Surgery and surgeons

1,981 articles · Since 2004

Articles, page 63

Implications of the surgical buy in when discussing informed consent

March 28, 2011Mar 28, 2011

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…

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 …

Conditions and diseases

Overeating is a behavioral problem, not a surgical one

Dr. Joe Kosterich

March 27, 2011Mar 27, 201132

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…

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 …

Physician voices

A surgeon on those who understand murderers, rapists and child molesters

bongi, MD

March 21, 2011Mar 21, 201113

(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.…

(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 …

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Physician voices

Surgical error: The difference between mistake and complication

Dr. Martin Young

March 3, 2011Mar 3, 201118

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…

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 …

Physician voices

Time with your patients in the hospital and time with your children

Felicity Billings, MD

February 16, 2011Feb 16, 2011

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,…

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 …

Physician voices

Your physician may be thinking about suicide

Heather Fork, MD

February 15, 2011Feb 15, 20114

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 …

Conditions and diseases

Closed loop bowel obstruction in your surgical partner

Sid Schwab, MD

February 8, 2011Feb 8, 20113

"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…

“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 …

Physician voices

Can a doctor and a nurse be friends in the OR?

Anesthesioboist T., MD

January 23, 2011Jan 23, 20114

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…

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 …

Physician voices

Your surgeon may be contemplating suicide

Kevin Pho, MD

January 18, 2011Jan 18, 20114

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…

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 …

Medical education

How surgery is a team sport, and in awe of neurosurgery

Suchita Shah

January 12, 2011Jan 12, 20116

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…

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 …

Physician voices

Should surgeons tell patients how much sleep they had?

Kevin Pho, MD

December 30, 2010Dec 30, 201010

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…

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, …

Medical education

Successful surgery rotation tips

MomTFH, DO

December 24, 2010Dec 24, 20102

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,…

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:

Scrub in before the surgeon but after the OR nurse.
Before you scrub in, introduce

…

Read more…

Successful surgery rotation tips

Patient voices

Why physicians ignore fatigue

Robert Wachter, MD

December 15, 2010Dec 15, 201011

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…

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 …

Read more…

Why physicians ignore fatigue

Physician voices

Stercoral perforation as a deadly cause of colon rupture

Sid Schwab, MD

December 9, 2010Dec 9, 20106

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…

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; …

Conditions and diseases

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

December 2, 2010Dec 2, 2010

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…

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 …

Medical education

A neurosurgical resident’s typical day

Colin Son, MD

December 1, 2010Dec 1, 201010

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…

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 …

Read more…

A neurosurgical resident’s typical day

Physician voices

There is no routine procedure in general surgery

Jeffrey Parks, MD

November 23, 2010Nov 23, 20108

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…

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 …

Conditions and diseases

Noninvasive fat removal in plastic surgery

Anthony Youn, MD

November 23, 2010Nov 23, 20104

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…

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 …

Patient voices

Using the internet for health information before surgery

Lisa Gualtieri, PhD

November 11, 2010Nov 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…

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 …

Medical education

Advice for a second year medical student

Skeptical Scalpel, MD

October 16, 2010Oct 16, 201017

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…

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

Surgery and surgeons

Articles, page 63

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