Surgeons Should Operate Naked to Decrease Risk of Surgical Site Infections

Image courtesy of adamr at  FreeDigitalPhotos.net This controversial claim was actually made by a well-respected surgeon, Dr. Dellinger , at a well-respected institution, University of Washington Seattle , and published in a well-respected journal, Clinical Infectious Diseases . Although this research article's title is certainly published in jest, there is an underlying more serious message. In any case, the argument goes like this:     • FACT : Humans constantly shed skin flak…

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How Much Paperwork for a Doctor and Other Professions?

Image courtesy of Gualberto107 at  FreeDigitalPhotos.net The Annals of Internal Medicine recently published a paper which investigated how much time a doctor spends on paperwork after following 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries. The conclusion was during a typical day, 27.0% of their total time was on direct clinical face time with patients and 49.2% on "…

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Hope for the Best and Prepare for the Worst

Image from Wikipedia This quote probably ranks somewhere in the top 3 among surgeons when operating on "challenging" cases. It simply is not enough to know how to perform an operation, but also plan for any possible complications that might occur when minutes if not seconds count. Certainly, the surgeon does not want to waste time coming up with a plan B or C on-the-fly if something untoward happens... but rather, it has already been figured out even before the initial incision wa…

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ENT House Visits? ENT Telemedicine?

Image from Van-cafe.com The year 2016 may be the tipping point where telemedicine and doctors making house calls may become a mainstream phenomenon. Certainly, in the areas of primary and urgent care, such services have been around for several years. More recently, specialty care in the fields of neurology, rheumatology, infectious diseases, etc have especially pervaded  small community hospitals where such services may be absent. Some doctor house visit services include Heal  in Los Ange…

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Surgeon Scorecard - Good or Bad?

There has been a media frenzy regarding ProPublica's Surgeon Scorecard which rates how "good" a surgeon is based on calculated death and complication rates for surgeons performing one of eight elective procedures. Unfortunately, a surgeon paradox will develop where one may actually WANT the surgeon with the WORST score because a surgeon with the BEST score refuses to operate on a high-risk patient. Why? Although great in concept, the Surgeon Scorecard introduces the law of u…

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Music in the Operating Room - Good or Bad?

Image courtesy of Stuart Miles at  FreeDigitalPhotos.net Does music in the operating room help or hurt how an operation goes? One research suggests that it helps. Another suggests that it doesn't. So what's true? I think both are true and depends on the individual... As a surgeon, I personally do not play music in the OR. However, throughout my surgical training and career, I've been in both types of environments and ultimately, I think the answer depends on the surgeon whet…

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Christopher Chang, MD Doppelgangers

Every once in a blue moon, I ( Christopher Chang, MD ) get contacted meant for one of my doppelgängers who has the same name as me and also a physician. However, I recently received one phone call that was particularly interesting as it came from the surgery department of INOVA Fairfax, a hospital system 45 minutes east of where I work. As I was talking on the phone, mentally I was thinking... What in the world is the person talking about? Plastic surgery? Need to attend a meeting? WHO IS T…

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Deputy Performs Life-Saving Tracheostomy on 12 year old in Car Accident

Image from WYFF4 On Nov 8, 2014, there was a terrible car accident that claimed the lives of 3 young adults and another barely hanging on. EMS workers who arrived on the scene found 12-year-old Cheyenne Queen trapped in the car and barely breathing. A deputy coroner on the scene was called to assess Cheyenne and determined that a trach was the only way to give her a fighting chance at survival. An emergency on-the-field tracheostomy was performed and was felt to have saved her life. On D…

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Are Surgeons Dumber than Anesthesiologists?

The British Medical Journal in 2011 published a multicenter prospective comparative study comparing the intelligence of orthopedic surgeons and anesthesiologists. Before I give you the answer, a little history... Traditionally, orthopedic surgeons have the unfortunate stereotype in the medical community of being  strong but stupid. Although making fun of orthopedic surgeons is a popular past-time among physicians giving rise to a number of jokes including: What do you call two orthopaedic…

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New Incisionless Device to Correct Reflux by Medigus

A new trans-oral incisionless device to surgically treat reflux was announced by Medigus , an Israeli company, called the " SRS system ." It is a competitor to two other incisionless devices currently available:  Stretta (Mederi Therapeutics) and Esophyx (Endogastric Solutions). Common to all incisionless devices is the fact that the procedure is performed using an endoscope introduced through the mouth threaded down into the stomach. At this point, the technique used by the de…

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Surgeon's Point-of-View (POV) Video Recording

Learning how to video record vivid, stable, high-def, and focussed shots from my (surgeon's) point-of-view has not been an easy endeavor due to technology limitations, though things do appear to be slowly improving. There have been pros and cons with most video-recording systems to date which I have summarized below. The "perfect" video-recording system has yet to be developed which must include all these elements: • Wearable on headlight or glasses • Camera located between t…

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Should Risk of Death Always be Part of the Surgical Consent?

