SurgeXperiences 201: Better

Welcome to the first edition of the second season of SurgeXperiences, the blog carnival for everything surgical and more! 

Here’s 2 pieces of great music to go along with this edition. 1st up: A pop/rock song, “Better Man”, by Robbie Williams

This 2nd smooth jazzy rendition by Rickie Lee Jones, entitled “Saturday Afternoons in 1963″.

 

I think we all have a desire to be better at what we do. For the doctors in the medical profession, it probably started with that incessant drive for excellence in pre-med years. We do our best to get into medical school. In medical school, we aim to do well. If we graduated top of the class, even better. We try to boost our CVs to attain a favourable match for residency positions. Then we aim to be the Chief Resident. Get to the most prestigious fellowship program. Set up and maintain the most profitable practice. This is a gross generalization, but i think we all have an innate desire to do better. For one reason or other…

The look of determination

Feature of the fortnight

I think this deserves the attention. It may take some time to follow it through.

It all started when Buckeye Surgeon wrote an article about the MedPac/general surgeon controversy. Then he followed it up with one about the distinction between surgeons with varying degrees of post-operative patient ownership. Somehow what is said within didn’t strike a chord with a certain intensivist.The comment he left described the frustrations he has with “these kind of problems he faces everyday”. Buckeye Surgeon had to remind him that general surgeons are actually trained to look after patients post-operatively, even critically ill patients. Frank Drackman also got involved with a lil’ post of his own. Later in the week, an encounter of his own with Mr. Pincushion reminds him on how surgeons differ from internists.

 

The question is, will this age-old controversy of whether the internist or surgeon should look after the patient post-operatively ever end? Personally, i think for us to do better, each hospital has to come up with certain guidelines, guidelines built on mutual understanding. The physician and surgical team must be able to come to a consensus on when the handover takes place. Both parties must be comfortable with the protocols. Personally, I’m more for the “i operate on the patient, i own him/her” idea. Its heartening to note that the impetus BEHIND all these is the patient’s welfare at heart. Ultimately, what is best for the patient? 

Early years

Books can do much to educate and inspire. I love to read the memoirs and tales of surgeons – how they recount their surgical training, their life as a surgeon, etc. A recent one on which this SurgeXperiences edition is based on is by Atul Gawande, entitled “Better: A Surgeon’s Notes on Performance”. Las Risas let us know what it is all about with this book reviews.

1st year medical student Jeffrey W. shares his days on the General Surgery service as part of his medical school’s early exposure to clinical life scheme - some pimping, and bumming. Hmph, is there really nothing to do around? How about learning some knot tying?

Next, we have Dr Scott, a family physician who blogs at Polite Dissent, share about his surgery rotations during medical school, and the time he got to do his first subcuticular stitch on the leg of a patient having carotid endarterectomy. 

Aggravated DocSurg, who frequently advertises he hails from “The Best Medical School in the Country®”, tells us of the many fathers he has in his medical career. These fathers have done much to shape who he is as a physician and surgeon today, so he highlights who they are and what they have done. 

Fancy a plaque like the above? Fret not, because Scapel or Sword has dispensed valuable advice on how to become “The Intern of the Year”. It was all about the extra effort to do better. Work hard, hard, hard. This fits perfectly with our theme this fortnight.

A gastrectomy with Bilroth II reconstruction was what Buckeye Surgeon did for Patient X, who had a non-actively bleeding large gastric ulcer on the lesser curve of the stomach. Now the hours spent digesting those pages of Cameron and Schwartz on peptic ulcer disease (PUD) turned out to be handy after all. The theme shines through with yet another example of how conscientious studying pays off.

Working years

A surgeon often has to deal with trauma. Most require surgical intervention. It isn’t an uncommon thing to have a young bloke not buckling up and a high speed MVA throws him out of the car. Buckeye Surgeon shares his thoughts on how and what to do with these blunt force trauma incidents, especially if it involves diaphragmatic injuries.

Take that!

Heading to the operating theatre/room, Intraoporate notes how those who scrub in the OR deal with their rings. What can their habits reveal about themselves? You have the pragmatic, and then the showy. Oh well… Just make sure you don’t make a mess of yourself when you scrub in, as Dr Liana from Med Valley High kindly and humourously shares with us.

More humour awaits us as Dr Edwin Leap recounts a telephone conversation with the circulating nurse in the OR. I appreciate your efforts at pronunciation, but its appendicitis! Not _______.  Read on to find out! 

