Thursday, September 20, 2012

Something To Add, Part 2 (15-50)

This is the second installment to part 2 in a series:
(Click here for the first installment: http://reikidoc.blogspot.com/2012/09/something-to-add-part-2-1-14.html)

What surgeons put up with...

#15
what Reader's Digest says:
It's always interesting to hear what people say when you're giving them anesthesia. I once had a guy who was a horse trainer who started going on and on about how this one horse was a sure thing to win. One of the nurses collected money from everyone in the operating room and bet on the horse. It came in second place. The smart people bet the horse to place, but some had bet the horse to win, so half the staff was happy, and the other was upset. He woke up and had no idea what kind of ruckus he'd caused.

what Reiki Doc says:
I once had a fourteen year-old girl who was crying so much in the recovery room no one could console her. She kept asking for the anesthesiologist. I was in fellowship at the time, so the attending went to check out the concern. She had gone unconscious from anesthesia for her surgery right before the punchline of a joke. She was upset that she did not hear the rest of the joke!

#16
what Reader's Digest says:
I did an intestinal operation on someone who had been stabbed. As I was running my hand along the bowel, I came upon something and said, 'What the heck is this?'. It felt like a condom. Then all of a sudden, it wiggled. I dropped it, shocked. The guy had worms.

what Reiki Doc says:
I did anesthesia once on a guy who was on coumadin and had been stabbed in the chest. My resuscitation was very aggressive in surgery, including Novo 7. By the time the trauma surgeon got in to the chest cavity, all the bleeding had stopped. I had beaten her to the punch! We closed and didn't say anything...

#17
what Reader's Digest says:
During my weeks as a surgical intern in the ER, I inadvertently stuck myself twice with contaminated needles, briefly nodded off in the middle of suturing a leg laceration, accidentally punctured a guy's femoral artery while trying to draw some blood, and broke up a fight between family members of a guy who'd come in with a stab wound to the abdomen. I was slugged in the head by a delerious patient in an alcoholic rage, spat upon, coughed on, vomited on, farted on, bled on, and mistaken for an orderly.

what Reiki Doc says:
As a categorical general surgery second year resident, I was so utterly sleep deprived the ICU beds started to look good. I didn't care if they poked me and inserted tubes. I just wanted some rest.

#18
what Reader's Digest says:
In medicine you can get a DUI, go to jail for a couple of hours, and walk out at 7 a.m. the next morning and do a surgery. You can be accused of sexual misconduct and drug and alcohol abuse in one state and pop over to the next one and get a license. Some state medical boards don't even thoroughly research your background; they argue that the less-than-$10 fee to access national data is too expensive.

what Reiki Doc says:
I had an attending in anesthesia who had booze on his breath. One day he didn't smell like that but had a tremor. Another attending came in the O.R. and asked if that tremor was new. He was sent to rehab that day. He lost his department head position, but returned and worked like normal ever since.

#19
what Reader's Digest says:
Surgeons are control freaks. When things don't go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.

what Reiki Doc says:
I have seen this in my training. Fortunately this behavior is going the way of the dinosaur. Surgeons still get upset, but they had to take anger management training if they lose it like the above doc says.

#20
what Reader's Digest says:
Mistakes are probably more common than you would think, but most of them don't actually hurt people. I work with residents, and I don't let them do anything that I can't fix if they screw it up. If there's an error that I fix that I'm sure won't affect the patient at all, I'm not going to say anything about it. That would accomplish nothing except to stress out the patient.

what Reiki Doc says:
I have worked with residents, too, on the anesthesia side. I kept a tight rein on them, but let them have the illusion they were making the decisions. I would not only let them make a mistake I could fix, and jump in and fix it, I believe they would never learn if I warned them and prevented them from making that mistake. Residents are cocky, and this is how you get through to someone like that. Anesthesia is serious and the margin for error is slim. There is nothing like a few moments of sheer terror to catch someone's attention, and the awe and respect that is gained by my easily fixing it. Again, nobody ever got hurt, seriously. It was always within the scope of normal anesthesia practice.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
The number of total major operations performed during a surgical residency is 909
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
One resident  in each large class of anesthesia residency programs dies from anesthesia drug abuse.
15% of surgeons may suffer from alcohol abuse or dependence.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Is This Really Necessary?

#22
what Reader's Digest says:
Some problems just don't fix well with surgery, like many cases of back pain. My advice? Grin and bear it. Some surgeons vehemently disagree. They say, 'Oh you have a degenerative disk, and that must be the culprit. Let's fix it.' But many people have a degenerative disk with no pain. There isn't a lot of evidence that we're helping very many people.

what Reiki Doc says:
Spine surgery, sinus surgery, and chronic pain are excellent fields for the introduction of Reiki into Clinical practice.

