Surgery and surgeons

1,981 articles · Since 2004

Articles, page 60

The honor of patient responsibility

December 4, 2011Dec 4, 20117

"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their lungs, but ... no pressure". Gulp. I was holding the mask as tightly against her face as I…

“So the patient has been temporarily paralyzed by the drugs, and you’re the one keeping them alive by squeezing air into their lungs, but … no pressure”.

Gulp.

I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from …

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The honor of patient responsibility

Conditions and diseases

MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery

mksap

December 4, 2011Dec 4, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin is …

Health policy

Rigid regulation can become detrimental to patient care

David Gelber, MD

December 2, 2011Dec 2, 20117

The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, but does take time away that could be better utilized caring for our patients. However, the last four days have demonstrated that the administrative …

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Physician voices

I will never be the physician that my father was

Aaron E. Carroll, MD

November 25, 2011Nov 25, 201114

Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology. My father, now retired, was a…

Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …

Physician voices

Changing the incentives in the operating room

Nicholas Fogelson, MD

November 21, 2011Nov 21, 201115

Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical. In Freakonomics, Leavitt…

In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive …

Physician voices

In Kenya, operating in our comfort zone

Bruce Campbell, MD

November 19, 2011Nov 19, 2011

"Traveling makes one modest – you see what a tiny place you occupy in the world. " -Gustave Flaubert We have come to Kenya, expecting to work outside of our "comfort zones." Our patient has arrived from miles away, riding…

“Traveling makes one modest – you see what a tiny place you occupy in the world. ”
-Gustave Flaubert

We have come to Kenya, expecting to work outside of our “comfort zones.”

Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor …

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In Kenya, operating in our comfort zone

Physician voices

Considering cancer and heart disease in opposing ways

Norman Silverman, MD

November 18, 2011Nov 18, 20113

The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring…

Response to treatment of limited incidence and duration are accepted and deemed beneficial. …

Physician voices

Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

Karen S. Sibert, MD

November 17, 2011Nov 17, 2011146

No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use. What you may…

What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was.

The Centers for Medicare and …

Physician voices

In both my driving habits and my surgical practice, I look both ways

Dr. Martin Young

November 10, 2011Nov 10, 20113

I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are…

I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have …

Conditions and diseases

Treating Adele’s vocal cord hemorrhage

Christopher Chang, MD

November 6, 2011Nov 6, 20115

Before going any further, the title to a Los Angeles Times story was "Adele to have surgery to treat vocal cord hemorrhage. What is it?" I sincerely hope that whomever her surgeon is knows not to perform surgery when the…

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

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Treating Adele’s vocal cord hemorrhage

Conditions and diseases

Does your doctor really know what you should be eating?

Gregory A. Buford, MD

October 28, 2011Oct 28, 20116

For years, it has been widely known throughout the medical profession that basic education in nutrition for training physicians has simply been ineffective. And whether this failure was due to a lack of time or simply a failure of emphasis, the point remains that the medical profession in general is woefully inadequate when it comes to a sound knowledge base related to nutrition and its effects on optimal health. …

Health policy

Evidence based medicine removes a physician’s autonomy

Angry Orthopod, MD

October 24, 2011Oct 24, 201121

Evidence based medicine. Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who…

Evidence based medicine.

Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?

Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, …

Physician voices

Aggressive care at the end of life continues to grow

John Mandrola, MD

October 24, 2011Oct 24, 201117

There are important medical studies, and then there are landmark studies–the kind of science that disrupts the entire medical community. The most recent game-changer was published recently in the Lancet. Well known surgeon and author, Dr. Atul Gawande and colleagues…

Well known surgeon and author, Dr. Atul Gawande and colleagues published this important look-back study on the intensity and variation of surgical care of 1.8 million elderly patients in the US. They put numbers to the well-known and ever-expanding problem of …

Physician voices

Physicians who cash in on a woman’s desire to be beautiful

Linda Burke, MD

October 24, 2011Oct 24, 201114

Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered …

Conditions and diseases

Makes you want to pull your hair out: Treating trichotillomania

Edwin Suddleson, MD

October 21, 2011Oct 21, 2011

One of the saddest, but more treatable, causes of hair loss in patients is trichotillomania, the impulse control disorder in which a person repeatedly pulls out hair from their body for non-cosmetic reasons. While some people have never even heard of trichotillomania, according to the Trichotillomania Learning Center, as many as ten million Americans (or 4% of the U.S. population) suffer from the disorder.

According to the Diagnositic and Statistical Manual …

Physician voices

Why haven’t surgeons been on the front line of public health?

Andrew M. Ibrahim, MD

October 20, 2011Oct 20, 2011

Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical …

Physician voices

Cardiac surgery is a team sport

Norman Silverman, MD

October 16, 2011Oct 16, 20116

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

Physician voices

The decision not to become a surgeon

Jim deMaine, MD

October 12, 2011Oct 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…

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

Physician voices

Transparency in health care preserves our ability to innovate and grow

Michael Tarnoff, MD

October 9, 2011Oct 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…

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

Patient voices

Is teaching bedside manner a thing of the past?

Jackie Fox

October 6, 2011Oct 6, 20117

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

Surgery and surgeons

Articles, page 60

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