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6-“DRUG BLUNDERS”

Drugs used for comorbid conditions must be continued unless they add risk.  Patients and family should reinforce history of allergies or sensitivities.  Clarify nonprescription drugs like Aspirin, Advil and other supplements.  Understand what new drugs are being used and reasons.

Include self-monitoring appropriate diet.  Steak on your tray the day after abdominal surgery should be rejected.

Do not hesitate to question diet, drug deliveries, and infusions if they do not make sense. Participate!

7-“KNOWLEDGE GAPS”

There is old knowledge and experience.  There is new knowledge that is available for all and clinically useful. There is other knowledge learned in medical school.  There are guidelines for classes of patients that must be interpreted and integrated into individual...

4-“POOR COMMUNICATION”

This section again emphasizes communication, but in another way, which the author calls “care transitions.”  Many transitions or “hand-offs” occur during modern surgical care.

For example:

A patient with 3 days of right lower quadrant abdominal pain comes to an emergency department (ED) with fever.  The PCP alerts the ED by telephone with the clinical impression for perforated appendicitis.  Besides the Financial interviewer, the Receptionist asks for the complaint, enters it in the computer, and then determines priority for Triage, who then determines the priority for ED examination.  The PCP’s impression might or might not be given weight.

This information might be verbally communicated to the next caregiver or the system is set up for the next caregiver to pick up t...

This series, in three parts, is prompted by the article, HOW THE HEALTH CARE SYSTEM CAN HARM YOU” BY RICHARD LALIBERTE, AARP Bulletin, September 2016, V57, #7, pp 18-25.

This article is featured in the AARP Bulletin received by many AARP members who are older than 50.

Stay with me!

The reference article provides valid and important advice.  I do not know the author but agree with his thesis.  I have been a Surgeon for 50 years starting with a Straight Surgical internship and I am still in active practice and have witnessed radical changes in the evolving American Health Care system.

I recommend that patients participate thoroughly in their surgical experience.  Whether operative or consultation, assure understanding of plans and the process by obtaining and listening to explanations, keeping you...

If a hernia is present before pregnancy, it will become more prominent as the pregnancy proceeds.  Umbilical hernias might present as a “belly button” (umbilical) bulge, or an increased preexisting “outey.”  Inguinal bulges may develop in the groin for a few reasons.  Some of these bulges are hernias and others are fluid collection.  Some are painful.  Groin pain can also occur without bulges in the third trimester because of pressure from the enlarging uterus or strain on the round ligaments of the uterus that exit the pelvis through the groin.  A sensitive nerve (genital branch of the genitofemoral nerve) accompanies this ligament.  The risk of an enlarging hernia is that bowel can become incarcerated or stuck causing severe pain and bowel blockage.  Fortunately, this is rare.  If the hernia is...

Interpreting my memory and experiences of the last half century, the more contemporaneous era of technology has replaced some of the manual art of surgery, using laser and cautery in many situations in place of the knife, scissor, clamps and ligature, staples replaced sutures for visceral repair.  Administrators gained control of hospital systems.  The profitable appeal of Centers of Excellence excited administrators who budgeted in favor of select procedures like cardiac surgery and joint replacement.  Masters of Diagnosis in Internal Medicine became sub-specialists with one specialty expertise, many of which included technologic applications.  Initially the growth of technology including sub specialization, then endoscopic techniques improved diagnosis and either replaced or complemented surgery...

Let us assume that surgeons and patients agree on the objectives of high quality, precise, knowledgeable, safe and skillful care in a supportive, well-managed environment that shares these objectives, in a rational financial system and government that shares these objectives.

The condensed viewpoint might be “optimum surgical care balanced between high quality for reasonable cost.”  Many dialectic factors affect these objectives.

These layers do not integrate as easily as an onionskin, but still can make everyone cry.

Vectors are forces with direction, originating at one point, presently at another point in the present and continuing on a line forward.  That is history in social sciences as well as Physics.

Do these forces still share common direction for medical care?

Are they convergent for common pu...

Traditionally surgeons understand the importance of the “Early Diagnosis of the Acute Abdomen,” the title of the classic book by Zachary Cope that we all read in medical school  that seems to have disappeared from the  contemporary curriculum.

 

Emergency Departments (ED) administered by hospitals and hospital systems are now  frequently the first line of defense for the diseased and processes causing the frequent complaint of acute abdominal pain.  The CT scan and sometimes the Sonogram, is assumed to make all diagnoses and physical examination as described by Cope takes a back seat.

 

However, knowledgeable and attentive clinical evaluation and prompt treatment plans  still solves  the serious problems sent  to the ED.  Patient and referring physicians  expect that the concerned orientatio...

I have spent 50 years focused on the craft of surgery.  In this blurb I wish to  share memoirs, observations, experiences, opinion, thoughts, science, art  and paradigms arising from my experience.  No specific reference will be made to particular persons or places.  Nothing  discussed should be taken as advice for any individual actual situation.

   

Each patient with his/her individual needs, comorbidities, multiple contributing factors, pathology and psychosocial needs will have a unique, individual problem and experience.  The patient and his/her immediate family will need to take an active part in evaluating their individual situation and participating in the selection of options explained and recommended by their chosen or recommended surgeon.

 

I hope to provi...

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A Douglas Heymann,
MD, FACS. 
Over 50 years of experience.

Dr. Heymann

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© 2020 by Dr. A. Douglas Heymann, MD, FACS.