Live Chat Today (July 10) at noon EDT

Live chat on my blog today at noon EDT (GMT-4).

Topic: Why did so many people believe that doctors would be rating patients online? That story can be viewed here.

Any other topic you want to bring up is fine too.

Note: The Live Chat app is not yet available for mobile users and cannot be viewed by them.

Breaking news-Turning the tables: Doctors to rate patients online

This just in.


BREAKING NEWS--Turning the tables: Doctors to rate patients online. LINK

Follow up. How many authors does it take…?

I recently blogged about the fact that for several different specialties, the number of authors of research papers has risen exponentially over the years. The post appeared on General Surgery News.

As is my nature, I was critical of this increase and blamed it on the "publish or perish" culture that pervades medicine and other sciences and the large number of new journals, which all are looking for content so they can make money.

A Twitter follower named @terpkristin ask me what my own experience has been. This is a fair question and I applaud her for taking me to task on it.

With some trepidation, I pulled up my CV and started counting.

Over the years I have authored or co-authored 97 publications, including peer-reviewed articles and case reports, review articles, book chapters, editorials and letters to journal editors.

My first article was published in 1975 and the last in 2010. That's a span of 35 years which is similar to the times covered in many of the articles on author proliferation.

After reviewing all 97 publications, the average number of authors was 3.0 with 23 having only me as the sole author.

Excluding everything but the 52 peer-reviewed papers, the mean number of authors was 3.5.

Looking at the peer-reviewed papers another way, the 22 papers written from 1975 to 1993 had an average of 3.2 authors, while those written during 1994 to 2010 averaged 3.6 authors.

This compares favorably to the numbers of authors listed in the articles I found on the subject and wrote in my previous post.

For papers written in this century in the fields of plastic surgery, orthopedics and thoracic surgery, the average number of authors ranged from 4.0 to 7.5.

Luckily, my inquisitor didn't ask me how many of the articles were any good. That's a different question.

LIVE CHAT TODAY (July 1)

Live chat on my blog today (July 1) at 11 a.m. Eastern Daylight time in the US or GMT-4.

Chat app is located in the right lower portion of your screen.

The topic is "Should students and residents memorize information or should they google it?" If it's the latter, how should they be tested?

If you want to review some background information before the chat, I suggest you read the following:

Dumber Doctors?

Will Today's Medical Students Make Inferior Doctors Because They Google Medical Information Instead of Memorizing It?

Not Dumber, but Different? Counterpoint from a Millenial

Other topics may be discussed if time permits.

Blakemore tubes. Should an inexperienced surgeon use them?

In response to a comment mentioning Blakemore tubes on my post about what surgery was like in the 1970s, I said they were instruments of the devil.

This sparked the interest of surgeon who works in a rural hospital with minimal endoscopy services. He emailed me and asked if I thought he should have Blakemore tubes available for use because he might have to transfer a patient with bleeding esophageal varices over a long distance for definitive treatment.

He trained in the early 21st century and admitted that he did not remember ever having seen a Blakemore tube. He wondered why I didn't like it.

I have witnessed all of its major complications such as tube dislodgement, necrosis of the nose and lips, aspiration, esophageal perforation, airway occlusion and death.

Without any hands-on experience, he probably should not try to use the device. In addition, the average nurse would likely also not be familiar with caring for a patient with the tube.

On the other hand, maybe as a last resort he could try it.

I had planned to write a post about the Blakemore tube, its insertion, maintenance and complications. But while researching it, I found that others had done so, and better than I.

Read this excellent article on Medscape. Registration is required, but it is free. It covers everything you need to know about Blakemore tubes.

And here is a link to a nice video from the Yale GI service that demonstrates the steps required to safely insert and manage them.

What do you think? After reading the Medscape piece and watching the video, should this rural surgeon, who has never personally seen a Blakemore tube, use it ?

Are millennials cut out to be surgical residents?

When you hear this story, you may wonder.

Recently in a surgical residency program somewhere in the United States, the residents requested a meeting with their program director and surgical department chairman to discuss a concern they had.

A few of them were upset because during a 31-day month, one resident on a three-person rotation ended up working an extra night of call.

6/28/13 ADDENDUM#1: The residents who complained included some non-designated PGY-1s who were hoping to be converted into categorical residents if any such positions became available. This would not be perceived as favorable by those in charge.

I know that old guys like me aren't supposed to say things like this, but if residents had approached my chairman with a complaint like this, he would have thrown them all out of his office immediately.

Residents were summarily fired for lesser offenses than that too.

Despite my previous post about a Harvard Symposium that suggested we should train residents like Navy SEALs, I know we can't turn back the clock.

But people, there is something really wrong when residents start haggling about the number of days worked.

What's next? Requesting an extra hour off because you worked the Saturday to Sunday overnight when Daylight Savings Time ended?

I didn't see anyone volunteering to work an extra hour to compensate for the night the DST begins.

OK, tell me I don't understand this generation of residents. Tell me I'm out of touch.

But you won't convince me that there isn't something wrong with complaining about an extra day of call.

6/28/13 ADDENDUM#2 As pointed out to me in comments on Twitter, my post does not pertain to all millennials. I acknowledge that such a generalization was unfair.

What was surgery like in the 1970s?

When I first started my residency in the early 1970s, things were remarkably primitive by today's standards.

There were no ultrasound machines. Believe it or not, we would diagnose acute cholecystitis by history and physical examination alone. The only diagnostic tests we had were oral cholecystogram (OCG) and intravenous cholangiogram (IVC). For OCG, pills were taken the night before the test. If the cystic duct was patent, iodinated contrast would appear in the gallbladder and stones could be seen. Non-visualization of the gallbladder meant either the cystic duct was blocked or the pills were not absorbed (presumably due to inflammation, not necessarily of the GB) or the patient forgot to take the pills. The test was useless in acutely presenting patients. IVC was similar except the contrast was given intravenously. The common bile duct could be seen faintly unless the patient was jaundiced. It rarely showed stones in the GB.

There were no CT scans. We had to make the diagnosis of appendicitis by, you guessed it, history and physical examination alone. And since laparoscopic general surgery did not become common in the US until 1990, all appendectomies and cholecystectomies were done as open procedures.

There were no computers in any clinical departments or nursing units. Everything was on paper. The good news? There was no way to "copy and paste" progress notes. We had different colored paper for different sections of the chart, which made things easy to find. The bad news? Charts often went missing. Handwriting analysis rivaled that of archeologists deciphering hieroglyphics in Egypt. But paper charting was faster to do and easier to "leaf" through.

When submitting a research paper, drafts had to be prepared on a typewriter (an ancient kind of word processor that put the words directly on paper). If you needed to change a paragraph on page 1, the entire manuscript had to be retyped from the beginning. And making slides for presentations involved cameras with 35 mm film, taking the film to be developed and hoping the slides came out OK. Find a typo? Take the picture over and have the film processed again.

Now we use PowerPoint. It's easier, but I'm not totally convinced that it's real progress.

Maybe the biggest change has been the advent of the Internet. In the palm of my hand, I can instantly access huge amounts of information formerly available only in print books and journals. To look up a paper, we had to use Index Medicus, an encyclopedic series of books listing every article by subject in most journals.

There were far fewer journals back then. You had to know the correct heading or keyword to search or you could miss something important. Cross-referencing was not easy because it was in print and there was a different set of volumes for every year. And libraries kept many years' worth of volumes of journals.

Of course, many more changes have occurred. Can any of my older colleagues comment?