Recently on Twitter, I asked this question above.
The 130 (2.5 percent) of 5,213 respondents who said they would allow a CEO to make a skin incision highlight the unscientific nature of Twitter polls. Restricting voting to surgeons only is not possible. Many people asked me why I asked the question because surely no surgeon would ever have allowed it. Here is …
The hospital CEO who made a surgical incision. What happened?
Ever since the publication of the infamous 2016 BMJ opinion piece claiming medical error should be considered the third leading cause of death in the U.S., the debate on the true incidence of deaths caused by medical error has been raging. Many, including me, felt the estimate of 251,000 deaths per year from medical error was grossly inflated. For example, the paper extrapolated the number of deaths from …
Medical error is not the third leading cause of death
This eating contest season, there was only one death this year, as far as I can determine. A 41-year-old California man died in August while participating in a taco eating contest at a minor league baseball game. The coroner said he choked to death. In case you were wondering, the Associated Press thoughtfully stated: “It was not immediately known how many tacos the …
Should speed-eating contests be banned?
“What About Recovery” is a provocative essay by Yale professor Lenore Buckley, MD, in JAMA.
She writes in detail about the death of her 68-year-old brother in a hospital. She felt his doctors did not do enough to help him recover because his nutritional and physical therapy needs were not met.
However, there’s more to it. She calls out the system existing in every hospital I’m aware of writing, …
Are hospitalists to blame for the fragmentation of medical care?
Google that phrase, and you will come up with lots of hits.
The following is a partial list of things that have been found to have more germs than a toilet seat:
Kitchen cutting boards, sponges and sinks, refrigerators, spatulas, pet food bowls, clean laundry, smartphones, electronic tablets, computer keyboards, carpets, faucet handles, handbags, can openers, ice served in restaurants, menus, reusable shopping bags, TV remotes, …
Why is the toilet seat the gold standard for germs?
In August 2014, a 13-year-old boy with Type 1 diabetes died after being treated by self-described “master herbalist” Tim Morrow who was tried for child abuse resulting in death and practicing medicine without a license.
He had told the boy’s mother to stop administering insulin and instead prescribed herbs which he sold. According to one report, Morrow told the parents that insulin was poison, and if they took …
The consequences of being treated by a master herbalist
This notice appeared on a general surgery news website in early February.
I don’t know who has been long anticipating this, but I’m pretty sure it’s not people on medical Twitter. My informal, nonscientific Twitter poll garnered 707 votes with 87 percent of those responding saying they would not allow their residents to participate in a reality television show.
Many of those who …
Should medical residents appear in reality TV shows?
By now, I’m sure most of you probably have heard about the Cleveland Clinic first-year resident who was fired last September when it became known that in 2012 she had tweeted she would “purposely give all the yahood [Jews] the wrong meds …”
The website Canary Mission documented numerous tweets expressing similar thoughts. She has apologized but will likely have great difficulty finding another job as a physician.
This …
Should residency programs review their applicants’ social media history?
A New Mexico woman, suffering from Dercum’s disease (adiposis dolorosa) which causes painful fatty tumors, is suing a Santa Fe hospital and an emergency physician claiming she was the victim of two negligent acts in 2016.
One, according to the Albuquerque Journal, she told hospital personnel she was allergic to Dilaudid but went into cardiac arrest after receiving an injection of the drug.
Two, despite the presence of a lawfully …
A patient sues when a DNR is ignored
A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred?
The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide …
A surgeon mistakes a kidney for a tumor. How can this happen?
Everything is being rated these days. But who is rating the ratings? As a public service, I have been blogging about the shortcomings of various rating systems since 2010. Two recent papers on this topic are worthy of review.
In a randomized controlled study, investigators from the University Hospital of Münster, Germany found that medical students who were provided cookies during academic course sessions rated the experience significantly higher than …
Patient satisfaction: Who is rating the ratings?
Here are a few thoughts about the latest chapter in the never-ending debate about antibiotics vs. surgery for the treatment of uncomplicated appendicitis.
You will recall the randomized controlled trial from Finland published in 2015 that found a 27% rate of failure of antibiotics within the first year.
Now that the patients have now been followed for five years, 100 (39%) of the 246 patients treated with antibiotics have experienced persistent …
Antibiotics vs. surgery for appendicitis: What one surgeon thinks
July was an interesting month for artificial intelligence in medicine.
A study from MIT found when human doctors order tests on patients, they factor in something that artificial intelligence is not currently aware of. The authors analyzed charts of about 60,000 ICU patients admitted to Beth Israel Deaconess Medical Center in Boston.
By looking at physician progress notes with positive or negative sentiments in patient records, they derived scores which they correlated …
Artificial intelligence in medicine: not ready for prime time
A patient with progressive neurologic disorder had a gastrojejunal tube placed for feeding. In a nursing home, the tube fell out and was replaced with a Foley catheter. He was sent to the hospital for placement of a new tube. When he arrived in the interventional radiology suite, the Foley catheter was not visible. A new gastrojejunal tube was successfully placed, and the patient was sent back to the nursing …
Why medical errors can never be completely eliminated
An 8-month-old baby fell 3 feet and hit his head on a carpeted floor in a San Francisco hotel room. He was crying and the parents, who were from South Korea, called an ambulance. By the time the child arrived at the hospital he was obviously fine. After a bottle, a nap, and a few hours in the hospital, he was discharged.
The hospital sent a bill two years later, which …
Why is trauma activation so expensive?
“Some data is better than no data at all.” Do you believe that?
I heard it frequently when the infamous ProPublica’s Surgeon Scorecard first appeared three years ago. Back then I blogged about it saying “To me, bad data is worse than no data at all.”
A recent study in BJU International confirmed my thoughts about this type of publicly posted data and identified a previously unreported issue. The paper attempted to …
The risks of publically reported surgical outcomes
A new study found several senior academic surgeons had published papers in what used to be termed “predatory journals.” The newer, gentler term is “solicited publishing,” but it defines the same pay-to-play, low-quality publications.
Surgeons from the University of California, San Diego examined 110 emails sent to the senior author from 29 publishers during a six-week period and early 2017. Nearly all were requesting manuscript submissions. The 29 publishers represented 113 …
Why do physicians publish in predatory journals?
In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:
There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or …
Residents should not be mandated to do research
Kang Se-hoon, a surgeon in South Korea, operated on a popular rock singer and song writer in October 2014. According to reports, Shin Hae-chul had abdominal pain, and the surgeon performed laparoscopic lysis of adhesions. Without having obtained consent, he decided to also do a weight reduction procedure.
The patient was discharged a few days after surgery but returned a day later with fever and severe abdominal pain. Kang did not …
What could be worse than being sued for malpractice? Prison.
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
The fall of the digital rectal exam
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