practice
Difficult Conversations: a Resident’s Perspective
By Dr. Kathryn McElhinney One of the most challenging aspects of our careers as surgeons is delivering bad news to patients, but it is also one of our most important jobs. No matter the subspecialty, every surgeon has to have frank conversations about unexpected outcomes or diagnoses with their patients. There are a number of different formal and informal curriculums that have been proposed on how to teach residents how to navigate difficult conversations with patients and their families but no singular method prevails. As a resident, it is the ultimate opportunity to learn how to master these communication, empathy, and leadership skills. 1. Embrace the opportunity to learn and be uncomfortable No one enjoys telling a family that the diagnosis is likely terminal or that the next best step in care may not be the surgery that they have been told would solve all their problems. It is okay...
No Longer Radical Contralateral Prophylactic Mastectomies: An Informed and Personal Choice
By Dr. Victoria Haney and Dr. Christy Teal As of 2020, breast cancer has become the most common cancer in the world (study). Overall survival has significantly increased in the past 20 years due to improvements in chemotherapy, endocrine therapy, genetic testing, and imaging studies used for screening (ACS statistics). Still, 1 in 8 women will be diagnosed with breast cancer during their lifetime. As women surgeons, the likelihood that our friends, family members, patients, or even ourselves will be affected by breast cancer is almost guaranteed. For most women, breast cancer is diagnosed in its early stages due to widespread screening initiatives for annual mammograms (ASBS screenings). Many patients with invasive cancers undergo breast-conserving therapy, or lumpectomy, along with adjuvant radiation. This treatment is well-established to have similar survival outcomes when compared to mastectomy (study). During treatment, patients will often ask the question, “What if it happens again on...
Awake Surgery
By Dr. Barbara Buccilli My initial exposure to neurosurgery was through awake surgery. I began my internship in the department, and I immediately joined an ongoing research project on awake surgeries for arteriovenous malformations (AVMs). This may seem unusual, but when considering my fascination with this type of surgery and my overall obsession with the nervous system, it becomes less surprising. These factors drew me closer to the field and motivated me to pursue that internship. The significance of awake procedures in neurosurgery extends beyond the remarkable experience of having our hands on a patient's brain while they engage in activities like reciting Shakespeare, answering questions, or singing a tune. Brain tumors, AVMs, and other lesions can often be located within or near eloquent areas of the brain, necessitating a delicate balance between efficient removal of affected tissue and preservation of function. Asleep-awake-asleep procedures have transformed these operations from a...
Palliative Care in the TICU
By Bethany Wood Harvey I think it’s a fair assumption to say the Trauma ICU is a bit different than anywhere else in the hospital. Our patients are often in our care unexpectedly; they are ‘healthier’, working, and independent just hours before arriving in the TICU. Moreover, they are acutely sicker -their status is often tenuous and can decompensate quickly. In these situations, families are often thrust into the position of being surrogate decision makers, being faced with questions they had never previously considered. These family members look to the team to help guide and support them through this process. Although as surgeons we have 9+ years of medical education, often less than 1 month of that time is dedicated to how to effectively have difficult conversations. While scrubbing for a trauma surgery, you may not know exactly what you will encounter, but at the sink, you rehearse the steps...
Making the Leap from Trainee to Staff Surgeon
By Lakho Sandhu ‘The more I read, the more I acquire, the more certain I am that I know nothing.’ –Voltaire The moment you’ve dreamt about for years finally arrives. You pack up your belongings and move across the country or perhaps just down the hall, to start a new journey as a staff surgeon. Without a doubt, it’s an exciting moment – the culmination of years of dedication, hard work and sacrifice. It’s also a significant transition into a new role that can stir feelings of doubt and anxiety. A sense of imposter syndrome can make even the most confident among us start to second guess themselves. During my first 18 months of practice, I received many pearls of wisdom from colleagues and mentors that have eased my transition from trainee to staff surgeon. What follows is by no means an exhaustive list but just a few lessons that...
Electronic Health Record fails the test of physician usability: What can we do?
By Lillian Erdahl Today I achieved what has been a challenging goal for me, zero tasks in my electronic health record (EHR) inbox. It is unlikely to last for very long, but it feels good to accomplish it even briefly. Much has been done with information technology in the interest of improving the delivery of health care. Not surprisingly, there are positives and negatives to the digitalization of health care delivery. Emerging literature shows that U. S. physicians find the burdens and poor usability of the current systems to be a major source of stress and dissatisfaction. We are spending “pajama time” trying to keep up with the seemingly endless list of tasks generated in our EHR inbox. Positive aspects of the current EHRs include electronic preservation of clinical data and accessibility of these data, the ability to share data in a timely fashion from one hospital to another when...
Surgeons and OR ergonomics: When Doing What We Love Hurts Us
By Geeta Lal Almost 3 years ago, I woke up with a familiar throbbing pain in my left jaw and face. My first brush with it was four years prior, while caregiving for my mother with cancer. “Stress and teeth grinding…” said the well-meaning oral surgeon I saw, and proceeded to advise soft foods, muscle relaxants and NSAIDS for what was diagnosed as myofascial temporomandibular dysfunction (TMJD). That episode resolved and aside from some intermittent discomfort, I had done reasonably well. This time, however, things were different. The usual measures weren’t helping, and as the days and weeks wore on, the pain extended to my head, neck, shoulder, and upper back – and it refused to go away. My journey to feeling better has involved many imaging studies, specialist consults, and treatment modalities. But what I didn’t know was that a major contributor for TMJD was the exaggerated head-down posture...
Racing back to work
By Bethany Harvey But, what about FMLA? That is the common response I receive when friends and family ask why I am working on formalizing a maternity/paternity leave and lactation guidelines for my residency program. Inspired by the work by Dr. Sarah Shubeck and Dr. Arielle Kanters at University of Michigan and with a now 55% female residency program; frequent AWS blogger and co-resident Dr. Jane Zhao and I decided that a formal policy was overdue. FMLA (Family and Medical Leave Act) entitles eligible employees of covered employers to take 12 weeks of unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Unfortunately, most surgical residents are unable to access even half of that time. A recent study by Rangel et al. surveyed 347 female surgeons who had had...
Imposter Syndrome: The Dirty Little Secret of Successful Women (and men too)
By Kandace McGuire We were sitting in a bar in Center City, Philadelphia. My co-chief resident and I were being hosted by our attending (and mentor) to wings, beer, and life advice. After he taught us how to deglove a chicken wing for the most efficient gustatory experience, he declared, seemingly out of nowhere, “You know, so many of us think we are doing a horrible job at surgery and life and one day someone will expose us for the frauds we are”. My co-chief and I looked at each other and then back at him and exclaimed, “I thought I was the only one!!!” This was my first exposure to the concept of the Imposter Syndrome. Since then, I have come across many who suffer from it and many who write about it. Beyond that wing and beer-laden explanation, the technical definition of Imposter Syndrome is “a psychological pattern...
Practice Finances
By Feibi Zheng For those in academic and/or employed practice, your practice finances can seem like a black box. Whether you are salaried, on a production model or a blend of both, I encourage you to pull back the layers and gain a basic understanding of how funds flow through your organization and into your practice. Some of you who are on a fixed salary model or who are paid on a wRVU only model may wonder why any of this should matter to you. I would reply with “no margin, no mission.” Your organization simply cannot pay you money it does not collect unless you are one of those rare individuals whose salary is supported by philanthropy. Ultimately, you are the only person who can make sure that you are being compensated fairly for your work. Clinical Productivity Measures: There are several measures institutions use to gauge/track clinical productivity...
