Showing posts from June, 2008

Milestone or Finish Line?

Well, staggering, flagging, and hyperventilating, I've made it (coupla' days short, but why wait?) to the two-year mark, bioarcheoblogically. Probably that's within a standard deviation or two of the average blogspan, and I'm not sure I have any more in me. My original intent -- to inform and to entertain, focusing on what it's like to be a surgeon, and to enlighten about some surgical diseases and situations -- seems generally to have been fulfilled and to have run its course. I'm satisfied with most of the stuff I've written, embarrassed by a few items here and there (one of my posts on anesthesia was so poorly realized and understandably misconstrued as to have engendered some really hateful responses; I didn't take it down, but added an apology at the end. It still bothers me, because in the main my relationship with the givers of the gas was always excellent and one of mutual admiration. Such are the results of hasty writing.) Some of my informatio

Food For Thought

Wedging a little update, for public interest, between my previous and tomorrow's (final?) post, I thought I'd mention a meeting I had recently. Some readers will recall I said I'm considering resuming, part-time, my surgical hospitalist gig. In discussing details, some interesting issues came up which go to themes about which I and other bloggers have written severally: namely, the changes going on in training programs and the products thereof. I talked with two surgeons; one was of my era, the other much younger but having finished training just before the invasion of the eighty-hour work week . They have big concerns. Having just hired a couple of the recently minted, they are finding the need to establish a mentoring program, because the newbies seem neither to have the skills nor knowledge to manage completely on their own, despite looking great on paper. This, of course, is exactly what I've written about. In fact, I've suggested such a mentoring program will n

Old Time Doc

Clueless at the time, when I applied to medical school I sort of imagined myself one day making house calls, good ol' Doc Schwab, paid in chickens and pies, smiles and blackberry jam. There I'd be, delivering babies on kitchen tables, patchin' up Old Lady Jones's leg on the sofa, shaking out thermometers and feeling foreheads. One of my roommates in med school was the son of such a doctor, although instead of clopping around with a horse and buggy, he raced across the back roads of Kentucky in an Aston Martin DB4 , before James Bond ever thought of it. State cops would look the other way: Aincha gonna stop 'im Jess? Do whut now?...hail no, that thar's Doc Munger, heading t' th' McCoy homestead, I reckin'... I liked the whole idea of it. More so in the early days of my practice, when I had a little extra time on my hands, but to some degree throughout my entire career, I actually made house calls. As time became more precious, I had to be reali

ER, Uh...

(Here's post I wrote but didn't publish, a long while ago -- well before a subsequent kerfuffle , or any of my recent rants and the comments thereon... So no, I'm certainly not talking about you. Or you.) [And the preceding was written longer ago still. I'd figured I'd not publish it at all, because it might be seen in light of some comment-conversations I've had with a particular ER doc. Such is not the case. It was WAY long ago that I wrote it. I suppose the post makes me a hypocrite; except I only rant on weekends, and describe it as such; whereas many ER blogs are suffused with extremities all the time. Plus, I'm about to hang it up, so WTF. Since, increasingly, I can't think of anything new and good, I may as well put the old and bad out there. At one point so long ago, I took the time to write it. So here it is:] It could be said that the blogs of ER docs are the most colorful of the medblogs (and, by golly, I just did!) With no exceptions that I

Delete "Elite," Tout de Suite

[Another weekend rant. But be of good cheer: it'll be my last. Also, I wrote it a while ago, so it's a little out of date. I'm emptying my drawers. As it were.] Here is an opinion column that pretty much says what I've been thinking ever since Hillary Clinton's and John McCain's dismissal of the universal condemnation by economists of their gas tax holiday proposal. "Elitists," they called them. Them there 'lekshuals. Well, I've been thinking about it since she (unexpectedly), the wife of a president and daughter of the Seven Sisters , and McCain (expectedly), the son of admirals and duacentamillionaire by marriage, began trying to paint Barack Obama as an elitist. Naturally, the talking heads have taken up the cry. Just as it's assumed without scrutiny that John McCain is a wizard at foreign policy, pols promote the Obama/elitist meme as neogospel. The writer of the opinion piece said it well enough, but here's how I'd have put it

Ignore RSS

See, Blogger has a new feature where you can schedule a post to publish automatically on a future day. All you need to do is indicate the day, and hit the "publish" button. Cool. Except that I thought I'd entered a future date when I hadn't. So a post just published prematurely. Unlike some other premature happenings, there's a solution, which is to delete the blog and do it again. Readers who honor me with an RSS feed from here will have received that wayward post. Others will see it next week, as intended. Sometimes I wonder why I don't walk into walls.


