KevinMD.com: Social media’s leading physician voice
The KevinMD newsletterReal physician voices, twice a weekFree, and one click to unsubscribe.
Subscribe free →
NEWExperts by KevinMDPhysicians and health care experts, by specialty.Jessie MahoneyPediatricianErin J. SilvertoothPsychiatrist and internistHowie MellEmergency physicianMarco FernandezCardiac anesthesiologistEmily WattersPsychiatristBarbara SparacinoPsychiatristGus W. KruckeInternistFranklyn R. GergitsOtolaryngologistSarima ChindaDentistAngelika LuehrsConsultant psychiatristVikas PatelEmergency physicianAli NovitskyObesity medicine physicianSanjeev SharmaEmergency physicianJ. Todd WalkerOrthopedic surgeonFady Hannah-ShmouniEndocrinologistBobby DuboisInternistCraig HaubenHealth care CEORao M. UppuEnvironmental toxicologistKaran KanwarTechnology CEONicole Drapeau GillenFamily caregiver advocateBrowse experts

Surgery and surgeons

1,981 articles · Since 2004

Articles, page 56

Physician voices

Operating on the hypercritically ill

I'm certain that if I hadn't been just finishing a midnight appendectomy, Daphne would have died. Not fully balancing all the bad luck in her life, she fortuitously chose to exsanguinate when a surgeon and OR staff were immediately available.…

I’m certain that if I hadn’t been just finishing a midnight appendectomy, Daphne would have died. Not fully balancing all the bad luck in her life, she fortuitously chose to exsanguinate when a surgeon and OR staff were immediately available. Nevertheless, vomiting all that blood, she damn near died before she got to the hospital.

Niceties like passing a scope to find …

Read more…

Operating on the hypercritically ill

Physician voices

Shopping for items in the operating room

You may have noticed that stores everywhere, and restaurants, too, are getting mobile -- as in mobile technology. In a store like Nordstrom, where thousands of items in many departments must be inventoried and managed, it saves a lot of…

You may have noticed that stores everywhere, and restaurants, too, are getting mobile — as in mobile technology.  In a store like Nordstrom, where thousands of items in many departments must be inventoried and managed, it saves a lot of time, personnel, and therefore money, at least for the store.  From last season’s belts to the spring’s platform shoes, it is in the system, on the iPod and available for …

Read more…

Shopping for items in the operating room

Physician voices

4 reasons why doctors should be outraged

21

Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication…

Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication we requested.

Outrage #2: Choosing a medication for cost, not effectiveness. A child cannot breathe because the acid and other nasty stomach …

Read more…

4 reasons why doctors should be outraged

Real physician voices, twice a week

Free, and one click to unsubscribe.

No spam. We never share your email.

Physician voices

Stopping extensive pre-op testing requires malpractice reform

6

As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared. A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in…

As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared.

A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% …

Read more…

Stopping extensive pre-op testing requires malpractice reform

Conditions and diseases

The benefit of CT scans for the diagnosis of appendicitis

Amid the mounting concern about radiation exposure and future increases in cancer rates comes a report from Washington State describing the benefits of imaging, particularly CT scanning, for the diagnosis of appendicitis. The authors collected data from some 55 hospitals…

Amid the mounting concern about radiation exposure and future increases in cancer rates comes a report from Washington State describing the benefits of imaging, particularly CT scanning, for the diagnosis of appendicitis.

The authors collected data from some 55 hospitals of all types and sizes over a six-year period for more than 19,300 patients older than age 15; 91% of patients underwent one or more imaging studies. There were …

Read more…

The benefit of CT scans for the diagnosis of appendicitis

Physician voices

How pain control comes from the front and back

2

She had only been in the hospital twice in her life: once when she was nine and now, 60 years later. She had gotten tonsils out then. She was getting tumors out now. Her abdomen hurt when she was awake.…

She had only been in the hospital twice in her life: once when she was nine and now, 60 years later.  She had gotten tonsils out then.  She was getting tumors out now.

Her abdomen hurt when she was awake.  Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia.  Her body would feel it, though, and could respond by dangerously spiking …

Read more…

How pain control comes from the front and back

Physician voices

Income inequality among physicians should matter to patients

6

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.” This in…

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …

Read more…

Income inequality among physicians should matter to patients

Physician voices

Mean doctors and nice nurses: It’s time to change our brand

84

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn't lost weight and clearly was feeling discouraged about practically everything. She was…

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery.  She hadn’t lost weight and clearly was feeling discouraged about practically everything.  She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

Read more…

Mean doctors and nice nurses: It’s time to change our brand

Physician voices

Why are we still failing patients despite open communication?

2

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to…

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.

I have never paid much attention to these tests. The nurses …

Read more…

Why are we still failing patients despite open communication?

Physician voices

Recognize and manage physician stress and burnout

3

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. "The tragedy of man is what dies inside himself while he still lives." - Albert Schweitzer Statistically speaking When is the last day you truly remember feeling peace,…

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

“The tragedy of man is what dies inside himself while he still lives.”
– Albert Schweitzer

Statistically speaking

When is the last day you truly remember feeling peace, happiness and a deep sense of well being? If you cannot answer this question, you are not alone among your physician colleagues. Doctors, in general, tend to die at an earlier age …

Read more…

Recognize and manage physician stress and burnout

Physician voices

The chef and the surgeon have much in common

From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon. Though many on the outside may…

From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.

Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …

Read more…

The chef and the surgeon have much in common

Physician voices

Performing surgery is not about empathy

3

The Surgeon had been handicapped by a burr in the plantar aspect of his left foot. All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning.…

The Surgeon had been handicapped by a burr in the plantar aspect of his left foot.  All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning.  There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp …

Read more…

Performing surgery is not about empathy

Patient voices

Having patient satisfaction data isn’t enough to choose a hospital

5

When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I…

When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I discovered, I wondered if perhaps a few measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients …

Read more…

Having patient satisfaction data isn’t enough to choose a hospital

Patient voices

Give patients the pros and cons of treatment options

2

If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons. While that seems like common sense, millions of people say "yes" without learning all the…

If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons.

While that seems like common sense, millions of people say “yes” without learning all the facts.

Some simply rely on the trust they have in their physician. Others assume the known benefits and risks are too complicated to fully understand. And some people just want to get …

Read more…

Give patients the pros and cons of treatment options

Physician voices

From surgeon to management: Was my decision selfish?

2

She was in her late thirties when her medical oncologist asked me to see her. Five years before, one of our community surgeons had removed part of her colon for cancer. She also had a recognized, single metastatic tumor in…

She was in her late thirties when her medical oncologist asked me to see her.  Five years before, one of our community surgeons had removed part of her colon for cancer.  She also had a recognized, single metastatic tumor in her liver at the time of that original surgery.

The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance …

Read more…

From surgeon to management: Was my decision selfish?

Physician voices

Oral board exams: A window into how you behave in the operating room

2

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta…

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there …

Read more…

Oral board exams: A window into how you behave in the operating room

Medical education

How to steel myself against this profession I have chosen

6

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…

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 …

Read more…

How to steel myself against this profession I have chosen

Physician voices

Why doctors don’t like to go to doctors

3

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…

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 …

Read more…

Why doctors don’t like to go to doctors

Physician voices

I am proud to have my father’s hands

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…

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 …

Read more…

I am proud to have my father’s hands

Physician voices

The Surgeon places hands on belly and the diagnosis is clear

9

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…

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 …

Read more…

The Surgeon places hands on belly and the diagnosis is clear

66
pages