Recently, a colleague lamented a change she had noticed among the young doctors at her hospital. “They are always in front of the hospital computers,” she said. “I never see them with patients, but I can always find them sitting at a terminal.” She paused for a moment, then added uncomfortably: “These days I probably spend as much time looking at the office computer as I do looking at patients.
More than twice as many lungs and nearly 50 percent more kidneys could be recovered for transplant operations if intensive care physicians were to work with organ procurement organization (OPO) coordinators to monitor and manage donor bodies after brain death has occurred, according to an analysis by UPMC and University of Pittsburgh School of Medicine physicians that is now in the online version of the American Journal of Transplantation.
I remember being told by a surgeon, while I was in medical school, that "you're not a real doctor until you've killed someone." I thought at the time (and still think) that there was a puerile bravado behind that admonition, but there is also a grain of truth. I have my own graveyard. Curiously, not all of its inhabitants are dead.
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.