shutterstock_59786566 When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?” When you steel yourself ...

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Watching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation. In the operating room, the ...

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A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours. Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay. The study, published online in the ...

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shutterstock_96224099 Part 3 of a series.  Read part 1 and part 2. The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. "Ho hum," says a lawyer who read my first two posts in this series. "Get out the violins." It's as if, because I make my living operating on ...

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Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, ...

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What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, ...

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shutterstock_98508260 I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance ...

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Anesthesiology used to be a job that was attractive for people who don’t like patients very much.  The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done.  Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the ...

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An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. A doctor’s self-worth can be tied up with a lot of issues. How well can we make a diagnosis? How elegantly can we perform the surgery? How happy are our patients? Our staffs? Our families? How many articles ...

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In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity's co-founder over the issue and echoed some of the comments I had made about the lack of objectivity and emphasis on reputation. I wonder if it is even possible to develop a set of valid ...

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