On a more serious note, Dr Amanda at Value For Your Life gives some nuggets of wisdom on what being a surgeon has taught her about personal finance. Indeed, managing your finance as your account grows can be tricky business. 

Managing professional relationships can be tricky business too. Dr Sheepish at The Paper Mask tells the tale of an encounter with an anaesthetist who had serious drug abuse allegations against him. Should he use his services again when the need arises? 

Patient care

Always striving to ascertain the best for patients, screening is often a major part of public health policies. This is especially so for breast cancer. Cancer is the no. 2 killer for women in the States, and breast cancer is the most common cancer in women. Yet, there seems to be a paradox when it comes to screening mammography and breast cancer. Find out more at Respectful Insolence’s blog.

While we are still on female mammary glands, let’s turn our attention to a fiery debate about the safety of breast implants. When in doubt, consult the expert. Thankfully we have our resident plastic surgeon Dr Ramona Bates who has blogged much about this at her blog Suture for a Living. She educates us aboutthe history of breast implants, breast reconstruction (part 1 & part 2), silicone vs saline implants, and lastly silicone implants & related health issues. There’s no better reliable source you’ll find on the Internet. 

Immediate breast reconstruction after a mastectomy. (Source)

How about retracted nipples? What causes them? A frightening sign that cannot be overlooked, Dr Bates points us to the right direction in a 100-year-old article which provides an algorithm on how to deal with retracted nipples. I guess this goes to show that some things never change, and its always wise to learn from the past in our efforts to manage these patients better.

Primary Non-Hodgkin Lymphoma of Breast. (Source)

Over at Surgery, Cooking, Art.. Life. Passionately, Dr B shares her thoughts on patients with (or without) carpal tunnel syndrome. It’s indeed heartening to note there are doctors like her who still spend the extra time and effort to educate patients and empower them with more information. This act of doing better has its positive repercussions; patients comply better, have their fears allayed, and in turn educate family members and friends with their new-found medical knowledge. 

As we move distally to the fingers, Dr Bates at Suture for a Living teaches us about extensor tendon repairs on traumatic injuries to these poorly protected extremities. 

Finally, Dr Bongi at Other Things Amanzi writes about “little k”, a paediatric patient of his years ago who had a burnt epiglottis. A heart-wrenching story, Dr Bongi shows how just a little extra effort in hugging “little k” before the day started or whenever he could is sometimes just what we can do, and perhaps it might just make all the difference in the world for a patient.

Patient’s perspectives

Patients seem to have caught the bug of excellence too. They want to be sure about their impending surgery. They want to know more. They want to do whatever possible to make the procedure smoother. They, too, are an integral part of the team.  In Terminal Obesity, Terry blogs about his upcoming laparoscopic adjustable gastric banding (Lap-band) operation and the associated risks.

Lap Band Surgery (Source)

Lisa, a Cushing’s patient who blogs at The Cushing’s Disease Journey updates us with what’s up with her so far. While we are on Cushing’s, hop on over to Musings of a Distractible Mind where family doctor Dr Rob discusses the shame that some obese patients feel when they visit him. Picking up a patient with Cushing’s and having that as an explanation to the weight gain can rid the patient of the unnecessary guilts of over-eating and under-exercise, etc. 

Serving the community

Jennifer Browning reports on Project Medishare Blog Emory’s surgical team’s recent trip to Haiti. Students get the opportunity to scrub in and learn, surgeons innovate and adapt to lack of surgical equipment. The desire to do better for the underprivileged community in Haiti has propelled these endeavours. The team raised $20,000 to make this mission trip possible. 

Emory Surgical Team in action

Final words

I guess we all have this desire to do better in whatever we do. It boils down to whether we care enough to make that extra effort, to stay that extra hour, to do that extra thing, etc. Similarly, i suppose we can all do better in this whole surgical grand rounds/carnival thing! Click the extra click to submit your posts via the carnival form! Do the extra reading and organising as a host. Besides, its fun and enriching. Previous hosts can attest!

With this, i conclude the first edition of SurgeXperiences Season 2. I hope you have enjoyed the music and the excellent articles linked herein. Next edition (202) will be hosted by Dr Ramona Bates at Suture for a Living on 20th July.

A catalogue of all 24 editions of Season 1 is available. If you would like to host a future edition, please take a look at the schedule and contact me. Thank you and have a good fortnight ahead.