Ever since reports of alleged medical negligence came up in the case of 13 years old Jahi McMath who suffered cardiac arrest and subsequent brain death after a "routine" tonsillectomy that occurred Dec 9, 2013, the question has come up whether risk of death should become part of every single surgical procedure's informed consent no matter how rare that risk might be. It also brings up the question whether patients would want to hear every single possible conceivable risk that m…

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Lawsuit for Botched Laser Vocal Cord Surgery

In February 2012, an ENT surgeon removed vocal cord polyps using a laser while the patient was asleep with a Medtronic Laser-Shield II endotracheal tube. Unfortunately, the laser perforated the endotracheal tube, ignited the 100% oxygen being used at the time resulting in catastrophic burns to the patient. [ link ] Subsequent lawsuit resulted in favor of the patient who received an award totaling $30 million on 12/5/13. What Happened? Even though an endotracheal tube meant for use with…

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Surgeons Should be Good at Social Media

Not just surgeons, but also any procedural intensive medical specialties like interventional cardiology and radiology should be reasonably good at social media. Why? Because we have built-in time points within our daily routine schedule that enable such activities. Let me explain... Between every surgical case, there is downtime that lasts anywhere from 15 minutes to as long as 45 minutes. It is the time during which the operating room is being cleaned, sterilized, and new instruments…

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Malpractice Lawsuit for Nerve Damage Sustained After Neck Cyst Excision

Earlier this month, a malpractice lawsuit resulted in a $4 million dollar award to the patient plaintiff who suffered permanent nerve damage after a family practice physician excised a cyst from the neck. [ link ] Briefly, the patient visited the family physician in July 2009 for a lump in his left neck . The family physician recommended that the mass be surgically excised which was subsequently performed by the same family physician (not a surgeon) in the office. After the procedure, the p…

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Unhappy with Your Appointment Day/Time with your Doctor?

A common complaint for patients is how long it may take to get in to see a medical specialist. A new patient appointment may be 1-2 weeks away when an earlier appointment may be desired. What to do? Of course, one can call around to every single specialist office in the region to see who has the next earliest appointment. Other options which may work just as well include the following: • Do NOT limit yourself to a specific day of the week and time. Always use the phrase "the very…

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Hospital Charges vs Surgeon Charges

Some of the most bitter complaints I get from patients are their hospital bills. Apparently, this complaint is not unique to me given numerous media articles about perceived outrageous hospital charges for seemingly simple procedures ( article #1 and article #2 ). The healthcare system as it currently stands establishes 2 separate charges (surgeon and hospital) with any type of procedure performed in a hospital (even if not in an operating room). There is even a 3rd charge if anesthesia is…

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Do Surgeons Swear When Operating?

Surgeons, whether deserved or not, have a reputation of being mean-spirited and foul-mouthed as a group overall. It does not help that TV shows and movies perpetuate this reputation. Well, a study was actually carried out to see if surgeons are truly foul-mouthed or not and published their findings in the British Medical Journal in 1999. Using a grading system based on how bad the swearing is, researchers secretly tallied how often surgeons used profanity in the operating room. The obs…

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ENT Uses Laser Resulting in Patient Death

In 2010, an ENT used a Sharplan laser with an Omniguide Sidefire Adapter to address a superficial lip hemangioma. The tip of the laser probe was inserted through a small incision made to one side of the hemangioma and activated. Seconds later, the lip and surrounding tissues immediately swelled up indicating trapped gas. A second incision was made in an attempt to release the buildup of gas (analagous to popping a balloon to release air). A short time later, the patient's vital signs dr…

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ENT Surgeon Sues Spine Surgeon for Wrong Sided Surgery

Wrong sided surgery is extremely rare occurring anywhere from 0.09 to 4.5 per 10,000 surgeries performed. It is almost unheard of when the patient is a surgeon as well. On Nov 13, 2012, media reported that an ENT surgeon (plaintiff) sued his spine surgeon (defendant) over wrong-sided surgery. The ENT surgeon had spine surgery in 2011 for low back pain which was allegedly due to pinched nerves. The treatment called for laminectomy surgery on the right side which entails bone removal t…

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