Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a "pre-op checklist" to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of ...
Jeffrey Parks, MD
How doctors can write about clinical cases online
Recently, Kevin Pho wrote about a physician, Alexandra Thran, who was disciplined by both her hospital and the state medical board for writing about a trauma patient she had seen. Although Dr. Thran hadn't divulged the patient's name, enough information was conveyed that allowed others in the community to identify the patient in question.That story really freaked me out. Because, as you know, I sometimes write about my ...
Why private practice surgeons perform more open breast biopsies
A Florida study assessed the rate of needle versus surgical breast biopsies over a period of five years.What we're talking about here are non-palpable abnormalities that are identified on screening mammography. A mammogram report will come back that assesses the relative risk of an abnormal collection of calcifications harboring an invasive or pre-invasive cancer (staged on a scale from I-V). With such data, one is obligated, as ...
Implications of the surgical buy in when discussing informed consent
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 ...
How MD anesthesiologists have become victims of their own excellence
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA's) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA's to dispense anesthesia without the overarching supervision of a physician.Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that ...
There is no routine procedure in general surgery
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 ...
Should CRNAs practice anesthesiology without physician supervision?
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 ...
Should physicians undergo random drug testing?
Lucian Leape MD, a public health professor at Harvard, wants to subject doctors in America to strict random and periodic drug testing to help identify those physicians who are impaired. All in the name of patient safety, of course:
"I'm very much in favor of random testing," Dr. Leape says. "We have a responsibility to identify problem doctors and bring them into treatment." And to protect patients in the process.Ok, I ...
When a biopsy cannot completely rule out cancer
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 ...
Surgeons need to reconnect with patients after an operation
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 ...
Tort reform for doctors in exchange for less salary
Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.
It's part of the social contract: doctors accept limited salaries in exchange for limited liability; ...
