tag:blogger.com,1999:blog-4968787219619380438.post6370233417343565816..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: What was surgery like in the 1970s?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-4968787219619380438.post-44863067808833466692018-08-07T14:10:06.971-04:002018-08-07T14:10:06.971-04:00Liz, all of what you said is true.Liz, all of what you said is true.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-19514198291271606512018-08-07T00:57:30.458-04:002018-08-07T00:57:30.458-04:00As a child who had 3 surgeries in the 1970s. It wa...As a child who had 3 surgeries in the 1970s. It wasnt fun. Nobody understood pediatric care. How s CD art it was to be in a cold strange room with people's faces covered. Then walking up and your parents were not allowed to be there. When I needed jaw surgery, there was nothing they could see before surgery besides a panorex to see what was going on. The panorex wouldnt have shown much.Lizhttps://www.blogger.com/profile/06570259673662002099noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-83846823999074561382014-02-17T20:22:19.836-05:002014-02-17T20:22:19.836-05:00Jon, thanks for commenting and agreeing with me. I...Jon, thanks for commenting and agreeing with me. I have said the same thing--those who make the rules are not always on the front lines.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-44618695490620028242014-02-17T20:14:38.736-05:002014-02-17T20:14:38.736-05:00Great article. I'm currently a surgical reside...Great article. I'm currently a surgical resident at a busy public hospital/academic medical center and still experience some remnants of the past. While we definitely have had some amazing advancements, including the CT scan as one example from above, in my opinion we've also had some setbacks. Most troubling, I think, is the adaptation of the new work hour restrictions. I agree with you that, although being on-call occurred more often, there was less cross coverage and you actually knew your patients better. Wish we could go back to that system - it's unfortunate that the people who make the rules aren't the same people who are teaching residents. JonMDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48229028314447498022013-07-02T13:41:55.544-04:002013-07-02T13:41:55.544-04:00I had the exact same call schedule in the early 19...I had the exact same call schedule in the early 1970s. As I have pointed out in a previous post, we got more sleep when we were on call because we weren't cross covering so many patients.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-88584609565069681872013-07-01T19:29:55.223-04:002013-07-01T19:29:55.223-04:00My straight surgical internship was at Columbia P&...My straight surgical internship was at Columbia P&S in 1968-9. We were on and in-house either Tuesday, Thursday and Friday, or Monday, Wednesday and the entire weekend. By Monday evening you could pick me up with a damp washrag, but I got to follow sick people as they progressed rather than sign them out to a colleague after an 8 hour shift. The difference was remarkable. <br /><br />jfkAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-16623268337105375052013-06-27T07:06:14.181-04:002013-06-27T07:06:14.181-04:00Yes, CT scan was a big advance. You are also right...Yes, CT scan was a big advance. You are also right about the treatment of an MI. It has come a long way.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-15391849497004214202013-06-26T20:05:37.619-04:002013-06-26T20:05:37.619-04:00CT was just coming into use when I was an intern/r...CT was just coming into use when I was an intern/resident. We had to beg/flirt with the booking secretary to get an "elective" scan on the only scanner in the city.<br /><br />If I have to pick the biggest impact on all medical (not specifically surgical)practice in the past few decades, it has to be CT.<br /><br />Detection and treatment of MI would be the second on my list. When I was an intern, an evolving MI was giving morphine, lidocaine (proven useless), and sent to the ICU to monitor for v-fib.<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58974420538967783272013-06-26T18:44:41.376-04:002013-06-26T18:44:41.376-04:00Rugger, I hope you'll post here when you get e...Rugger, I hope you'll post here when you get everything put together. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85045393225957118972013-06-26T15:56:35.009-04:002013-06-26T15:56:35.009-04:00Those are excellent results. How many open abdomen...Those are excellent results. How many open abdomens does your group do per year?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18725000902856244122013-06-26T14:49:56.480-04:002013-06-26T14:49:56.480-04:00Not if you do it right. You leave it open and was...Not if you do it right. You leave it open and washout 2 or 3 times and get them closed when inflammation/edema settles down and if you cant you can put in a biologic and do a component separation to close.<br />Should be part of every acute care surgeons repertoire.<br />We have but one or two bellies get stuck open in last five years and only one fistula.<br />In fact, are going to be writing it up soon.<br />RuggerMDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-30099452349380221762013-06-25T19:58:41.576-04:002013-06-25T19:58:41.576-04:00I'm not so sure about that. True we closed som...I'm not so sure about that. True we closed some abdomens that maybe we shouldn't have, but today there are probably far too many being left open to develop fistulas and large hernias.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70213177974876664412013-06-25T18:37:32.931-04:002013-06-25T18:37:32.931-04:00Hate to say it, but I suspect there were quite a b...Hate to say it, but I suspect there were quite a bit more complications and deaths back then as well.<br />I still remember the dogma of having to get the belly closed.<br />I'm sure lots of trauma patients and general surgery patients died from abdominal compartment syndrome.RuggerMDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48868367019418326012013-06-25T17:50:23.917-04:002013-06-25T17:50:23.917-04:00It's hard to argue with those choices, althoug...It's hard to argue with those choices, although you left out robotic surgery.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35723900537784323332013-06-25T17:34:08.068-04:002013-06-25T17:34:08.068-04:00No pulse oximetry. Patient looks kind of blue? Umm...No pulse oximetry. Patient looks kind of blue? Umm, maybe. Or not.<br /><br />I would rate routine availability of CT, pulse oximetry, and laparoscopy as the biggest peri-op innovations in the past 25 years.<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18273607707336094332013-06-25T15:53:33.659-04:002013-06-25T15:53:33.659-04:00Cholera Joe, yes, those are all very good points. ...Cholera Joe, yes, those are all very good points. I used to hate V/Q scans. And Blakemore tubes? Instruments of the devil.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-17127148159942107702013-06-25T15:27:01.892-04:002013-06-25T15:27:01.892-04:00No CT so used V/Q scans to dx PTE. Not very accura...No CT so used V/Q scans to dx PTE. Not very accurate. Sent lots of folks for thoracotomy for pulm nodules. Abd aneurysm repair was all open, long and bloody.<br /><br />Blakemore tubes for bleeding varices, not endo banding.CholeraJoenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82956177914985536142013-06-25T11:28:49.525-04:002013-06-25T11:28:49.525-04:00Until I retired I made a point of looking at image...Until I retired I made a point of looking at images with the radiologists as often as I could, nearly every day. Even in the age of PACS, I felt it was worth the effort to discuss the case, verify the reading and get other opinions if necessary.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-4276645608355782842013-06-25T10:20:53.723-04:002013-06-25T10:20:53.723-04:00While I recognize the inefficiency, I miss the col...While I recognize the inefficiency, I miss the collegial ritual of going to radiology every day, or twice, sometimes three times a day. We'd look at the films of every patient on our service and discuss them with the radiologists. Now I look at the images wherever I am just after they're shot and only discuss with the residents when there is something important to see. The closest I come to a discussion with a radiologist is occasionally reading his/her report long after decision making is done.Anonymousnoreply@blogger.com