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.

7 disruptive changes that will affect medicine

Stephen C. Schimpff, MD

Health Policy

June 24, 2010

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Residents who specialize in surgery are influenced by family

MedPage Today

Physician

June 11, 2010

by Chris Emery

Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.

Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …

Waiting is a part of surgery, and how a surgeon perceives time

Bruce Campbell, MD

Physician

May 30, 2010

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …

Endocrinologists may improve surgical care in diabetic patients

Kristina Fiore

Physician

May 15, 2010

by Kristina Fiore

Shorter hospital stays and lower costs were the result when surgical patients with diabetes and dysglycemia received endocrinology consults, researchers said.

Adding endocrinologists to surgical care teams for patients with abnormal blood glucose readings cut total length of stay among patients in a single center by 1,342 days and saved the hospital $1.15 million, according to Arthur Chernoff, MD, of Albert Einstein Medical Center in Philadelphia.

Chernoff presented his findings …

Hiatal hernia in women can present with heartburn

Kevin

Conditions and Diseases

May 8, 2010

by David Edelman, MD

Heartburn and acid reflux disease are common problems affecting women of all ages. The problem develops when acid in the stomach backs up into the esophagus. There is a muscle known as the diaphragm that separates the chest from the abdominal cavity. When you eat or drink, the food goes from the mouth down the esophagus, through the diaphragm and into the stomach. …

The Danny Williams surgery shouldn’t be controversial

Kevin

Health Policy

March 2, 2010

Originally published in MedPage Today

by Michael Smith

OK, don’t take this the wrong way, but ….

Chill. Relax. Give the other guy the benefit of the doubt. Don’t jump to conclusions. And most of all, think before you speak, blog, natter, comment, or otherwise pontificate on issues of the day.

And when I say ‘think,’ I don’t mean trying to find the …

Atul Gawande’s The Checklist Manifesto reviewed

Robert Wachter, MD

Physician

February 24, 2010

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

Laparoscopic procedures injure the surgeons that perform them

Kevin

Physician

February 19, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.

More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the …

A cockpit checklist to improve patient safety

Kevin

Physician

December 29, 2009

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Medical teams should take a lesson from airplane crews, a new study concludes.

Medical personnel who used procedural checklists modeled after preflight checklists used by airplane crews were more likely to report safety-related incidents and feel empowered to address safety issues, according to an online report in the Dec. 21 …

Issues surrounding videotaping surgeries in the operating room

Dr. Martin Young

Physician

December 23, 2009

The rapid advance in digital video and still camera technology has found its way into the operating room.

There is the potential to capture and record just about every minute of every surgical procedure in some way. The newest endoscopic camera systems and operating microscopes have integrated systems to record video footage. Storing all that data is just the press of a button away.

The advantages for surgeons are obvious, like the …

iPhone radiology app to diagnose appendicitis

Kevin

Health Technology

December 2, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

For years, the pager and cell phone have summoned on-call radiologists to the emergency room. Now this leap in technology: an iPhone App that lets radiologists diagnose a patient remotely, wherever they may be.

Using a $20 iPhone application called OsiriX, radiologists made correct diagnoses of appendicitis in 124 of …

Surgeons don’t receive enough training when resident work-hours are capped

Crystal Phend

Medical Education

November 13, 2009

by Crystal Phend, MedPage Today Senior Staff Writer

Limiting surgical residents’ work hours has compromised both surgical education and patient safety, according to an analysis concluding that an 80-hour work week isn’t enough.

The maximum 80-work week imposed in the U.S. for residents is too little to provide mastery in surgery, Gretchen Purcell Jackson, MD, PhD, and John L. Tarpley, MD, …

Will video cameras in the OR decrease the rate of wrong-site surgery?

Kristina Fiore

Conditions and Diseases

November 12, 2009

by Kristina Fiore, MedPage Today Staff Writer

Rhode Island Hospital, located in Providence, will pay $150,000 and install video cameras in all of its operating rooms after performing its fifth wrong-site surgery since 2007, according to the state’s Department of Health.

The hospital will also have to open its ORs to an inspector who will observe surgical procedures and protocols for at …

Does robotic surgery for prostate cancer help patients?

Kevin

Conditions and Diseases

October 19, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Men who opt for minimally invasive prostate surgery — often with a helping hand from a robot — are twice as likely to have genitourinary complications as men who have a traditional prostatectomy.

That finding is especially troubling because the use of robotic-assisted minimally invasive prostatectomy has increased exponentially in …

Is incident reporting effective in reducing medical errors and increasing patient safety?

Robert Wachter, MD

Health Policy

October 6, 2009

When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.

But one lesson from …

Is medical technology making doctors less relevant?

Edwin Leap, MD

Conditions and Diseases

September 23, 2009

It happens over and over. I call a surgeon about a patient with abdominal pain.

‘Well, what’s the white count?’

‘Normal.’

‘Did you get a CT Scan?’

‘Yes, and it was normal. But they just look uncomfortable.’

‘Sounds like nothing for me to do. Call the hospitalist.’

It happens in other specialties. Cardiologists who aren’t interested in a patient with a normal stress test, pediatricians unimpressed with negative chest x-rays and normal labs. ENT’s unconcerned if …

How to protect yourself from abdominal aortic aneurysms

Kevin

Conditions and Diseases

September 22, 2009

by Mark Adelman, MD

While diseases like prostate cancer and heart disease have become household concerns, abdominal aortic aneurysms (AAA), the 10th leading cause of death in men age 55 and older, have been overshadowed by more prominent diseases for far too long. It’s time we pull back the curtain and take a closer look at this serious disease and how it can be both detected and prevented.

An AAA, which …

How hospitals should deal with disruptive physician behavior

Kevin

Physician

September 20, 2009

by Mark N. Simon, MD

What can hospital medical staff leaders learn from University of Oregon football coach Chip Kelly? In the morning of September 4th, Kelly had an opportunity to review video tape from the conclusion of his team’s game with Boise State University the night before. What he saw was his senior running back LeGarrette Blount punch an opponent and then lose his cool with the fans …

A patient dies after doctors fail to communicate in the operating room

Kevin

Physician

September 10, 2009

by Jerry I. Meyers, Esq.

Communication is essential between health care providers but sometimes communication fails because of the arrogance or carelessness of the persons involved in the needed medical communication.

Several years ago, a female client about to enjoy an important anniversary was admitted to a University affiliated hospital for the purpose of having a colostomy wound debrided.

This was to be a one-day inpatient hospital procedure and was associated with little …

Do resident work-hour restrictions increase surgical complications?

MedPage Today

Medical Education

September 8, 2009

by Chris Emery, Contributing Writer, MedPage Today

Reductions in resident physician work-hours at teaching hospitals in 2003 were associated with an increase in complications related to surgery to repair hip fractures, a new study found.

The rates of pneumonia, hematoma, renal complications, and blood transfusions associated with hip surgery rose disproportionally at teaching hospitals compared to other hospitals after resident …

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