#23
what Reader's Digest says:
You should know that practically all surgeons have an inherent financial conflict of interest. That's because they are pain approximately ten times more money to perform surgery than to manage your problem conservatively.

what Reiki Doc says:
When all you have is a hammer, everything looks like a nail. I see doctors who operate like an assembly line, either to be efficient or to make money. One interaction with a burn surgeon and a burned child's mother was disgusting. 'Doctor, is my daughter going to be like this for the rest of her life? What am I going to do?'. He ignored her and walked right out of the exam room with his entourage, my resident butt being a part of it. How calloused and insensitive! He met an early death himself, actually, not long after this.

#24
what Reader's Digest says:
Always ask about nonsurgical options and whether there's anything wrong with waiting a little while. Surgeons are busy, and they like to operate. A professor from my residency would say, 'There is nothing more dangerous than a surgeon with an open operating room and a mortgage to pay.'

what Reiki Doc says:
They can't do 'anything' any more. Insurance companies got smart to this. Follow your intuition though. If it's not a cancer, or a surgical emergency, it can wait.

#25
what Reader's Digest says:
Your doctor should not push you to make a speedy decision about prostate cancer surgery. Most prostate cancers are extremely slow-growing, and there is so much misleading information out there, so you should take your time.

what Reiki Doc says:
Agree 100%. Have seen some nasty local tissue damage after radiation for prostate cancer though. Fistulas are not a good thing. Research the complications of radiation before you commit.


Stay Safe After Surgery

#26
what Reader's Digest says:
The only real way to understand what happened in the operating room is to read the operative note dictated by the surgeon. If you have unanswered questions about your surgery, ask for the report.

what Reiki Doc says:
this is excellent advice.

#27
what Reader's Digest says:
If you have pain in your calf after surgery, or if it swells and looks red, call your doctor right away. These are the main symptoms of a blood clot, which is a risk of just about every surgery.

what Reiki Doc says:
They train us to look for the five W's: wind (atelectasis, a pulmonary complication), wound (seroma or local infection), water (urine infection), walk (blood clot0 and winnebagos (mastitis after childbirth)

#28
what Reader's Digest says:
What really keeps us up at night? It's not making a mistake in the operating room; it's the noncompliant patients. When patients don't do what we tell them, bad things can happen.

what Reiki Doc says:
True, true. I have done cases in the middle of the night on people who did not follow through with their foley instructions and clotted it off.

#29
what Reader's Digest says:
Obese people have no idea how challenging their care is. Starting an i.v. is tough because chubby arms don't have many visible veins. It's difficult to place a central venous catheter. Post-op, they're more likely to get infections. Just getting someone who weighs 300 pounds out of bed is hard.

what Reiki Doc says:
Go to a center of excellence in bariatric surgery. No matter what the procedure, they will have the gowns, wheelchairs, gurneys, and operating room tables that are safe for you. They will also have a sleep apnea protocol in place, which is a major life-threatening risk after any surgery requiring narcotics for pain relief in the morbidly obese. And 300 pounds is average size for the South and also for some OB centers all over the country.

#30
what Reader's Digest says:
If you ask too many quesitons, you can be branded as a pain in the neck. When one extremely hostile relative bombarded me every time I walked in, I developed a tendency not to go in the room. If you have three pages full of questions, show them to the nurse. Say, 'how many of these should I wait to ask the doctor about? How many can you help me with?'

what Reiki Doc says:
The type of people who do this to their doctors probably won't take this wise advice, above. I find Reiki most helpful in these patients. They are reaching for reassurance through the mind with all their questions. Your Reiki attitude, loving-kindness, and calm are contageous, and instantly settle them down.

What Hospitals Don't Want You to Know

#31
what Reader's Digest says:
About 25 percent of operations are unnecessary, but administrators e-mail doctors telling them to do more. This is not an insurance company putting pressure on doctors; this is not a government regulation. This is private hospitals pushing doctors to generate more money by doing more procedures. It goes on at America's top hospitals. The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do.

what Reiki Doc says:
I have worked both for salary and for private practice. This is news to me, the 'incentives'. For salary, you have no reason to operate if you don't have to , you get paid and would rather do less, especially in the middle of the night. You would rather be in bed. The fee-for-service takes the sting out of being woken up at all hours, spending time away from your family. Being paid overtime like I did at my old job somewhat helped.

#32
what Reader's Digest says:
Rules that restrict resident's hours mean doctors come out of training with a lot less experience. When I was training, I was almost always in the hospital. Now it's more like shift work. 'Hey, it's 7 p.m. I'm out of here. He's your problem now.'

what Reiki Doc says:
I found my work-hour restricted residents studied more than I did. I was constantly falling asleep with my face in my general surgery book. Once I changed to anesthesia, I was expected to work on routine cases till eight at night to make money for the department, and was not able to read and study at home because I was too sleepy. I had to take time off between jobs to study for my board examinations instead. Being able to know something well enough to do it, and well enough to test on it, are two different things.

The Truth About Medical Devices

#33
what Reader's Digest says:
Some doctors hire practice management consultants to help capture more revenue. The consultants may want the practice to sell equipment like knee braces or walkers at a markup. They may want the doctors to buy or build a surgery center to capture facility fees. They usually want orthopedic surgeons to get an in-office MRI. Every time a doctor does this, he becomes more financially conflicted. As soon as you put in an MRI machine, you order more MRI's so you won't lose money on it.

what Reiki Doc says:
See if your doctor is a member of the Association for Medical Ethics. These physicians are screened to make sure they have no conflict of interest with suppliers. It is a start. Again, trust your intuition. And best of all, Reiki is free.

#34
what Reader's Digest says:
Some orthopedic surgeons make millions in soft consulting agreements with device manufacturers. Sometimes the same doctors have performed a record number of implants for that company.

what Reiki Doc says:
Again, Association for Medical Ethics will protect you from this. Anyone on this list does NOT do what the above says.

#35
what Reader's Digest says:
If you need a medical device, ask if you doctor has a financial relationship with the vendor--if so, chances are you are going to get that type of joint or screw, even if it's more expensive or not the most appropriate.

what Reiki Doc says:
A lot of these devices come from reps, such as Sythes. Some companies are better at supplying the needed materials, better at giving advice in the O.R., or the only one allowed by contract with the hospital. Ask why your doctor likes that brand first. Ask about the rep. Ask about the hospital. Then spring the financial question.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
The average income of a surgeon in 2011 is $256,000.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Forty percent of surgeons have said they felt burned-out. (Reiki anyone?)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Our Softer Side

#36
what Reader's Digest says:
Every time a patient dies, I think about the family, the funeral, the kids. I operated on a man who had something very complex and died in the operating room. He had a wife and two children. When I came out to tell them, the children were screaming, 'Mommy, Mommy, I want my daddy.' That was very hard. Even though we present ourselves as very strong, we're vulnerable to depression and other problems. We're human.

what Reiki Doc says:
Many times, after experiencing something like this, when I get home, there is no one to talk to that really 'gets it'. People are kind, and try to understand. But your colleagues are working like you when you are at work. What I used to do was try to find the hospital chaplain to help me break the news. I could leave to do my work, the family would not be alone, and later the chaplain would be the one who was there for me, a shoulder to cry on.

#37
what Reader's Digest says:
That tiny thank-you card that took you 15 seconds to write? It was very meaningful. Letters are a good reminder of how important this is and how people entrust themselves to us. I save every one.

what Reiki Doc says:
I have a stainless steel mug with a holiday design on it from a mother I put an epidural in who was part of a large coffee family in the area. It sat at the front desk for months, I never even thought the pretty package was for me. Finally a nurse said, 'aren't you going to get your package a patient left you?' I treasure that mug. I also saved every gift and thank-you note, too. The nicest thing you can do when you are happy with your care is to write a letter to their supervisor. It goes up the chain of command, and really makes your doctor look good to the hospital.

#38
what Reader's Digest says:
Patients think that we are so wrapped up in our hectic schedules that we don't care. But we do. We care deeply. Those of us who are spiritual pray for our patients. My family and I pray for my patients at dinner the night before surgery.

what Reiki Doc says:
this is what Doctors with Reiki is all about: adding the spiritual component back into health care.


We All Make Mistakes

#39
what Reader's Digest says:
I was about to approach the back of a patient's knee instead of the front for a biopsy. Because of a checklist, I looked at the imaging again and thought, yikes! What am I doing? Thankfully, I caught the mistake before I even draped the patient, and no harm was done. I felt horrible about it. It was more than a year ago, and I still think about it.

what Reiki Doc says:
In training I once put a line into the carotid artery while trying for the jugular. I called my vascular attending right away, apologizing profusely. He said, 'All this means that you have done enough. And no matter how you think you will never do this again, you will. We all do. If you had gone further with the procedure, I would have had to do surgery to fix it. But you listened to your intuition and you stopped. Hold pressure like this for twenty minutes'. And to my joy, the patient was unharmed!

