tag:blogger.com,1999:blog-4968787219619380438.post2974878840489962953..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: A new surgeon confronts self-doubtSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-4968787219619380438.post-40972602493611280362015-07-24T05:11:12.775-04:002015-07-24T05:11:12.775-04:00Nice Post!Nice Post!Garnerhttps://www.blogger.com/profile/12467533989658958541noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-72917162032095018652015-05-21T07:33:57.543-04:002015-05-21T07:33:57.543-04:00We've heard from both sides. Our chief residen...We've heard from both sides. Our chief resident was leaning toward waiting. I hope we find out what happens.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25216059876444723232015-05-20T15:06:26.902-04:002015-05-20T15:06:26.902-04:00I would say he/she should read the book later, hav...I would say he/she should read the book later, having already grasped the key lesson: that even the best are prone to make mistakes. He/she is already miles ahead of the surgeon who never made (was unaware of) any mistakes. <br /><br />About the only consolation of making mistakes is the opportunity to serve future patients better. There is always something to read, and a natural "hook" is to use personal experience as a guide of what to explore in greater detail. While the retrospectoscope is often a cudgel in the arena of medical malpractice, it can be a useful tool when used to conduct personal CQI.<br /><br />He/she probably already has a series of patients who are memorable in part because of the conclusion that something could have been done differently and that with better knowledge, doing the different something could have been known. Those are the cases where an in-depth exploration will have the highest retention rate.<br /><br />He/she should set the memoir aside for now, but put it at the top of whatever time constitutes reading for pleasure. That may be awhile in the future.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-50112459128166003732015-05-19T15:09:32.886-04:002015-05-19T15:09:32.886-04:00Anon, I share your concern about this. I do not se...Anon, I share your concern about this. I do not see how the 1200 or so chief residents in surgery can all be trained at the select high-volume hospitals. I asked Dr. Birkmeyer, one of the proponents of the policy to restrict low volume operations to major centers, how this would impact surgical education, and he said, "If teaching hospitals aren't meeting those low volume bars, they're mainly teaching bad habits."<br /><br />I also asked if the data on volumes and outcomes could be biased by patient selection. Maybe people who can afford to go to high volume centers are better socioeconomic and physiologic specimens than those who must be treated at low volume hospitals. I didn't receive a response.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58580810625975112132015-05-19T14:19:38.192-04:002015-05-19T14:19:38.192-04:00Lord knows the poor young surgeon won't get an...Lord knows the poor young surgeon won't get anything out of this: http://www.fiercehealthcare.com/story/major-teaching-hospitals-impose-restrictions-low-volume-surgeries/2015-05-19. This is scary. How do you learn, teach young surgeons? What happens when it is THEIR turn to teach? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-17921905506120586262015-05-19T10:03:16.693-04:002015-05-19T10:03:16.693-04:00Thanks for the two comments above. I'm sure ou...Thanks for the two comments above. I'm sure our young surgeon will take them to heart.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18421892087483891182015-05-18T21:11:48.853-04:002015-05-18T21:11:48.853-04:00He should read the book. He might learn something....He should read the book. He might learn something. He might be exposed to a situation he has not been exposed to in his training.<br />I used to ask the administration to have a conference to discuss<br />the malpractice cases brought against the hospital . They always refused. Too bad. There are thing to be learned from bad outcomes.In my experience bad outcomes<br /> almost always were the result of a weird combination of factors,<br />some medical, some administrative, some social , some due to events that were bizarre and never brought up in training. Always listen when things go wrong. It is shared experience .Experience is invaluable even bad experiences.William Reicherthttps://www.blogger.com/profile/10062067819184876941noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-63627675865217134282015-05-18T19:48:40.118-04:002015-05-18T19:48:40.118-04:00I'd say it read it, but talk to patients and a...I'd say it read it, but talk to patients and ask them how they would feel when a doctor doesn't return the trust we are expected to take in someone who doesn't see us before surgery, doesn't see us after. Think about how and what that says about surgeons. We have no reason to trust you when this is what we deal with and you can't even be bothered to spend some time with us. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-74096790456343751832015-05-18T15:09:31.860-04:002015-05-18T15:09:31.860-04:00Anon, good comment. It is hard to focus on other t...Anon, good comment. It is hard to focus on other things when a patient is not doing well especially if you could have done things differently. The truth is you can always second guess yourself, and if you don't do it, plenty of others will.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-54549512811859320412015-05-18T14:19:35.443-04:002015-05-18T14:19:35.443-04:00I think the fact that the aspiring surgeon wants t...I think the fact that the aspiring surgeon wants to read the book is a good sign. I agree with their observation that the timing has to be right. <br /><br />I'm struck by Marsh's admissions of guilt and remorse over his mistakes. Trying to balance those feelings with the necessary concentration to continue to perform surgeries must be a tremendous challenge. Anonymousnoreply@blogger.com