The Curious Scalpel

When I see a patient with a horrible injury, as I did last week, I'm always reminded of the hit 70s TV show The Six Million Dollar Man, starring Lee Majors. I know of it peripherally, but never watched very much - it was cancelled almost a decade before I was born (editorial note: remind me to talk about older generations blaming younger generations for not knowing about the culture that preceded theirs). (Bonus editorial rant: $6M is a pittance compared to what it would REALLY cost today to rebuild a human to that degree. Even partially. $6M might cover part of the surgery and/or maybe part of the ICU stay. But you'd need to tack on a whole lot more to that tab, such as the nursing, the drugs, the anesthesiologist, the post-operative therapy... and who would pay for the dozens of administrators necessary to ensure quality, safety, reliability, and 17 other things that end in "-ty"?) Invariably, someone will jokingly refer to the most famous line from that show...

If you can fill this board, you might be a hand surgeon...

Sometimes I'm shocked by how differently two people can experience the same phenomenon. A symptom that one patient would just shrug off as "not a big deal," another might complain is the worst tragedy that's ever befallen them. One huge factor in this is the patient's outlook, their attitude toward life. If you maintain a victim's mentality ("Woe is me, disadvantage X put me starting behind the line, obstacle Y blocks my path, and hurdle Z is too high to jump..."), then a symptom can seem immense. Pain looms like an enemy. It portends failure, signals doom. A related phenomenon called pain catastrophization has recently been described and elaborated on . Its significance in Hand surgery is being discussed by prominent hand surgeons including Dr. David Ring, Dr. Ryan Calfee, and others. I'm sure there's an overlap with the catastrophization of pain and those who posses a "victimhood mentality", but I haven't seen it describ...

Today was awesome. It was also a totally regular day. I hope those thoughts still occur simultaneously in a few years. Outside of the workday though, I did have the opportunity to speak with my brother, (shout-out!) and one thing we discussed did bring up some interesting thoughts I had about medical sub-specialization. (Side note: yes, I did update the layout to the blog for the first time in... well, maybe ever. Please feel free to leave a comment if you hate it or can't read it because the inter-chromatic contrast is too low or something) I touched on this briefly in a previous post , but I want to expound on a facet of it today. It's commonly understood that, especially in surgical fields, medicine has become hyper-compartmentalized. The days of going to your GP for everything from a cold, to choking on a hot dog, to a broken leg to delivering a baby, are done... at least in developed areas. In or around major metropolitan areas, nobody is Archibald "Moonlight...

I'm not typically a "theme" person, but this week has had a theme. I saw several patients that received borderline or frankly inappropriate treatment, and all share a common unfortunate thread. I already talked about patients who want surgery but don't need it. I also saw two patients this week who came in because they had gotten surgery that they didn't need, and now have problems. And another who kept coming back to the Urgent Care with what ended up being an abscess that was "lanced" (e.g. a tiny nick in the skin was made to allow the egress of some pus, and inadvertently trap the rest of it deep inside to continue to fester) and eventually needed to go to the OR for a formal debridement, which could've been avoided had it been done correctly the first time or had the patient been admitted to the hospital sooner. I'll give you one other illustrative example. A patient comes in because they got a cut on their arm. Yesterday, 18 hours ago. I...

As I'm in fellowship training, I often introduce myself as a fellow, but I find many patients don't have a clue what that means. Many know what a resident is ( or at least they think they do ) but have never heard of fellows.   Having to frequently explain where I am in my training gets me thinking again about what exactly my experience is.  I'm board-eligible in Orthopedic Surgery.  I've been clinically learning and practicing it for over 5 years now (depending upon exactly how you define those terms). Most patients who come into the office these days don't present the diagnostic challenge they once might have. I even readily identify "sub-clinical entities" (medical jargon for other, incidental, non-related problems that were sort of bothering the patient but not really to the level that they'd complain about it, and are not why they came to the office). While that makes me feel good about myself, it does have a tendency to keep me in the room ...