Drug shortages can jeopardize patient safety A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. When doctors don’t have access to medications that are necessary to successfully perform procedures, patient safety is at risk. Over the past several years, drug shortages have significantly impacted the health care industry, making it not only difficult for physicians to do their jobs, but for ...

Read more...

Pilots never expect to hit a flock of birds on take off, or flame out an engine in mid-flight.  No one plans to get disoriented in the air or have an equipment malfunction miles from the nearest airfield.  And, it certainly isn’t routine to fly into hostile airspace with a heightened awareness of the known ground threats, the position of each member of your formation, and the safety of the ...

Read more...

One of my Physician's Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training. Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking. Another commenter said, "We are ...

Read more...

I don’t have much in the way of eyebrows.  They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back.  There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often. I was in there about a year ago when she told me, “I ...

Read more...

An anesthetized patient fell to the floor headfirst from an operating room table during a laparoscopic appendectomy in Scotland. The table had been tilted into an extreme head down position to facilitate the operation. Fortunately, no injury occurred. The Edinburgh Evening News account says that there were 10 staff members in the room at the time the case started, but no one had placed a safety restraint on the patient. A follow ...

Read more...

His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway.   My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain.  Fortunately, his testicle was still intact and only needed to be put in the proper place. I am an attending physician in the emergency department and trauma center at San Francisco General Hospital.  I ...

Read more...

Arthroscopic knee surgery is big business in the United States. Arthroscopic partial meniscectomies alone cost $4 billion per year. Yes, billion. But do they work? I’ve written previously about arthroscopic surgery for a torn meniscus and how it adds nothing above and beyond physical therapy for people with arthritis. We also know that arthroscopic knee surgery for arthritis isn’t effective either. Given the poor performance of these other arthroscopic surgeries, ...

Read more...

Anesthesiologist assistants should be able to practice in every stateA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who'll be giving you anesthesia.  If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking ...

Read more...

Referring to the idea that, like athletes, surgeons are engaged in demanding physical work, I wrote about having an "off-day." Another side of the same coin is having a tough day: as distinguished from not being on one's game, here I mean to describe what it's like to face an exceedingly difficult and danger-filled situation. Notwithstanding having one's faculties and wits gathered and finely honed, as in command of yourself as you ...

Read more...

Recently, after a fairly long day of surgery where everything was going well, I was finishing my fourth case.  It was about 2pm on a Friday, and we were running on schedule, which made me happy. As I walked out to the waiting area in search of the family of the elderly woman on whom I had performed an elective procedure, I noticed her husband sitting in the corner.  He stood ...

Read more...