We had the wonderful opportunity to interview an experienced surgeon who now runs a very informative and successful blog. With over 90 publications including peer-reviewed papers, case reports, editorials, letters and book chapters, it is really a valuable resource to have unrestricted access to a wealth of reliable information ranging from personal experiences in the OR to hospital politics. We asked him questions based around topics that we aim to do feature articles on in the coming weeks. Scroll down to read the full interview.
1. As a physician what were the biggest challenges in your line of work?
My biggest challenges were the commitment of time and overcoming and constantly battling the stress associated with having people’s lives in my hands.
2. Do you believe that open source research (Making academic research freely accessible to everyone online) will benefit scientific discovery and collaboration? or education?
Yes, I believe open source research will become standard in the next several years. I think traditional journals will disappear unless they can adapt to the online environment. There are still many problems with open source journals, such as the fact that authors are charged exorbitant sums of money to publish their work by many journals.
3. What role do you think third world countries have in advancing medical research, if any?
I’m not sure that third-world countries should invest any of their precious and limited resources in funding medical research.
4. In your opinion how can we increase global healthcare standards?
I don’t know. I am not an expert in this area.
5. Do you believe that there is any obligation for developed countries to provide medical assistance to poorer nations?
I don’t think it’s an obligation. I believe most developed countries are providing large amounts of medical assistance to poorer countries.
6. How do you see America’s healthcare system in 20 years time?
I wish I could say we will be moving to a single-payer system, but I don’t have much confidence that it will happen.
7. If you had 1 billion dollars to spend on one area of academic research, what would it be?
Tough question; I really don’t know
8. How do you deal with stress on a day-to-day basis?
I have dealt with it by retiring from practice. When I was practicing, it was a matter of compartmentalizing the stress so that it would not interfere with my thinking.
9. Have you seen major improvements in the healthcare system since you first began practicing as a physician?
When I first started my residency in the early 1970s, Things were remarkably primitive by today’s standards.
There were no ultrasound machines. Believe it or not, we would diagnose acute cholecystitis by history and physical examination alone. The only diagnostic tests we had were oral cholecystogram (OCG) and intravenous cholagiogram (IVC). For OCG, pills were taken the night before the test. If the cystic duct was patent, iodinated contrast would appear in the gallbladder and stones could be seen. Non-visualization of the gallbladder meant either the cystic duct was blocked or the pills were not absorbed (presumably due to inflammation, not necessarily of the GB) or the patient forgot to take the pills. The test was useless in acutely presenting patients. IVC was similar except the contrast was given intravenously. The common bile duct could be seen faintly unless the patient was jaundiced. It rarely showed stones in the GB.
There were no CT scans. We had to make the diagnosis of appendicitis by, you guessed it, history and physical examination alone. And since laparoscopic general surgery did not become popularized in the US until 1990, all appendectomies were done as open procedures.
There were no computers in any clinical departments or nursing units. It was all on paper. The good news? We had different colors of paper for different sections of the chart. There was no way to “copy and paste” progress notes. The bad news? Handwriting analysis rivaled that of archeologists deciphering hieroglyphics in Egypt. Charts often went missing.
There was no ” evidence-based medicine.” I know there are doctors who wish EBM still didn’t exist, but for the most part, I think EBM has been useful in getting us to look at data and proof instead of anecdotes and opinions.
Maybe the biggest change has been the advent of the Internet. In the palm of my hand, I can access huge amounts of information formerly available only in print books and journals.
10. What piece of advice would you give to aspiring surgeons & trainee surgeons?
I think aspiring surgeons should remember that medicine is a lifelong learning experience. Trainees should read as much as possible about not only medicine but politics economics and social issues. They would also do well to read my blog.
11. In China there is a new branch of medical tourism, where thousands of hopeful patients from around the world are flocking to receive stem cell therapy for cancer and neurodegenerative diseases. Much of this work has not been heavily researched or standardized, what dangers do you see in this? For patients who have a very poor prognosis, do you see this as a viable option?
I see a lot of danger in this and I don’t think it’s a viable option.
12. Generally, medical tourism seems to be booming at the moment for many different forms of treatment. Some would argue that this is because other countries have ‘caught-up’ to the rest of the world and offer treatment at more affordable prices. Do you see this as a success?
It can’t be classified as a success because I believe the number of people who actually engage in medical tourism is extremely small. There is also the very real issue of what happens to a patient who has a complication after a procedure done in another country. The complication must be treated by doctors who had nothing to do with the original surgery. Also, what if there is negligence by the original surgeon? How does the patient recover damages from a citizen of another country.
13. Lastly, Medical Information is also becoming more accessible over the internet and quite often patients come in to a clinic having already made some sort of self-diagnosis or knowing the risk factors of a particular course of treatment. Do you believe this to be a bad thing or do you think it enables patients to make more informed decisions about their treatment if they can assess the risk themselves?
Information is like any other tool. It depends on how it is used. For example, a gun can be used to hunt for food or to kill another person. There is danger on the Internet because many web sites contain erroneous information. I mentioned this in a recent blog. Here is the link.