Tuesday, April 26, 2016

It's time to discuss surgeon headgear again

I received this email last week:

My state has recently banned the time-honored surgical cap,
Timed-honored cap
in favor of the “bouffant” cap.
"Bouffant" is French for "doofus"
I have been wearing the disposable surgical caps for my entire career, and have one of the lowest infection rates of any surgeon at my hospital.

Not only are the bouffant caps uncomfortable, I have now developed a severe allergy to them, making them unwearable. Now they say I must wear a full head/beard cover type cap in order to satisfy their requirements...REALLY? 

Head and beard cover even more uncomfortable than bouffant
I asked the hospital to show me a study that proves that the use of a bouffant cap has ANY advantage at all. Of course they can't, because no such study exists.

Monday, April 25, 2016

Does talking about burnout cause more burnout?

Almost every day over the last few years, someone has written about physician burnout or depression.

The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself.
The paper equated faculty and residents supervising students to “zombies, vampires, ghosts, and other supernatural figures.” In dealing with the state of the world today, the authors cited a comment by the novelist Stephen King saying that to cope with adversity, people make up horror stories. That sounds pretty serious.

Could the problem be declining student resilience? An article about college students in Psychology Today pointed out that they are less able to deal with seemingly minor affronts. And teachers are reluctant to “give low grades for poor performance, because of the subsequent emotional crises they would have to deal with in their offices.”

This has forced faculty “do more handholding, lower their academic standards, and not challenge students too much.” The article pointed out that college students exhibit more anxiety and depression and take more prescription drugs for these problems than ever before.

It’s not just students.

A systematic review of 54 studies found that 29% of resident physicians were depressed or had depressive symptoms. The number ranged from 20.9% to 43.2%, depending on the method studies used to assess depression.

Investigators from the Mayo Clinic and the AMA found that more than 50% of practicing physicians surveyed exhibit symptoms of burnout, and the problem has worsened since 2011. Depression and suicidal thoughts are also common.

All of these studies have been covered extensively by media such as the Washington Post, NPR, Time Magazine, Forbes, among many others and were widely discussed on Twitter.

Here’s a thought. What about “emotional contagion,” the subject of a 2014 paper published in PNAS? The authors studied 689,000 Facebook users and found that negative emotions can be transferred from one person to another without direct contact. They concluded, “…emotions expressed by others on Facebook influence our own emotions, constituting experimental evidence for massive-scale contagion via social networks.” If emotional contagion has such an impact on Facebook users, maybe all these stories about burnout and depression have an impact on students and doctors too.

There is certainly much to be depressed about in medicine—stress, declining reimbursements, soul-sucking electronic medical records, long hours, arbitrary rules, and much more.

Could it be that the more stories written about burnout and depression, the more burned out and depressed doctors become?


Thursday, April 21, 2016

Here’s a problem with that new 6-step hand hygiene study


A 6-step alcohol-based hand hygiene technique is significantly superior to the standard 3-step technique in reducing bacteria colony counts.

So says a randomized trial with 78 nurse and 42 doctor participants recently published online in the journal Infection Control and Hospital Epidemiology. The full text of the study is available here.

At 42.5 seconds, the 6-step process took significantly longer than the 35 second 3-step.

Multiple media outlets, including the New York Times, published stories about this study.

The study was done properly. But after reading it, I had an issue.

Tuesday, April 19, 2016

Many journalists miss major flaws in research papers


Google "jet air dryers" and you will find more than 100 articles about a recent study claiming that jet air dryers dispersed 60 times more "germs" than warm air dryers and 1300 times more "germs" than paper towels.

Here are a few of the juicier headlines:


It wasn't about germs. The study involved measuring the dispersal of a benign virus from the hands of research subjects at various distances and heights from the different hand drying methods.

So what's wrong with it?

Thursday, April 14, 2016

FAQs from IMGs about applying for surgery training

Here are some of my responses to common questions from international medical graduates (IMGs) looking to match in categorical general surgery residency programs.

1. Which programs should I apply to?

You should apply to a number of second and third tier programs, especially if you USMLE Step 1 scores are not outstanding.

2. What would you consider second and third tier academic programs?

There is no short answer to this question. I suggest you go to Doximity’s residency navigator and look at their list of surgery programs. You should start at the bottom and work your way up. Doximity’s list is not perfect, but it is better than any other one I have looked at.

3. How much of a level playing field is the interview process?

I’m not sure what you mean by this question. The object is to get some interviews. Most programs will not waste their time interviewing people they have no interest in. If you are offered an interview, you should obviously make the best impression you can.

4. What about observerships?


Wednesday, March 30, 2016

Do medical students have drinking problems?

A study from the Mayo Clinic says one-third of US medical students drink too much alcohol and something must be done about it.

In 2012, the authors sent a survey with questions about alcohol abuse, burnout, depression, fatigue, suicidal ideation, and quality of life to 12,500 medical students of whom 4402 (35.2%) responded.

Of those responding, 1411 (32.4%) “met diagnostic criteria for alcohol abuse/dependence.”

According to the Mayo Clinic’s press release, “Nationally, that translates to about one-third of those responding, compared to only 16 percent of peers not in medical school, and double the rate of alcohol abuse or dependence of surgeons, US physicians or the general public based on earlier research by this team.”

The paper also found that burn out, depression, high educational debt, being unmarried, and being younger were associated with dependence on or abuse of alcohol.

The authors called for a multifaceted approach “addressing burnout, medical education costs, and alcohol use.”

Here are some problems with this study.

Thursday, March 24, 2016

Less crowded EDs = less waiting & "big data" isn't so big

Two recent papers caught my eye. As usual, I will preface my critiques with a disclaimer that I have never written a Nobel Prize-winning paper myself.

The first paper, “Emergency department ‘undercrowding’ is associated with decreased waiting times” appeared online in the journal Emergency Medicine Australasia.

The authors looked at emergency department patient numbers and waiting times before and after a nearby tertiary care hospital opened a new emergency department.

Their main finding was that after the new ED opened, their ED saw 28% fewer patients with a concomitant decrease in patient waiting times of 15 minutes from 26 to 11 minutes with p < 0.001, a significant difference.

They concluded, “Wait times are strongly associated with patient presentation numbers.” Furthermore, “Controlling demand may benefit patient processing, flow, and patient perceptions of level of care.”