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.

There is no routine procedure in general surgery

Jeffrey Parks, MD

Physician

November 23, 2010

The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.

One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …

Noninvasive fat removal in plastic surgery

Anthony Youn, MD

Conditions and Diseases

November 23, 2010

One of the hottest things in plastic surgery is noninvasive fat removal.

I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis? Does this device actually remove fat without surgery or needles?

Well, let’s review the different fat removing technologies:

1. Diet and exercise. The …

Using the internet for health information before surgery

Lisa Gualtieri, PhD

Patient

November 11, 2010

Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.

She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her …

Advice for a second year medical student

Skeptical Scalpel, MD

Medical Education

October 16, 2010

A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.

I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai …

Should CRNAs practice anesthesiology without physician supervision?

Jeffrey Parks, MD

Physician

October 5, 2010

Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …

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Should CRNAs practice anesthesiology without physician supervision?

Cosmetic foot surgery can have serious downsides

Howard Luks, MD

Physician

September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Cosmetic foot surgery can have serious downsides

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

Physician

September 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Preparing for gastric bypass surgery by eating more

Douglas Perednia, MD

Conditions and Diseases

September 2, 2010

Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.

This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with …

Watchful waiting pays off for a torn ACL

Merrill Goozner

Conditions and Diseases

August 30, 2010

“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.

My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in …

Does a stereotypical surgical personality exist?

Kevin

Physician

August 28, 2010

by Shawn Vuong

Recently, our class learned and practiced how to correctly ‘scrub’ for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.

I said I didn’t really know yet, although I did find surgery pretty fascinating. With that, they told me that they thought I would make a good surgeon. due …

Balancing a surgeon’s beliefs with the needs of the practice

Peter J. Polack, MD

Physician

August 20, 2010

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the …

Does surgery prevent knee osteoarthritis?

MedPage Today

Physician

August 7, 2010

by John Gever

Surgery for torn knee ligaments and meniscal cartilage may have improved patients’ short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said.

A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have …

When a biopsy cannot completely rule out cancer

Jeffrey Parks, MD

Conditions and Diseases

July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

How industry money continues to influence orthopedics

Ford Vox, MD

Physician

July 30, 2010

Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.

The …

Preventing postop infections need to be implemented as a package

Kristina Fiore

Physician

July 27, 2010

by Kristina Fiore

Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.

When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.

But the three core infection prevention measures taken …

Does restricting work hours hurt surgical training?

MedPage Today

Medical Education

July 23, 2010

by Michael Smith

Life is better but the quality of surgical training has gone down in the wake of a Swiss law restricting surgical residents’ hours.

That was the view of both the residents and the surgical consultants who supervise them in a survey conducted by Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues.

Less than 9% of residents and less than 5% of surgical consultants saw the change …

Cancer in a transplant kidney, is it the doctor’s fault?

Amy Tuteur, MD

Physician

July 13, 2010

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting …

Ambulatory surgical centers may have higher infection rates

MedPage Today

Conditions and Diseases

July 8, 2010

by Todd Neale

Failure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers — even during formal inspections, researchers found.

Of 68 centers in three states participating in a pilot inspection program, about two-thirds (67.6%) had a lapse in at least one of five infection control categories, according to Melissa Schaefer, MD, of the CDC’s Division of Healthcare Quality Promotion in Atlanta, and colleagues.

The most common …

Tomorrow’s surgeons are today’s video gamers

Dr. Martin Young

Physician

July 7, 2010

As a young medical student I remember the arrival of the first video arcade games very clearly: Asteroids, Space Invaders and Pacman.

I spent whatever spare cash I had on them, never playing long enough to be any good, or rich enough to get any better. When I bought my first computer in my late-twenties, I relived my excitement with the newest computer games, spending a disproportionate amount of time long …

Surgeons need to reconnect with patients after an operation

Jeffrey Parks, MD

Physician

June 30, 2010

It’s worth your while to browse through Sid Schwab’s sampler one rainy Saturday afternoon when you get a chance.

The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It’s a shorter post (for him) but very powerful and moving.

He describes what it’s like to enter an abdominal cavity of a patient, with all its …