There's something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it's a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying. Stark and ...

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From MedPage Today:

  1. Surgery Tops Muscle Training for Incontinence. Women with stress urinary incontinence (SUI) reported better subjective improvement and had higher cure rates at 1 year when treated initially with surgery instead of pelvic floor-muscle training.
  2. Academics Argue: 3 Years or 4 Years to Educate Doctors? If medical school were reduced from 4 to 3 years, it wouldn't necessarily mean that doctors were ...

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One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts. I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and ...

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Google Glass for medicine: 4 reasons why it could be disastrous The buzz is that Google Glass will transform medicine.  But unless it’s carefully vetted it could be a disaster for patients, clinicians and hospitals.  Until the FDA or research confirms its safety, Google Glass is banned from my clinic as a privacy and medical practice hazard. Here are four reasons why: 1.  Privacy violations. Google Glass make it extremely easy to take pictures or ...

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If you are interested in patient safety and medical errors and haven't read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe. The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch. The Texas Medical Board is over-worked, slow to act and ...

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Today in clinic, I interviewed a formerly morbidly obese woman. She has lost almost 300 pounds since undergoing gastric bypass surgery a few years ago, a presentation that has become increasingly common. She was here to see the plastic surgeon for her four week follow up appointment, status post abdominal skin flap removal. See, after losing a ton of weight, loose skin remains, especially in places like the arms and abdomen.  ...

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10 questions to ask before anesthesiaA guest column by the American Society of Anesthesiologists. Not so many years ago, surgeons wouldn't operate on patients they considered too old to tolerate the stress of anesthesia and surgery.  Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures. Realistically, even if you believe ...

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What should doctors disclose to patients in the aftermath of adverse events?  Does it matter if the adverse event was related to an error?  Does it matter if it was preventable or not, anticipated or unexpected? Recently, I was at the Carolina Refresher Course facilitating a session on adverse events in anesthesiology.   We touched on a variety of issues, but spent the most time discussing the importance of disclosure conversations, as ...

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When Tiger Woods addresses the ball, he's focused like a cat that heard a rustle in the leaves. He takes a few practice swings, moves up to position, adjusts his feet, steadies his shoulders, locks his eyes onto the target. He waits until there's absolute silence, brings his breathing under control, funnels all his energy into the impending swing; takes the club back, and explodes in an immensely balletic movement. ...

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A few months ago I read an essay by Dr. Herbert Fred of Houston, Texas. After reading his essay, "Medical Education on the Brink," I was inspired to start a revolution in surgical education. His essay ends with the following recommendation:

“…raise the bar of performance in all training programs to a distinctly higher level, with excellence as the perpetual goal.”
As the Fourth of July approached, I began to view his ...

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