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.

How to steel myself against this profession I have chosen

Shara Yurkiewicz

Medical Education

October 25, 2012

An elderly man startles awake after a man in a white coat touches his shoulder. He looks around and sees three other white-coated people standing around his bed.

“Sir? Good afternoon, sir. How are you?” says the man who touched the patient’s shoulder.

“Oh, I’m fine.” He’s perfectly calm.

“I know this is a silly question,” continues the man, “but do you know where you are right now?”

“Of course, of course. I’m at …

Why doctors don’t like to go to doctors

bongi, MD

Physician

October 24, 2012

Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …

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Why doctors don’t like to go to doctors

I am proud to have my father’s hands

Miranda Fielding, MD

Physician

October 18, 2012

I never gave my hands much thought until a few years ago. They were never pretty, but they were functional serviceable hands that did what they were asked—I could examine a patient, type fast and accurately enough, and everyone always told me that my handwriting was outstanding. That has always been a point of pride for I knew that I was never going to kill a patient because a pharmacist …

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I am proud to have my father’s hands

The Surgeon places hands on belly and the diagnosis is clear

Jeffrey Parks, MD

Physician

October 14, 2012

The call comes in at 9pm or so. The patient sounds sick as all hell. The Surgeon listens to the random assortment of numbers and vitals the nurse provides and clicks off his cell. He finishes reading a boring Berenstain Bear story to his daughter and tucks her into bed. He looks at the clock and runs some mental numbers. By the time he arrives at Hospital, close to ten. See the …

How a drug addicted scrub tech changed my life forever

Kate O'Reilley, MD

Physician

October 10, 2012

It was a cold winter day in 2009 when my life changed forever, however, it would be months before I figured that out. On that fateful day, a drug-addicted surgical scrub tech assigned to my operating room stole syringes of fentanyl, a potent intravenous narcotic, from my anesthesia cart. According to news reports, investigative summaries, and the scrub tech’s confession, once she took the syringes, she used them on herself.

It’s …

In the OR during an appendectomy, an unexpected visitor

Jim deMaine, MD

Physician

October 8, 2012

It was Trevor’s first weekend to relax since moving to Seattle. He was out in a park walking Bailey, his year old lab, when his pager unexpectedly beeped. He called in to the operating room office, where the frantic head nurse told him he had to come in. The scheduled anesthesiologist was very ill with the flu, and no one else was available. He had to come in for at …

Why going to a board certified plastic surgeon is important

Usha Rajagopal, MD

Physician

October 6, 2012

The popularity of plastic surgery today is no secret; 13.8 million cosmetic procedures were performed in 2011 alone. Unfortunately, however, an increasing (and unsettling) number of people in the United States are undergoing procedures conducted by unlicensed, so-called “underground,” individuals these days—individuals who have no business billing themselves as plastic surgeons.

The primary factor leading people to the doors of these backdoor doctors is, of course, cost. There’s no way around …

Morning rounds in the SICU

Amanda Xi, MD

Medical Education

September 27, 2012

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination, a small room containing a couple desks and computers dedicated to mid-level providers, but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it …

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Morning rounds in the SICU

My first day as a surgery intern

Richard Patterson, MD

Physician

September 23, 2012

Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who:

1. combine the MD with a JD or PhD;

2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums;

3. are named Michael Crichton.

Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery …

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My first day as a surgery intern

As I reach the end of my career, I empathize more with my patients

Skeptical Scalpel, MD

Physician

September 20, 2012

As I contemplate retirement from clinical practice as a general surgeon, something I’ve been doing for over 41 years including residency, I’ve been having some unsettling thoughts.

Like many physicians, I’ve tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long.

I have written in a previous blog about the …

Remember the Professionalism APGAR during times of stress

Dawn Baker, MD

Physician

September 17, 2012

What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients …

The ethics of conducting a pelvic exam on an anesthetized woman

Peter Ubel, MD

Physician

September 12, 2012

I felt a woman’s uterus without her permission. How this happened, and why I thought I had done the right thing at the time, tells us something important about medical education and shows us why doctor/patient interactions often play out like conversations between earthlings and aliens.

To understand my inappropriate actions, you need to know something about the physical exams that we physicians conduct on our patients. More specifically, about the …

Why I’m thankful for my son’s surgery team

Anesthesioboist T., MD

Physician

September 6, 2012

My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine – healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He …

Why doctors complain: A history of physician income

Richard Patterson, MD

Physician

September 2, 2012

We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.

Let’s deal with …

Only trained physicians should provide interventional pain services

Asokumar Buvanendran, MD

Physician

August 29, 2012

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

As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most …

Inducing anesthesia on YouTube: How many ways is this wrong?

Karen S. Sibert, MD

Physician

August 24, 2012

Really, sir. What were you thinking?

I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol. Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow.

I would insert the link here, but the …

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

Physician

August 17, 2012

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

Work-life balance in medicine: Is it possible?

Karen S. Sibert, MD

Physician

August 13, 2012

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two …

Why do we teach surgery the same way we did 40 years ago?

Skeptical Scalpel, MD

Medical Education

July 27, 2012

When I was a surgical residency program director, I often wondered what the establishment, you know those guys who ran surgical education, was thinking. Some may remember the rule that a resident had to see at least 50% of the patients he operated on in the clinic or the private surgeon’s office in order to claim credit for having done the case.

There was the emphasis that still exists today on …

Dr. Google is currently only medical student Google

Linda Pourmassina, MD

Physician

July 27, 2012

A few days ago, I came across an article entitled “Calling Dr. Google” by Jeff Jarvis. The writer describes his experience “Googling” his symptoms and finding that the internet brought him the correct diagnosis. He uses his personal story of appendicitis to point out that physician fear of information on the internet is overblown.

One would hope that the argument that you cannot find any trustworthy information on the web is …