A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than…
Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, as well as for acute and chronic pain, is nearly absent in many …
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.…
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 …
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…
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?
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…
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 …
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…
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 …
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.…
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 …
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…
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?”
Do ear surgeons perform facelifts? Absolutely! And we perform nose surgery and throat surgery, too! A recent article in the New York Times presented a scathing editorial on complications caused by poorly trained surgeons. However, the implication of the title…
Do ear surgeons perform facelifts? Absolutely!
And we perform nose surgery and throat surgery, too!
A recent article in the New York Times presented a scathing editorial on complications caused by poorly trained surgeons. However, the implication of the title “Ear surgeons performing facelifts,” is misleading and overlooks the fact that a large portion of training in the specialty of ear, nose and throat surgery includes plastic and reconstructive surgery of …
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…
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 …
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…
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 …
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…
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 …
“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…
“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 …
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…
I admittedly snorted out loud when I read a New York Timesarticle 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 …
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…
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 …
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…
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 …
Most of you are quite familiar with the rather astounding facts regarding medical errors. There are many reasons why medical errors occur in healthcare. There are errors in omission, there are errors because of poor communication, there is the ever…
Most of you are quite familiar with the rather astounding facts regarding medical errors. There are many reasons why medical errors occur in healthcare. There are errors in omission, there are errors because of poor communication, there is the ever present risk of human error and perhaps the ever increasing stress on physicians to see more and more patients in less and less time. …
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me…
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.
What kind of shoes should you wear in the hospital?
There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide …
The principle of autonomy is one of the four guiding principles of medical ethics, the others being beneficence, nonmaleficence, and justice. It means that patients have the right to decide what is done to their own bodies. For children under…
The principle of autonomy is one of the four guiding principles of medical ethics, the others being beneficence, nonmaleficence, and justice. It means that patients have the right to decide what is done to their own bodies. For children under eighteen, the age of majority, this means their parents decide for them. What happens when parents refuse a treatment that their child’s doctors recommend? (The right of a minor child …
What causes a doctor to commit suicide? A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected…
What causes a doctor to commit suicide?
A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …
It can’t be ignored that dramatic transformation in our healthcare system is imminent. The economy, market forces and increasing political demands will soon force physicians and healthcare professionals to change how we take care of our patients. Just as the…
It can’t be ignored that dramatic transformation in our healthcare system is imminent. The economy, market forces and increasing political demands will soon force physicians and healthcare professionals to change how we take care of our patients. Just as the days of housecalls are gone, so is our current system of delivering care.
The rising cost of healthcare now has the government and insurance companies placing more emphasis on controlling costs, …
