tag:blogger.com,1999:blog-30499448.post1066079381339569323..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Are You Experienced?Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-30499448.post-91792834347091500922007-11-04T00:37:00.000-07:002007-11-04T00:37:00.000-07:00A 'balanced perspective' seems to be a well worn p...A 'balanced perspective' seems to be a well worn phrase when measuring some results, particularly those cases that generally don't have a great mortality rate. Poor patient selection can undo the best of them. There are many talented operators, but with a poor prognosis, how can you measure up?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-10650819382080421962007-11-03T13:10:00.000-07:002007-11-03T13:10:00.000-07:00Patients get overwhelmed by commercial hype. In pr...Patients get overwhelmed by commercial hype. In prostate cancer surgery, they encounter distracting hype in the form of device ads. Much more important to ask who's my surgeon than to ask who's my gizmo? This point is reviewed in a recent <A HREF="http://www.laprp.com/article.php?aid=340" REL="nofollow"> podcast on laparoscopic and robotic prostate surgery </A> produced by the Prostate Net.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-40700705698557940342007-08-29T18:35:00.000-07:002007-08-29T18:35:00.000-07:00I think one has to have a serious "meta-understand...I think one has to have a serious "meta-understanding" of something to say one has truly mastered it on one's own. Until then, it's apprenticeship, picking up more bits of knowledge along the way. That may not translate 100% with pure surgical skill (time, etc.), but I'd consider it a prerequisite (in a perfect world, from my point of view, of course :P) for true "solo flying" in private practice. Just knowing how to do a thing and doing it over and over the same way just shouldn't be "good enough," at least not for me.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-61181835706889434842007-07-28T09:18:00.000-07:002007-07-28T09:18:00.000-07:00Dr. Schwab, you're a flatterer, but I appreciate i...Dr. Schwab, you're a flatterer, but I appreciate it anyway. I'll try to keep it interesting.Anonymoushttps://www.blogger.com/profile/04071711894125638696noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-16317637731238503272007-07-27T11:02:00.000-07:002007-07-27T11:02:00.000-07:00and from the looks of your blog, anne, you've take...and from the looks of your blog, anne, you've taken it to a much higher plane than mine!Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-2679830963361435482007-07-27T10:45:00.000-07:002007-07-27T10:45:00.000-07:00I blame you! I was once an innocent aspiring docto...I blame you! I was once an innocent aspiring doctor, and now I've created a blog/monster. I found your blog, enjoyed it, and decided, "Hmmm. . .I should try this. . ."Anonymoushttps://www.blogger.com/profile/04071711894125638696noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-77581521586561323822007-07-27T06:47:00.000-07:002007-07-27T06:47:00.000-07:00Wow... this touches on so many difficult to discus...Wow... this touches on so many difficult to discuss (and blog about) topics. As an academic surgeon, my patients want to know who will be doing the procedure. Our newest consent forms have check boxes detailing various tasks that the residents might be doing: incision, resection, tissue rearrangement, implants, closing, etc.<BR/><BR/>I am struggling to know how to address these issues with patients and families. It is not straightforward.<BR/><BR/>Thanks for bringing the topic to light.Brucehttps://www.blogger.com/profile/13796821092673583519noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-53634492644563369062007-07-26T18:39:00.000-07:002007-07-26T18:39:00.000-07:00Greg: I agree with everything you said.It's also a...Greg: I agree with everything you said.<BR/><BR/>It's also a strange range, this particular study: 10 vs 250. What about eveyone in between? Another solution I failed to mention is the progress being made in "virtual surgery," whereby trainees can get more and more realistic technical experience without drawing blood.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-3608899711974723922007-07-26T17:08:00.000-07:002007-07-26T17:08:00.000-07:00We've seen enough of these studies at this point t...We've seen enough of these studies at this point to I think generalize: those who do more of X procedure do a better job than those who do only a few.<BR/><BR/>For the reasons discussed, there's only so much we can learn from this, and we have to suspect there are some other very important lessons to be learned. Surely, volume isn't the ONLY criterion that is important. What we need now is a more in-depth analysis of approach, training and techniques that go along with better outcomes, some of which may relate to volume, some of which may not. You have to wonder if some of the volume difference is related to surgeons developing a restricted practice, limiting themselves to a shorter list of procedures which they are comfortable doing, then doing a lot of them.<BR/><BR/>After all, if we cannot understand any better than more is better, how are we to advance the care of patients?<BR/><BR/>I have the sense that there are some who will never be notably good surgeons regardless of how many times they do a given procedure -- a sad but true fact, I think.Greg Phttps://www.blogger.com/profile/18422487877167541900noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-82607250287980045892007-07-26T15:47:00.000-07:002007-07-26T15:47:00.000-07:00Tough questions about who does the case. As a pla...Tough questions about who does the case. As a plastics resident, I often hear patients ask the faculty, "You'll be doing the surgery, right?" My faculty are very dedicated to resident education. They always respond, "No, the resident does a significant portion of the operation. I supervise him (or her) the entire time and may do parts that they aren't ready to do. But if I don't let them do operations now, there won't be anyone around who knows how to do them ten years from now when I'm retired." <BR/><BR/>Patients usually understand after that, but I'm sure some do schedule with the private guys instead.