I received an email from a reader who plans on a career in surgery; she asked about empathy, or lack thereof, and how it affects a surgeon. It's an interesting question, and it plays in both directions. Other than situational intensity, I think it's the same for all docs. Conventional wisdom has it that doctors must retain "professional distance" from their patients. To allow oneself to cross the line (where ever it might lie) and become too close (what ever that might mean) is to risk letting one's judgment become clouded when difficult decisions must be made. The argument is not without merit; to the extent that physicians must be dispassionate in their thought-process, I fully agree. But I think the calculations that are made necessarily include some knowledge of who the patient is. And, as I've said more than once , I think it's part of a doctor's job to instill confidence and trust in her/his patients, because I think it helps them to deal with

To Sleep, Perchance...

Last night, as is occasionally the case, I watched "60 Minutes." (I love PIP . In my form of ADHD [figuratively] I rarely watch one thing at a time. I was watching the NBA finals, too.) Most of the show was devoted to sleep, and the lack thereof. It raised issues about which I've thought often over the years. To anyone more than an occasional reader of this blog, it's well-known that I learned surgery in those bad old days before work-hour restrictions. Spending a couple of weeks straight (and in some cases a couple of months) in the hospital was the norm. Working through many nights, catching a couple hours' sleep here and there was how it was. And although I was frequently exhausted, and despite the fact that on my rare nights off I routinely fell asleep whenever I went to a friend's house, I would say then and I would now still insist that I never made a poor decision or improperly carried out an operation because of sleep deprivation. And I recognize that

Love and Marriage

[Weekend rant. Homophobics and those uncomfortable with their own sexuality ought not read further.] During training, in San Francisco, our landlords were Dan and Del, a couple who'd been together for several years, and who remained together for another twenty-five or more, until Del died. Loving, thoughtful, and kind, they were the best landlords ever; eventually we bought the house we'd been renting from them, and they gave us a great deal. Terrific guys. We visited them whenever we returned to SF. I talked to Dan recently, not long after Del had died, in his seventies I think. Here are a few things that I consider inarguable. First: By logic, and by mounting scientific evidence , sexual preference is largely determined by genetics or other biologic factors. (Logic = in a society that discriminates and harasses and to a large extent reviles, who'd choose to be gay?) I recognize there's a spectrum, and that people at all points on the spectrum are capable of exp

Credit Where Credit Is Due

Here's a couple of websites commenting on the fact that the state of Minnesota, the liberal bastion, has just passed a law designating practitioners of naturopathy as "doctors." I share their concerns. According to at least one interpretation, they'll be able to admit patients to regular hospitals and manage their care. To the extent that it's even imaginable, I find it frightening. On the other hand, in my state of Washington it's been the case for years that, by law, health insurance must cover such crapola as chiropractic, accupuncture, aroma therapy, massage therapy (yes, to the extent that it's the same as physical therapy, I have no problem, but there's all that other therapeutic touch nonsense...), and, of course, naturopathy. Far as I know, homeopathy, too, which is at the very bottom of the barrel, unproven-bullshit-wise. But that's not my point. My point is to give credit when it's due. Seattle is home to Bastyr University , the mec


Below are three pages from the latest ACS (American College of Surgeons) Bulletin. I apologize for the quality, but it was a pdf file and I couldn't copy it directly; these are screen shots. For any readers who are surgeons, I also apologize for picking at a scab. Assuming it's not really readable, let me explain. It's three pages of codes and explanations for how to bill for lymph node biopsy (SLN: sentinal lymph node biopsy ) in various scenarios with or without various breast procedures. Let me also add: improper coding, as far as Medicare is concerned, is a felony. Fraud. Punishable by very heavy fines, and imprisonment. For nearly any other operation, there are similar rules, exceptions, combinations, suggestions, complications. Now consider this: unless over-ridden by Congress, there are scheduled payment decreases in the pipeline for Medicare reimbursement, to the tune of about 16% in the next year. That's, of course, after lowering payments by about two-thirds

Stem the Cell?

Until recently my main problem with cellphones was that they turn drivers into idiots. My wife and I have both had close calls with distracted drivers, obliviously pulling into traffic, making turns, whatever, without even an indication of seeing us. Nor, when the tires squeal and the horns honk (and, unwisely in these times, a finger rises), a recognition of error. When I was working, no one knew my cellphone number. I wore a pager, and when it went off in the car, I pulled over to call back. That, of course, hasn't changed; and in terms of killing us off I'd guess it'll always be in the driving mode that they are most dangerous. But there's something rising above background noise: do cellphones cause brain cancer, or do they not? Ted Kennedy, among other things a crusader in the fight against cancer, now has it, in his left parietal lobe, which is where a right-hander holds his phone. A senator, I'd assume, is on his cell a lot. Of course, it's not just him; b