A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery. Anesthetic care has improved dramatically ...

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Complicated medical procedures can be dangerous, even when done by highly skilled and experienced people. Why? Because, irrespective of the procedural risk itself, all of us are human and we can overlook or forget things, no matter how many times we have done the procedure. This was recognized many years ago in the airline industry. Flying an airplane is a complicated and potentially dangerous activity and their are many steps ...

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I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa deferentia.  In other words, could my patient, a 42-year-old ...

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Every time I see a GlideScope, I can’t help but lament, “why didn’t I think of that?”  To me, the GlideScope exemplifies how physicians can apply their practical knowledge of medicine to create technology that improves patient outcomes. I had a front-row seat to physician-designed technology prior to my residency, when I worked at an early-stage venture capital fund advising on health care investments.  We invested in a number of physician-founded ...

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While there are many creative people who go into medicine, the challenge of turning experience into innovation can be stifling. My classmates at Johns Hopkins, fellow residents at Harvard, and peers came from a wide variety of backgrounds. But medical school, internship, and residency don’t afford students much time to tinker around. “Free time” in academic medicine means working in a lab with the “publish or perish” dictum hanging over one’s ...

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Palliative surgery is tough stuff. Nobody wins much, and it often challenges one's ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who's the object of comfort. And yet, when there's nothing else to do, it's often just the right thing. I hate it. To be clear: We're talking about surgery to relieve some sort of specific problem, ...

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It is unethical not to be compassionate when you are a physician.  Treating people or their families poorly isn't helpful to anyone in a stressful situation.  But a big problem exists there - ethics is not taught in medical school.  Then again, neither is compassion.  So where do you learn them?  Can you learn compassion, or is it something you just have? Or don't have? She could have been anyone's grandmother.  White ...

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As the number of people undergoing plastic surgery rises, the number of people who get bad results also increases. Numerous cases of botched plastic surgeries persist to linger the news which continue to put plastic surgery in a bad light. As a doctor specializing in cosmetic and reconstructive surgery myself, I am saddened by the fact that such cases carry on. With more and more people choosing to undergo plastic surgery, ...

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Google Glass has a long way to go in the OR The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion. Here is what I thought about the event. The case started about 30 minutes late, which is similar to what would have happened in any ...

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Top stories in health and medicine, June 9, 2014From MedPage Today:

  1. Surgeons Not Very Involved in ACOs, Survey Says. Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.
  2. Early Allergen Exposure Cuts Wheeze Risk. A new study confirmed that when ...

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