, so I choose sigmoid colectomy as my prototype; it’s always been one of my favorites, although the particular …

Operating on myself: What could possibly go wrong?

bongi, MD

Physician

February 26, 2013

As I have mentioned before, all surgeons think they are the best. Of course when we ourselves need surgery, there is a bit of a dilemma deciding who is the best qualified to carry out the procedure. So when I realized there was a strange looking skin lesion in my right inner thigh, I decided only the best would do to operate me.

In my rooms I informed the sister I …

Can you really choose a hospital based on the best price?

Trudy Lieberman

Patient

February 21, 2013

shutterstock_108241016

Consumerism in health care is coming to mean patients must shop around for the best price — for a doctor’s visit, Cipro, health insurance and maybe even your next operation. The marketplace gurus are telling us we can buy health care like TV sets and search for the lowest price tag.

But can you really choose a place for surgery based on the …

Anesthesiology and the heart: Working together for the best outcomes

John R. Rotruck, MD

Conditions and Diseases

February 19, 2013

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

February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to best care for one of the most important organs.

Each medical specialist takes great care to focus on …

Part of medical education is to learn limitations

Neil Baum, MD

Medical Education

February 16, 2013

There is a strong relationship comparing sports to the military, business, and also to medicine. Young athletes, in their late teens and early 20s, are mostly brawn and use their strength and speed to achieve success early in their professional careers. As the athlete matures in their late 20s and early 30s, the physiologic processes slowly decrease and efficiency and maturity and other cerebral skills emerge.

There are 2 rainbow arcs …

You’re still a doctor, even if you’re not on call

David Gelber, MD

Physician

February 13, 2013

Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.

“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.

Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.

So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …

Should we expect patients to think about costs?

Skeptical Scalpel, MD

Health Policy

February 9, 2013

Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …

The days of the primary care gatekeeper are coming to an end

Jeffrey Parks, MD

Physician

February 6, 2013

The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.

Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of …

Read more…

The days of the primary care gatekeeper are coming to an end

What are the different types of anesthesia?

Shirie Leng, MD

Physician

February 5, 2013

For most people, anesthesia is one of the more mysterious branches of medicine. What we do for patients is done, generally, when they are asleep. You the patient don’t exactly know what we are going to do, or how it’s done, but you put yourselves in our hands willingly. It’s sort of a weird relationship we have with other humans. We have done our job right if our patients don’t …

Anesthesia awareness: Look beyond the headlines

Karen S. Sibert, MD

Physician

January 31, 2013

Don’t be surprised if patients start asking more questions than usual about awareness under anesthesia. We can all thank a recent article in The Atlantic magazine, with a large-print headline on the cover: “Awake Under the Knife”. Written by a UCSF medical student in preclinical training, the article not only assures everyone that awareness can happen, but takes pains to point out that anesthesiologists can’t always prevent it.

The …

Quiet moments are a precious and rarely appreciated gift

Bruce Campbell, MD

Physician

January 30, 2013

How we spend our days is, of course, how we spend our lives.
-Annie Dillard

I wish I could add up all of the moments I spend waiting for things to happen.

I wait for computers to boot up. I wait for computer screens to load. I wait for programs to ask for and accept my user name and password for the umpteenth time so I can view a CT scan and then re-enter a different …

Big Joe: Living proof of our fallibility

Sid Schwab, MD

Physician

January 24, 2013

When I think of Big Joe, I see his overalls, and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of the earth, tough, stoic. On the day I met him, if it’d been Halloween, I might have tried to stick a candle in him. That’s how orange he was. My …

The quandary of resident involvement in surgical procedures

Bruce Campbell, MD

Physician

January 23, 2013

Skill to do comes of doing.
-Ralph Waldo Emerson

We are in the last steps of getting surgery arranged; the counseling is complete and the consent is on the clipboard. Just as the patient is putting pen to paper, she asks, “When I’m asleep, you’re not going to let some trainee practice on me, are you? I mean, I wouldn’t let the brand …

New Year’s resolution: Get healthy to improve surgical outcomes

Nina Singh-Radcliff, MD

Conditions and Diseases

January 15, 2013

Losing weight can decrease the incidence of several chronic and debilitating diseases, as well as their associated complications and risks during the surgical period. Additionally, it can facilitate recovery after surgery. Obesity increases the risk for:

Diabetes
Obstructive sleep apnea
Hypertension
Cardiovascular disease
Depression
Joint degeneration
Cancer

Additionally, obese patients may present special challenges for anesthesiologists:

Blood pressure monitoring (finding an appropriate fitting blood pressure cuff)
Locating …
Read more…

New Year’s resolution: Get healthy to improve surgical outcomes

The surgery gods can be your best friend or your worst enemy

David Gelber, MD

Physician

January 13, 2013

“Will this case take very long?”

“If the surgery gods are with me we should be done in an hour.”

The above brief exchange took place between me and the anesthesiologist attending to my patient on a recent surgery. The patient was a middle aged woman who was about to undergo surgery to relieve a small bowel obstruction. She had been visiting her husband in a distant city where he was working …

If your doctor won the lottery, would he show up for work?

Lisa Maurer, MD

Health Policy

January 10, 2013

Some physicians will make over 7 times what the average college dropout will earn over a lifetime. Even within medicine there are significant differences in lifetime earnings between primary care, surgery, and specialty care. With the recent Powerball lottery jackpot at a record high, there was a lot of daydreaming going on recently for many Americans, maybe even some doctors: What would you do if you actually won it all? …

The physicians of today have given up their unique soul

David Gelber, MD

Physician

January 4, 2013

I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in …

The role of faith in a patient beating long odds

Sid Schwab, MD

Physician

January 2, 2013

I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …

Patients have trouble giving true informed consent

Harriet A. Hall, MD

Physician

January 1, 2013

Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient. It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they …

Surgery

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts