You know it’s bad when the attending surgeon has to write this at the beginning of his operative note:
“I certify that the services for which payment is claimed were medically necessary and that no qualified resident was available to perform the services.”
So there you have it.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
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*
Just 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*
Why are so many stories so unquestioning about these runaway surgical Twitter practices? Just look at this frame grab from a Google search showing all of the stories (so far) on one hospital team’s surgical Twitter exploits. One story stated:
“Senior hand fellows…when not actively involved in the surgery, sat at a laptop just outside the operating suite and tweeted real-time updates during the procedure, according to a hospital press release. According to the Twitter feed, expert teams of hand surgeons rotated in and out of the operating room throughout the surgery.”
Oh, phew, their hands were tweeting when their hands weren’t operating! I might rather that my surgeons — even when not actively involved in the operation and when rotating out of the OR — would just rest their digits and not flex them digitally. But what an old-fashioned guy I am.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
In a development that may have you undergo your next medical procedure the old-fashioned way, two researchers from the University of California-San Francisco and the University of Oslo are reporting that inhaled anesthetics significantly contribute to the destruction of the ozone layer and add to the overall global warming gas content in the atmosphere.
Moreover, the study’s authors conclude with some valuable advice for your own practice: “From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.”
We’d like to venture even further. Not only would we recommend closed-circuit, low-flow anesthesia even with sevoflurane (damn those kidneys!), we’d also suggest that patients arrive by bicycle or, if absolutely necessary, a biodiesel-powered ambulance.
Press release: Study Shows Global Warming Impact of Anesthetics …
Abstract in Anesthesia & Analgesia: Global Warming Potential of Inhaled Anesthetics: Application to Clinical Use
Image: brutal
*This blog post was originally published at Medgadget*
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