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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Just as elite athletes are born with amazing skill, elite surgeons and doctors in other procedure-based specialties are also equipped with innate abilities that others do not possess.  Surgical skill is often difficult to quantify.  Certainly, outcomes data can be obtained and reputations are formed over time.  Years of training allow the truly gifted surgeons to develop their skills and perfect their craft. However, all surgeons are not created equal.  During ...

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Do safety scalpels reduce the risk of injury? A Twitter follower wrote me this: "Hospital making me use 'safety scalpel' w/retractable sheath. I've almost cut myself x 2. Do you know of any data about it?" That got me interested because I like to question things. Was this going to be yet another rule without evidence? I thought I would have to do an exhaustive search to see if anyone had ever ...

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I have written a good amount about automation, the good, the bad and the ugly.  I have written about doctors and ancillary providers and physician extenders, also good, bad and ugly.  A recent comment on Karen Sibert’s excellent blog A Penned Point caught my eye as an amalgamation of these subjects. This person wrote, and I hope he doesn’t mind my quoting him:

American anesthesiologists should focus much more on ...

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Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes. Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited ...

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