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.

Cardiac surgery is a team sport

Norman Silverman, MD

Physician

October 16, 2011

It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical …

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Cardiac surgery is a team sport

The decision not to become a surgeon

Jim deMaine, MD

Physician

October 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

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The decision not to become a surgeon

Transparency in health care preserves our ability to innovate and grow

Michael Tarnoff, MD

Physician

October 9, 2011

Collaboration between medical professionals and the healthcare products industry has long been vital to advancing patient care and safety. Healthcare professionals help companies better understand unmet clinical needs, while companies invest in innovative research and product development that are squarely focused on improving patient care and enhancing patient safety.

As a society, we should acknowledge the value of these bona fide relationships. Balanced provider input into corporate decision-making has broad …

Is teaching bedside manner a thing of the past?

Jackie Fox

Patient

October 6, 2011

I caught the tail end of a recent #hcsm (health-care social media) tweetchat and it looked to be a good one. I saw a few comments about teaching bedside manner and whether it’s a thing of the past (oh, how I hope not). It occurred to me that sharing a real-life story could be instructive.

I put on a brave face when I got a mastectomy for stage 0 DCIS …

Patients and families must be tireless in expressing any frustrations

Norman Silverman, MD

Patient

October 4, 2011

I was reading the other day in a magazine the personal account of a woman who had a “perfect example of a mitral valve click” (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like …

Is medical tourism a dire threat to American surgeons?

Richard N. Fogoros, MD

Physician

September 30, 2011

In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made …

Discussing a colostomy in a patient with rectal cancer

Sid Schwab, MD

Conditions and Diseases

September 21, 2011

Sturdy and thickly-built, long since widowed, cheery in a sardonic sort of way, tough and opinionated, Flora’s European roots ran deep; she’d been an Italian farm girl, and she’d rather be in her garden than anywhere else. The only reason she agreed to come inside and go to the doctor was that her bowel movements had finally gotten too painful, and too bloody to ignore. Which she had been doing, …

The shortage of general surgeons demands attention

Skeptical Scalpel, MD

Physician

September 17, 2011

There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.

Demand-side facts

The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.

As baby boomers age, the increase …

The dual tragedy of suffering catastrophic illness and being uninsured

John Maa, MD

Patient

September 9, 2011

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.

One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I …

The graveyard hidden in a surgeon’s mind

bongi, MD

Physician

September 9, 2011

This is a difficult story to tell but if I am to be true to the complete experience of a surgeon, I do need to tell it.

One of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. He went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. …

Don’t always blame anesthesia for problems in the OR

Anesthesioboist T., MD

Physician

September 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

Heart valve repair without open surgery

Stephen C. Schimpff, MD

Conditions and Diseases

September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

The emotional costs of malpractice mean more to doctors than money

Kevin Pho, MD

KevinMD

August 19, 2011

Every year, according to a recent study from the New England Journal of Medicine, a typical physician has about a 7% chance of being sued for medical malpractice.

Surgeons almost certainly will face a malpractice claim sometime during their career. Neurosurgeons, for instance, have a 19.1% chance of being sued in a given year, while that number is 18.9% for …

What do tonsils do and why would we take them out?

Christopher Johnson, MD

Conditions and Diseases

August 19, 2011

There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …

Demystifying anesthesia to put patients at ease

Kenneth Elmassian, DO

Patient

August 15, 2011

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

As patient safety advocates responsible for monitoring vital signs, managing pain and safeguarding a patient’s overall health through the surgical process, anesthesiologists are committed to informing patients about the anesthesia experience. The American Society of Anesthesiologists (ASA) and the Michigan Society of Anesthesiologists (MSA) have launched a new public education campaign to help patients better prepare and …

The different types of frail to consider before surgery

Bruce Campbell, MD

Patient

August 6, 2011

“If I’d known I was going to live this long, I would have taken better care of myself.”
-Eubie Blake

He leaned forward, energetically listening to my conversation with his daughter. There was more than one cancer treatment option. We reviewed everything and she asked what he could expect with either a major surgery or seven weeks of daily radiation treatments. Soon, both the father and daughter were peppering me with questions about …

The different ways hysterectomy can be performed

Suzanne Hall, MD

Conditions and Diseases

August 3, 2011

When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.

There are several routes by which a hysterectomy can be performed. You and your gynecologist …

Why physicians are clueless about malpractice implications of DVTs

Angry Orthopod, MD

Physician

July 29, 2011

A medical malpractice attorney and an orthopaedic surgeon are on a golf trip. This sounds like the worst joke of all time, but it’s actually the story of my brother and I 20 years ago.

Amidst the rough, he laid some serious philosophy on me. In most families, that might be about life and love and whatnot. Not in our family. We were engaged about deep venous thrombosis (DVT) and …

Perfect is the enemy of good when it comes to work-life balance

gcs15, MD

Physician

July 26, 2011

Over the years, I have come to the painful realization that I am not perfect.

Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don’t read this, patients, because you wish even more than I do that I were perfect (especially when I’m operating on you). But it’s true.

Long ago, I remember feeling …

If I could pick patients, they would be Native American Guatemalans

Chris Porter, MD

Physician

July 25, 2011

Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.

A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also …

Surgery

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