The relationship a physician has not only with their patients, but also with their patient’s families, has long been the foundation of the medical system.
Over the course of time this once valued bond has had its ups and downs; however today with the internet, Obama healthcare reform, and Medicare cuts to name a few, the doctor-patient relationship finds itself in its …
Physician characteristics that are universally appreciated
This has been a very busy week already. I have seen many second opinions and I am always very interested in the reason why the patient initiated the second opinion.
In many situations it was simply to see if I would perform the surgery. After I spent a while listening to the patient, examining them and coming up with an appropriate …
Why patients seek a second opinion
Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea.
Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from …
7 procedures that can affect the way you breathe and sleep
Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.
Suppressing the urge to tell him not to even consider …
Think about medical school tuition debt before becoming a doctor
Pauline Chen had a post in the New York Times recently about surgical informed consent. Informed consent is an important part of the surgeon/patient communication transaction.
Surgeon reviews the proposed operation, the rationale behind it, and the possible complications. For example— a patient comes in with biliary colic. We describe the anatomy and pathology. We aver that surgical resection will lead to …
Implications of the surgical buy in when discussing informed consent
Overeating is not a surgical problem.
This may seem to be a statement of the obvious, but the solution to a behavioral problem is not surgery. Overeating is not a surgical problem — it is a behavioral one. The problem is not because the stomach is too big and needs to be made smaller. It is a function of how …
Overeating is a behavioral problem, not a surgical one
(Editor’s note: reader discretion advised)
Recently I was involved in a discussion with a guy that was explaining how we should understand criminals. The emphasis was on farm murders but we touched on murderers in general, rapists and child molesters. My point of view was that I did not understand them and felt that he was justifying their actions. In the end I was informed that I was smug. Apparently that …
A surgeon on those who understand murderers, rapists and child molesters
One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.
At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately. So what really is the difference between the two?
A complication may be described as …
Surgical error: The difference between mistake and complication
As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule.
The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the …
Time with your patients in the hospital and time with your children
Very few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide. We are often left alone, with the painful questions,
“Why?”
“What could we have done differently?”
Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ideations in the …
Your physician may be thinking about suicide
“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were half-way through a thyroid operation and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, and Doug, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best surgeon …
Closed loop bowel obstruction in your surgical partner
One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.
By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …
Can a doctor and a nurse be friends in the OR?
I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients.
Burnout starts early in residency, with entering interns having a depression rate of 4%, similar to the general public. But after the first year of residency, that number balloons to 25%.
Now, another study adds fuel to this disturbing trend.
A paper published in the Archives of General Surgery …
Your surgeon may be contemplating suicide
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I recently finished my 10 weeks in Internal Medicine and have moved on to 1 week each of Ophthalmology, Neurosurgery, Anesthesiology, and Otolaryngology. This week: brain surgery. (Tomorrow, the world.)
In 3rd grade, I wrote “I want to be a brain surgen [sic].” Ever since, it’s been a goal of mine to be a neurosurgeon. Well, until college … when other interests and the anticipated reality of a 7+ year residency …
How surgery is a team sport, and in awe of neurosurgery
In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.
The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.
As summarized in the WSJ’s Health Blog, …
Should surgeons tell patients how much sleep they had?
I recently finished my two months of surgery rotations.
I am happy to say that I really enjoyed my surgery rotations. I thought I was going to be intimidated by the OR, but I found it fascinating. I am relieved, since surgery is a big part of OB/GYN.
Here are a few things I learned on my surgery rotation:
Successful surgery rotation tips
Several years ago, I spoke at Baylor College of Medicine in Houston, where Michael DeBakey, the legendary heart surgeon, was master of the universe for nearly half a century.
I heard lots of DeBakey stories during my visit, but one in particular really stuck with me. “A few years back,” someone told me in a voice of hushed reverence usually reserved for descriptions of flawless beach days and single …
I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …
Stercoral perforation as a deadly cause of colon rupture
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …
MKSAP: 70-year-old woman with hypothyroidism and a fractured hip
I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.
To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …
A neurosurgical resident’s typical day
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