Video comparing quality of surgeons

[Espadaleader]

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http://well.blogs.nytimes.com/2013/10/31/a-vital-measure-your-surgeons-skill/?ref=health&_r=0

Please watch. Not all surgeons are equal.

 

[roehriat]

Great piece for those of us interested in surgery. Really hits home the concept of as an art like painting or sculpture (but with perhaps a bit more technical aspect). Thanks for posting.

 

[IlDestriero]

The quality of the surgeons practicing out there is very variable. It was certainly something I considered when looking for anesthesia jobs. Working at a place that attracts and retains the best surgeons makes the job easier, more predictable, and limits my liability.

 

[roehriat]

Really hits home the concept of as an art like painting or sculpture

the concept of surgery** as an art

 

[Matt20]

The difference between those two surgeries was like night and day. It's not something I've really considered before in this way. To echo what others have said, it's like one guy is a surgeon and the other is an artist. Thanks for sharing!

 

[mcloaf]

Interesting to read how bad her attendings were in training, considering that, according to her bio, she trained at Yale, NCI, and UCLA.

 

[histidine]

Interesting to read how bad her attendings were in training, considering that, according to her bio, she trained at Yale, NCI, and UCLA.

Talk to surgeons out in private practices - many will tell you that quite a few of their counterparts in academia are excellent researchers and educators, but poor surgeons.

It takes about 10 years of full time dedication to master a subject. I'd imagine surgery is quite a task to master. In academia, some surgeons only see a handful of patients a week. How can academics keep up with the private practice surgeons who do 10 times the number of operations? Repetition is key to becoming a master.

Atul Gawande sums it up in his descriptions of the "hernia factory"
http://www.newyorker.com/archive/1998/03/30/1998_03_30_074_TNY_LIBRY_000015236

'Consider hernia repair. In most hospitals, hernia operations take about 90 minutes and cost more than $4,000; in 10-15% of the cases, the operation fails and the hernia returns. At the Shouldice Hospital, a small medical center outside Toronto, however, hernia operations take 30-45 minutes, the recurrence rate is 1%, and the cost is around $2,000. The secret of the clinic's success is that the 12 surgeons at Shouldice perform hernia operations and nothing else; each surgeon repairs between 600-800 hernias a year--more than most general surgeons do in a lifetime. All the repetition apparently changes the way they think: the surgeons become accustomed to dealing with nonstandard situations in an automatic mode.'

 

[SunsFun]

It would be awesome to have a way to evaluate surgeons' work in the OR.

Also, I like that hernia story from Toronto. I can see surgeons having much better outcomes if they specialized in one procedure rather than try to do everything.

 

[Awesome Sauceome]

'Consider hernia repair. In most hospitals, hernia operations take about 90 minutes and cost more than $4,000; in 10-15% of the cases, the operation fails and the hernia returns. At the Shouldice Hospital, a small medical center outside Toronto, however, hernia operations take 30-45 minutes, the recurrence rate is 1%, and the cost is around $2,000. The secret of the clinic's success is that the 12 surgeons at Shouldice perform hernia operations and nothing else; each surgeon repairs between 600-800 hernias a year--more than most general surgeons do in a lifetime. All the repetition apparently changes the way they think: the surgeons become accustomed to dealing with nonstandard situations in an automatic mode.'

Seems boring as crap... though I have heard of this happening more and more. There are certain areas in medicine which seem to be going from being a specialist to an ultra-specialist. I have heard this is common with other specialties such as interventional cardiology where they only do a handful of different procedures but they are MASTERS of their craft and attempt to find perfection in the few procedures that they do.

 

[histidine]

Seems boring as crap... though I have heard of this happening more and more. There are certain areas in medicine which seem to be going from being a specialist to an ultra-specialist. I have heard this is common with other specialties such as interventional cardiology where they only do a handful of different procedures but they are MASTERS of their craft and attempt to find perfection in the few procedures that they do.

Well, similar trends are happening in most fields, from engineering to bio research. And I believe the trend is occurring in most fields of medicine. As fields become more complicated and branch out, it becomes harder to be experts on everything. I mean, to give you an example, I bet there is a team of engineers at Apple whose sole purpose is to design the on/off switch.

It doesn't have to be boring as long as you find what you enjoy. My goal is to become an academic surgeon in a super specialized field, so I can master the subject and be able to push the field with research.

 

[Omppu27]

Wow. The less-skilled video was hard to watch...

 

[La Presse]

Wow. The less-skilled video was hard to watch...

Definitely!

@NuttyEngDude You should check this out. I know surgery really isn't you thing, but it's interesting nevertheless.

 

[deleted407021]

It's like the second surgeon was operating through an earthquake.

 

[armybound]

I wonder if all else is equal between those two surgeons. The second one honestly looks like a resident who hasn't done many.

 

[Deadlifts]

Well, similar trends are happening in most fields, from engineering to bio research. And I believe the trend is occurring in most fields of medicine. As fields become more complicated and branch out, it becomes harder to be experts on everything. I mean, to give you an example, I bet there is a team of engineers at Apple whose sole purpose is to design the on/off switch.

It doesn't have to be boring as long as you find what you enjoy. My goal is to become an academic surgeon in a super specialized field, so I can master the subject and be able to push the field with research.

It might be difficult for some people to mesh with a hernia factory-type setup...

 

[Cambover]

Read the NEJM article - it talks about the inclusion criteria. All submitted videos were from experienced, actively practicing bariatric surgeons in the state of Michigan.

That's concerning. I haven't read the article yet but does it discuss what makes a surgeon better or worse?

 

[mehc012]

It might be difficult for some people to mesh with a hernia factory-type setup...

Hopefully they don't snap and strangulate somebody...I'd hate to see a whole bunch of hernia docs get incarcerated.

 

[armybound]

Read the NEJM article - it talks about the inclusion criteria. All submitted videos were from experienced, actively practicing bariatric surgeons in the state of Michigan.

I've read it. It was posted in the surgery subforum a week or two ago.

It still doesn't explain if someone has 20+ years experience or 20+ cases of experience. Picking a new guy vs an old guy could explain that huge difference.

I'd be interested in seeing a comparison between two surgeons of equal tenure and who have performed the same number of cases. I just would like more information regarding the surgeons in those two videos. All else could be equal, but it may not be either.

 

[SouthernSurgeon]

I've read it. It was posted in the surgery subforum a week or two ago.

It still doesn't explain if someone has 20+ years experience or 20+ cases of experience. Picking a new guy vs an old guy could explain that huge difference.

I'd be interested in seeing a comparison between two surgeons of equal tenure and who have performed the same number of cases. I just would like more information regarding the surgeons in those two videos. All else could be equal, but it may not be either.

The article addresses all of this. The mean duration of practice didn't differ between any of the quartiles (see table 1 in the article) - they had all been in practice for an average of about 10 years. They would have to have been practicing for quite some time to have enough patients in the database to have their outcomes tracked.

They did note that the skill ratings correlated pretty closely with volume.

 

[Alexf]

As someone who will most likely be getting knee surgery in the coming weeks, this worries me even more. 🙁