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How To Have A Pain-Free Hospital Stay

This is a guest post from Dr. Anita Gupta.

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How To Have A Pain-Free Hospital Stay

Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care.

One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain comes second. Fortunately, this doesn’t need to be the situation. Here are a few tips for patients to ensure that their pain does not go overlooked:

Let someone know if you are in pain. This may seem obvious, but patients often hesitate to question their doctor. Pain control during your hospital stay is not a luxury, and you need to know you have a right to pain control during your stay. If you doctor or nurse is not answering your questions regarding pain, ask to see pain specialist who will likely address your concerns as well as the concerns of the doctors and nurses taking care of you. Unfortunately when it comes to treating pain, not all doctors are trained equally.

Have a family member or good friend to act as your advocate. Have this individual get involved in your medical care and act on your behalf during your hospitalization. Read more »

Tired Surgeons: How Long Was The Patient Asleep?

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate. The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.

As summarized in the WSJ’s Health Blog, the perspective piece argues for more regulation for tired surgeons:

… self-regulation is not sufficient. Instead, “we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived,” they write. For example, elective procedures wouldn’t be scheduled for the day after a physician is due to be on all-night call.

And the authors suggest that patients be “empowered to inquire about the amount of sleep their clinicians have had the night before such procedures.”

It’s a noble goal, and indeed, data does show that fatigued surgeons tend to make more errors. Patients, once confronted with a choice of being operated on by a tired surgeon, may choose to postpone surgery. Read more »

*This blog post was originally published at KevinMD.com*

Breast Implants Under Local Anesthesia?

Reader question:

A surgeon I’m thinking about seeing said on his website that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up, there are lots of differing opinions out there, but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?

I am not a fan of local anesthesia or twilight sleep for breast implant surgery except in rare cases (simple redos and such). The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles, and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic. Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Nurse Anesthetists: Allowed To Work Without Doctor Supervision?

New Jersey’s state health department is considering a rule that would allow nurse anesthetists to work without a doctor’s supervision, as long as there’s a plan to reach one in case of an emergency. New Jersey would join the 30 states that allow nurse anesthetists to work without direct supervision.

On the other end of the country, a California court upheld the state’s decision to opt out of a Medicare requirement that doctors be present while a nurse anesthetist works in order to be reimbursed. The Centers for Medicare and Medicaid Services have allowed states to opt out of that requirement since 2001.

Since then, there has been no evidence of increased inpatient deaths or complications, researchers reported in the August 2010 issue of Health Affairs. Earlier this month, the Institute of Medicine reported that nurses should have a larger role in medical care, including anesthesiology.

*This blog post was originally published at ACP Internist*

Transcontinental Anesthesia

Transcontinental AnesthesiaJust two weeks after we reported on teleanesthesia in the form of remotely-performed nerve blocks, the first report of transcontinental anesthesia comes in.

On August 30, anesthesiologists of McGill-McGill University Health Centre in Montreal, kept watch over a patient in Pisa, Italy, undergoing thyroid gland surgery. Basically they used a teleconferencing setup with four cameras, with two cameras streaming the anesthesia data (ventilation parameters and vital signs), one camera aimed at the operating field, and the last one for any special purposes. Read more »

*This blog post was originally published at Medgadget*

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