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-47397097433530824882007-07-26T15:32:00.000-07:002007-07-26T15:32:00.000-07:00seaspray: it depends on the surgeon, and, to some ...seaspray: it depends on the surgeon, and, to some extent on the relationships. If you're there on direct referral to a surgeon and you are his/her "private" patient, it might be that the surgeon would do every bit of the operation him/herself. But not necessarily. In teaching institutions, there's an understanding that all or part of an operation might be done by residents, under the direct supervision of the attendings. There's no hard and fast rule: it's something a patient can feel free to ask their surgeon.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-3407254296950557912007-07-26T14:33:00.000-07:002007-07-26T14:33:00.000-07:00I am confused.What if you are a patient referred b...I am confused.<BR/><BR/>What if you are a patient referred by your surgeon to go to a teaching hospital because you were a high risk case and felt you'd be better off in a facility with around the clock care (Doctors on staff 24/7) and also be on a wing that specializes in your particular post-op care?<BR/><BR/>If a patient is high risk -who does the surgery?SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-28551246780473796772007-07-26T14:02:00.000-07:002007-07-26T14:02:00.000-07:00Enjoyed the post as well. As a 3rd year resident a...Enjoyed the post as well. As a 3rd year resident at an academic medical center, I agree with most of has been said. I agree with Dr. Schwab - some of the slickest surgeons out there are in private practice. Why? They operate much more and can focus on efficiency and technique rather than showing the resident where to Bovie. Regarding the breast patient who chooses to go "downtown" - unknowingly, she just signed up to let me (actually, usually an intern) do her lumpectomy and sentinel node. Having said that, the resident rarely "does" the case; we are always under close scrutiny and most attendings will take the case over if they see too much fumbling). One of the better reasons to go "downtown" is probably the multidisciplinary effort at a larger center - oncologist, surgeons, radiation oncology - although community centers have these teams as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-39119150569121397242007-07-26T13:26:00.000-07:002007-07-26T13:26:00.000-07:00As a young surgeon just starting out in practice, ...As a young surgeon just starting out in practice, I too have lost a couple cases to the big tertiary referral centers. All of them had to do with breast cancer. It's frustrating and a little humbling. Breast cancer requires a lot of office time spent discussing pathophysiology of the disease, diagnostic options, and the varying treatment protocols. You build a relationship. You sense the woman trusts and understands what you're saying. And then you get a message from your office worker saying Mrs. so and so decided to have her surgery done downtown. All that work....<BR/><BR/>And breast surgery, technically speaking, is not exactly like doing a Whipple. It's pretty straightforward, basic surgery. Not that any idiot could do it, but I don't think surgeons are doing breast fellowships to become more adept at the intricacies of lumpectomy. It's a cse you pretty much master by third year of residency.<BR/><BR/>The other thing about the large tertiary referral centers you have to consider is that these are "teaching" centers. Teaching means "resident does the case" in many of the basic general surgical cases. If you're flying to Johns Hopkins to get your gallbladder taken out, you're probably fooling yourself if you think John Cameron is the guy actually doing the case. <BR/><BR/>Great post. I don't turn cases down either.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-75707003445684617172007-07-26T11:43:00.000-07:002007-07-26T11:43:00.000-07:00When I lived in a small town, word of mouth was th...When I lived in a small town, word of mouth was the method of choosing a surgeon or doctor. <BR/>I don't remember who said the following, but it has always stuck with me....An older doctor has more experience, but a young doctor who has recently begun practice has learned the latest and greatest. Although any respectable older doc keeps up on the latest and greatest, I suppose there is some truth to both. <BR/>I have seen young surgeons with remarkable technique and good outcomes, and young surgeons who are tentative and unsure of themselves. It's hard now, on the inside looking out, to know how to help someone choose.<BR/>Personally a lot does depend on the procedure, but I tend to lean towards experience over youth. I would love to assist in a teaching hospital, but I'm not so sure I would want to be operated on at one.make mine traumahttps://www.blogger.com/profile/18149160428613740527noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-61973898329337856282007-07-26T10:36:00.000-07:002007-07-26T10:36:00.000-07:00Rob: I think your point about a wider range in pri...Rob: I think your point about a wider range in private practice is well-taken. On the other hand, some of the best teachers -- in terms of judgment, experience, wisdom -- I had in training were far from the best operators. And your selection of surgeons confirms my comment about people putting trust in their primary docs when it comes to referral time.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-5432391038966791412007-07-26T09:57:00.000-07:002007-07-26T09:57:00.000-07:00I think you get a wider range of good to bad in pr...I think you get a wider range of good to bad in private practice. There are some terrible surgeons making money in the private world. As a PCP, I have some of each that I use. For less-specialized surgeries, I use the general surgeons that I would (and have) use myself. We have an ENT at the local teaching hospital who is renown for his minimally invasive thyroid and parathyroid surgeries. I send all of those procedures to him. So I think it really depends on the procedure.Dr. Robhttps://www.blogger.com/profile/01871792467587364512noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-10588744469290385302007-07-26T09:10:00.000-07:002007-07-26T09:10:00.000-07:00Interesting post! Forgive me for being a little s...Interesting post! <BR/><BR/>Forgive me for being a little slow on the uptake here so would a surgeon who has a private practice but also works in a teaching hospital be the optimum choice? Then of course there are exceptions for various reasons.<BR/><BR/>I think I am going to start a Dr Schwab- Surgeonsblog file. I want to go back over your posts and pull the ones that may be useful in the future should I or anyone else I know ever need surgery. Lots of good info in this blog. So glad you are here! :)SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.com