#40
what Reader's Digest says:
Fatigue and impatience have undoubtedly contributed to some mistakes I've made in the operating room. But unless you ask, your surgeon is not going to tell you that he was up all night on call before your procedure and that he may not be in tip-top form.

what Reiki Doc says:
True. True. But surgeons and anesthesiologists have been trained to be able to work while fatigued. It is like soldiers in battle. We may not be out best, but we can function, and we are safe. I have seen a surgeon delay a case for lack of sleep, everyone understood, and was totally supportive of his decision.

#41
what Reader's Digest says:
I always ask at national conferences of doctors, 'How many of you know of another doctor who should not be practicing medicine because he is way too dangerous?' Every time a hand goes up.

what Reiki Doc says:
I have seen doctors who have had their names dragged through the papers do excellent work. I have seen respected department heads so old they are falling asleep in the doctors lounge every time they sit down to wait for their case (which is often).  Many die before they quit operating, although most stop by 70.


Free Advice From A Plastic Surgeon

#42
what Reader's Digest says:
Very often, plastic surgery patients don't admit to a previous surgery, and I don't find out until I'm in there. I'll go in on an eyelid or nose, and it's just a mess. If you don't tell us you had lipo, there will be scar tissue, and the fat won't come out normally. So please be two percent honest. There's no need to be embarrassed. We've heard it all, and we don't judge.

what Reiki Doc says:
Twice in my career I have been unable to intubate a patient because of a prior chin lift/neck lift that was too tight and not disclosed. I had to cancel the case because myself and all my buddies couldn't get the breathing tube in. The patients were angry and unable to appreciate the safety motivation behind that call. I lost a day's worth of work over it, too!

#43
what Reader's Digest says:
Products like ScarEase, Scarguard, and Mederma do work to reduce scarring. Start applying daily as soon as your wound has healed, and avoid sunlight or use a sunscreen with zinc oxide for at least six months after surgery.

what Reiki Doc says:
Agree. And don't put on the Vitamin E. It doesn't work.

#44
what Reader's Digest says:
Patients get really detail-oriented about a surgery technique but forget to focus on basics like pre-op and post-op instructions. That's just as, if not more, important.

what Reiki Doc says:
I have seen plastics patients take out their cosmetic stitches at home, too early, 'because they didn't like them and they bugged them'. This totally ruined the surgery.

#45
what Reader's Digest says:
The biggest mistake during recovery is not giving yourself enough of a break. Give yourself time to heal. If you don't, you can cause complications and prolong your recovery.

what Reiki Doc says:
If you drive within six weeks of non-laparoscopic surgery you might have to slam on the breaks and risk popping your internal stitches. Allow one week of recovery for every day spent in the hospital, and four weeks for outpatient major surgery. Sleep is a medicine. And so is Reiki.

Be Saavy About Heart Surgery

#46
what Reader's Digest says:
If you doctor wants to give you a stent, always ask, 'Is this safer than medicine?' If you're not having a heart attack or an unstable angina, you will do equally well with a stent or medicine, studies show. Having something in your body is not a risk-free proposition. There is evidence that thousands of people have had stents they likely did not need.

what Reiki Doc says:
The cardiac surgeon that goes in on a heart that has previously been stented and stented again will call it a full-metal jacket. It increases the complexity of his or her work a great deal.

#47
what Reader's Digest says:
If I had any kind of serious condition, I'd go to a teaching hospital. You'll get doctors involved in the latest in medicine. Even for simple cases, if there's a complication that requires an assist device or a heart transplant, some hospitals may not be able to do it. At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available.

what Reiki Doc says:
agree

#48
what Reader's Digest says:
Before any operation, always ask what's broken and how fixing it will help. Just because you have a blockage to an artery doesn't mean you need it fixed, especially if you don't have symptoms.

what Reiki Doc says:
Unless you have collaterals with good runoff, I would fix a blockage, especially on the LAD or Left Main (the widowmaker).


Lawsuits Scare Us

#49
what Reader's Digest says:
We're all afraid of getting sued. It's the big black cloud hanging over us, and it permeates a lot of the things we do: the tests we run, the labs we order to make sure we're not missing something. I'm guilty of that.

what Reiki Doc says:
Ask, 'How will the result of this test affect your plan of care?' If it doesn't and is a 'nice to know', you don't need it. We do urine pregnancy tests on all women from 11-80, even the ones who are involved in a relationship with another women. That does not make sense.

#50
what Reader's Digest says:
Your surgeon may say it's better to do your operation right away even if it's not urgent. Why? If you let the patient leave the hospital and something adverse occurs, someone may raise the question, 'Why wasn't the operation performed right away?'

what Reiki Doc says:
Your surgeon may have an open time slot in the O.R. schedule to fit you in. If we wait until you are ready and it's the dead of night, a whole on-call team will have to drive in from home to do your case!


Namaste,

Reiki Doc






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