When a surgeon is considering an implant, whether it be a synthetic implant or allograft tissue – transplant tissue from another human – there are multiple factors that the surgeon has to consider. The first and foremost is: What is the reason that the surgeon is using the implant? What goals does the surgeon want to achieve with implant of that particular material? For instance, if the surgeon is putting metal screws and rods into somebody’s back, , the question is, what is the benefit that screw and rod? What is it going to achieve for that patient? In the case of spine surgery, oftentimes, that means you’re restoring stability to the spine.
Months into Ruth’s treatment for breast cancer, after she had completed her chemotherapy, she needed a break. So did I. We cobbled together our airline miles and made plans for a short break in the Caribbean. One long flight and then a change to a 10-seater and up in the air again. The small plane was hot and Ruth took off her Courtney Love travel wig.
All Mark Rockoff, MD, wanted was an operating room cart that could safely transport and discard the needles and tubes he inserted before surgery, hereby eliminating the current inefficient system in every operating room for putting catheters into patients. At the time, the needles and supplies were individually carried to each patient’s bedside, used to set up the lines for IV fluids and medications and arterial monitoring, then carried away again for proper disposal.
Pauline Chen had a post in the New York Times recently about surgical informed consent . Informed consent is an important part of the surgeon/patient communication transaction. Surgeon reviews the proposed operation, the rationale behind it, and the possible complications. For example— a patient comes in with biliary colic.
Cryopreserved human tissue (allo)grafts have been used for cardiovascular reconstruction for over 50 years. Aortic valve allografts are used primarily in cases with extensive aortic root destruction from native or prosthetic valve endocarditis. Because they provide normal hemodyamics, unlike man-made valve prostheses, they are also very useful in patients with aortic valve disease who have small aortic roots or significant left ventricular dysfunction.
“A case of back pain?” I thought to myself. “Perhaps an exacerbation of the scoliosis she’d had since childhood?” I shrugged my shoulders and carried on with my day, flipping through a few more charts. Just another patient. When the time came, I strolled into the lobby, her chart in hand.
One afternoon in clinic, a patient’s wife stopped me in the hallway. I had just finished describing an operation to her and her husband, obtaining his consent and answering their questions, but I wasn’t surprised that the woman was still worried. Despite her easy smile and infectious throaty laugh, she had appeared anxious throughout the visit, the corners of her mouth twitching and her hands flitting from her hair to her face to her pocketbook and back to her hair again.
What is the physician’s most precious possession? Some might answer that it is his patients. Others might respond it is the training and education that the physician has obtained to practice his (or her’s) craft. But the real answer is that it’s the physician’s reputation .
A research study assistant slid the informed consent document for the clinical trial across the desk to us. My wife, Ruth, sitting next to me, signed it. She was in treatment at Memorial Sloan-Kettering Cancer Center, where I am also a doctor and cancer researcher. Ruth had flipped through page after page of the informed consent forms.
Medical school is a wonderful, but at times difficult experience. As you start this fantastic journey, there are a few “rules” I think might help.
Toward the end of my general surgery training, a senior surgeon pulled me aside to ask about my plans for further training. One of the best surgeons in the hospital, he had done his own subspecialty training at a hospital famous for vascular surgery. He nodded in approval when I told him where I was going; the hospital was known for excellent results with sick patients undergoing difficult operations.
Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic. This is a no-brainer situation – the patient is in sepsis and septic shock.
Organ removal through body’s orifices is minimally invasive approach to surgery that is increasing in popularity. March 15, 2011 When Patricia Manrique was told she needed her gallbladder removed she immediately thought about the classroom full of children who rely on her to teach them tap and ballet each day.
What, exactly, is a difficult patient? Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall doctors whom they would say are difficult to work with as well.
More patients are checking themselves out of the hospital against their doctors’ advice, new government data shows. The Agency for Healthcare Research and Quality reports a 40 percent increase in the number of patients who left the hospital against medical advice over a recent 12-year period.