Tuesday, July 22, 2014

New post on "The Medical Bag" website

I am now writing for a website called "The Medical Bag."

No it's not about a female doctor.

The site is a medical news and social area for physicians, but others are welcome to read what's there.

This week's new post (link) is about a recent paper claiming that cardiac surgeons' skills deteriorate after even one day of not operating. You won't be surprised, but I disagree.


Anonymous said...

ROFL Is that a 723.1 or a 724.3?

Congrats! Hope you get paid more than here. :)

Skeptical Scalpel said...

It's neither of those codes and yes, the pay is better than here.

Libby said...

You're terrible..."female doctor"...tut tut

Glad the pay is better than here & congrats on the new gig.

George Gasman said...

Vladimir Horowitz: "If I don't practice for one day, I can tell. If I don't practice for 2 days, my wife can tell. If I don't practice for 3 days, my audience can tell."

That said, I'm not sure that manual skills in a surgeon are (ducking) all *that* important. As someone who sees lots of guys operate, I am frequently surprised to see that those whom I consider to be marginal surgeons get excellent results. We tend to judge based on speed and personality on my side of the ether screen; not, unfortunately, on the basis of outcome.

It seems to be a remarkably poor study (based on your comments). Nevertheless, I'm sure it'll be all over the media and the blogs within a matter of days.

Skeptical Scalpel said...

Libby, thank you.

George, a New England Journal study from a few months ago strongly disagrees with your experience. Here's the link: http://www.nejm.org/doi/full/10.1056/NEJMsa1300625

George Gasman said...

SS - thanks for the link. Interesting, to say the least. Perhaps I wasn't clear enough. My perception of what I consider to be a "good" surgeon is clearly biased by what I can see. My eye is predisposed to look at speed, determination, lack of wasted movement and other things. I am not what the study you cited refers to a "peer". So, my perceptions may be skewed by what I said above - personality, timeliness, etc.

I am not surprised that those who are perceived to be "less (for lack of a better word) handy" have more complications. My point (obviously inadequately conveyed) is that I am not in a position to judge that handiness. This study affirms that less handy (as judged by peers, not the likes of me) don't do as well.


Aren't you aware of surgeons whom you consider to be "less handy" who get good results?

Skeptical Scalpel said...

George, I do know some surgeons who are not particularly dextrous but seem to get good results. Apparently that is not the case with bariatric surgeons in Michigan. Also, some surgeons who are great technically are not so good in the bedside manner department.

Anonymous said...

Some speedy surgeons are just being reckless. Some slower surgeons are being careful (I fall into this latter group.) I am impressed by speedy, careful surgeons -- they are the real elite surgeons, and they are the ones who should be doing the highest risk operations.

I think the literature has shown increased rates of anastomotic leak and wound infection with prolonged anesthesia times. I think bowel surgery in general, and bariatric surgery in particular, demands a speedier approach.

That being said, I have had excellent results over the years with simple, lower-risk general surgery cases such as lap chole, lap appy, all sorts of hernia repairs, etc. I have had good results with operations for SBO (because I don't make those stupid enterotomies that my speedier colleagues seem to get into.) I have never yet (knock on wood) had a mesh infection. I can only recall one clinically evident PE in the last decade, and zero DVTs (because I use plenty of postop ambulation, SCDs, and use Lovenox when I am not worried about bleeding.)

I think our educational system has done surgeons a severe disservice by not letting us pick up scalpels until our later 20s -- nobody in their right mind would train virtuoso musicians or world-class athletes the way we "train" surgeons. Our society has a huge overdose of classroom, in my opinion.

Skeptical Scalpel said...

Anon, thanks for commenting. You make an excellent point about the timing of surgical training. I have never consider that. I'm not sure how it could be addressed. Some sort of education has to come before the technical skills part.

Anonymous said...

How about "operating" on animals? More virtual reality or simulation type of operations?

Skeptical Scalpel said...

In most cases, operating on animals does not really recreate the situations that you find in humans. Simulators are OK up to a point for laparoscopic cases, but are not as realistic as aircraft simulators. Simulators for open cases do not exist as far as I know.

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