In 2012, celebrated surgeon-cum-writer Atul Gawande penned an incisive essay for the New Yorker entitled “Big Med.” Deliberately provocative, yet disarmingly reasoned, it suggests that American health care should borrow management practices from the Cheesecake Factory. To set the stage, Gawande paints an unflattering picture of the status quo: medical costs are too high, quality is not reliable, service is often poor, and physicians differ widely in their approaches and outcomes ...

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An excerpt from Beyond Embarrassment, reclaiming your life with neurogenic bladder and bowel. Conceivably one of the areas of life most affected by neurogenic bladder is sexual intimacy. When I was first diagnosed, I was afraid to have sex. Because I was new to using a catheter, I was sore ...

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Burnout, burnout, burnout.  It seems like that is all anyone wants to talk about these days.  And I admit, some days, I can get burnt out on burnout.  But, all the attention on the subject got me thinking.  Did burnout not exist 30 years ago? Why is this such a hot topic now? And that is what brings me to this post; I came to the realization that burnout very much existed ...

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The parental drive to protect your child is passionate, and learning that your child needs surgery is jarring at best and terrifying at worst.  As her guardian and provider, your instinct is to prevent harm to her at all costs, and even if you know that surgery is ultimately in your child's best interest, the thought of her going through an invasive procedure, combined with the presence of illness or ...

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As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it. Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Fire Prevention Week.  National Volunteer Week.  Save Your Vision Week.  The list goes on! These observances or “awareness weeks” aim to advocate important messages both locally and nationally to the media and public. You may wonder about the effectiveness of an overload of awareness weeks, ...

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Picture this: You’re in the operating room, performing a challenging procedure. (If you’re not a doctor, roll with me here and play along. You’ll get it soon.) You’re feeling pretty good about how the surgery is going. You’re grateful that your usual team is with you, because that always makes you feel more confident. Then something happens … Right at the most critical part of the procedure, crisis ensues and the instrument you’re using ...

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What does a 3 year old know? If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds.  The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a  doctor at that age all the more amazing.  But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to ...

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A JAMA Surgery Viewpoint recently suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics. The paper acknowledged my criticisms of the Finnish study that found that simple appendicitis could be treated successfully with antibiotics in almost 75 percent of patients. I respect the authors of the JAMA Surgery article and am happy they
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What do you do when you love your job, but it’s killing you? That’s an easy question if it’s asked by someone else.  It’s a hard question when you’re asking it of yourself.  As a physician, I give advice to people all the time -- other people.  If you have diabetes, control your diet.  If you are obese, then lose weight and exercise.  If you have COPD, then you better not ...

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