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 ...

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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 ...

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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, ...

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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 ...

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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 ...

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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 ...

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An anesthesia practice is sold, and a warning to young doctors We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon. The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California ...

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Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism. One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. ...

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I don’t remember three days of my life. I have generally felt in control of my life and behavior. Although I understand the future is always uncertain, I do as much as I can to plan for it and minimize risk to myself and my family. This includes focusing on avoidance of stress, healthy eating, and daily exercise. Despite this, anything is subject to change at any time for no apparent ...

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By its very nature, medicine involves close personal contact with others. Communication with patients, families, staff and colleagues is essential to success. All physicians have different ways in which they communicate -- some more effective than others. The best communicators are able to inspire, engage, and cultivate trust. Everyone is born with different skill sets and communication styles may vary widely. Recently, I came across an article in Inc.com ...

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