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.
It’s cool. So cool, that President Obama used one. So cool, it’s been on the cover of Newsweek. It’s been in multiple television commercials, radio advertisements, highway billboards, and was even coined one of the top 14 medical breakthroughs of 2011 by Boston Magazine, a city teeming with medical innovation. Yet surgeons and health economists are unable to explain the fascinating rise of robotic-assisted surgery.
Currently, a single company manufactures and …
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Why isn’t everyone excited about robotic assisted surgery?
Does muscle weakness improve after disc surgery?
For an NFL fan arguably the best thing that could happen to your team is to sign Peyton Manning and have him perform at or near his pre-injury level. The corollary is that one of the worst things to happen to your team would be to take a huge salary cap hit to get a Peyton Manning with such weak throwing arm that even …
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Will Peyton Manning ever fully recover from his spinal nerve injury?
If you live in southern California, you can’t miss the billboards advertising laparoscopic gastric banding at “1-800-GET-THIN” outpatient surgery centers. They feature happy people who’ve lost 100 pounds or more, and urge you to “let your new life begin” by having a “lap band” inserted. Fees at these centers are much lower than they are at university medical centers or other major hospitals.
Recently, however, those surgery centers and their owners …
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Why would anyone believe that cheap surgery is a good choice?
Since the America Society of Plastic Surgeons (ASPS) released their 2011 plastic surgery statistics, I’ve seen a lot of talk online about how, “despite the economy,” plastic surgery numbers are rebounding from the lows they hit in 2007 and 2008. People say this as if plastic surgery is—against all odds—somehow rising above the general trends and setting unprecedented records.
I can see why it’s tempting to frame it that way—while the …
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Plastic surgery as an economic indicator
In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn’t relax, and I was always irritated. Even a few days off didn’t help because of the mountain of phone calls and paperwork waiting for me upon return to work. I asked myself, is this burnout?
Coincidentally, I happened …
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How locum tenens can solve physician burnout
One of the curses of kalafong (hell) was that there was no neurosurgical service. This meant us mere general surgeons had to handle the many head injuries that came in.
So, for example, when some guy decided to cave in the head of his so-called best friend with a five iron on the golf course because they had started with the nineteenth hole instead of the first, we ended up either …
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Extubating the overzealously intubated patient
There’s been a great divide between the medical and surgical specialties ever since I can remember. Surgeons believe internists perseverate too much when decisions need to be made. Internists consider themselves the true intellectuals of medicine. I suppose anesthesiologists like me fall somewhere in the middle–we work in surgery, but have to take care of all the medical problems the patient brings to the OR table. Does that make us …
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Are anesthesiologists the last true generalists?
Back in the 1990’s, my husband and I spent a year working at one of the largest hospitals in West Virginia. The patients were the nicest people in the world, and the hospital staff was terrific—kind, generous, and hard working. Some of the surgeons were excellent, but others definitely were not. My husband (a cardiac anesthesiologist) and I had to cope with surgical complications the likes of which we had …
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When is it better for doctors to make mistakes?
I have tried to write a letter of thanks but don’t know what to say or even how to begin. I don’t know the persons I am writing to, but part of their loved one is literally now a part of me.
It began with a phone call from my brother. “Jim, what the hell is Fuchs’ Dystrophy anyway – do you have it too?”
I racked my brain and tried to …
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A letter of thanks to my organ donor
I’ve only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case the heart had stopped beating. Death was clear.
Brain death is tougher to cope with, both clinically and psychologically. I imagine it would make anyone want to say, at some point, “Are you sure? Are you really sure? How do you know? How can you be sure?” Some times …
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Why an anesthesiologist would be needed for organ donation
Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of …
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How algorithm driven medicine can affect patient care
If you’ve ever spent time in the operating room, you are already familiar with the words the circulating nurse uses to signal the time out – the few minutes before a procedure begins when the surgical and anesthesia teams review a patient’s case. If you’re a non-medical type, or a medical student whose surgical rotations are scheduled late in the 3rd year, then you’re just as clueless as I was …
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Appreciating the beauty of a time out in the OR
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about a decade ago. From it we learned that anywhere from 44,000 to 98,000 individuals die each year of preventable medical errors (and other sources suggest the number might even be much higher). In this continuing series of posts on disruptive and transformational technologies, there are some that can …
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Innovative technologies can markedly enhance safety
I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.
There is no question that electronic devices distract physicians as the article pointed out. But that’s like complaining about a leaky faucet when there’s a flooded basement …
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Paperwork causes unintended distractions for physicians and nurses
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: “Question is: are there more things in nursing, Horatio, than science can explain? Can we touch patients and zap them with calmness or take away their pain? Can we, by our mindset during our provision of care, substantially affect our patients’ outcomes? Can any of this be taught? Can we do …
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How touch can calm patients
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care across time and geographical space barriers. Robotics offers the opportunity to enhance quality of care through extension of clinical expertise and leveraging of integrated datasets and best practices. It can be used across the continuum–from the hospital setting (e.g. OR, ER, etc.) into primary care offices and even …
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Robotics can revolutionize the delivery of medical care
