Maxwell Tabarrok, at X, asks:
Does anyone have good resources or a blog post on how surgery practice and outcome has improved or changed over the past several decades?
My first thought was that I’ll bet Michael Kennedy can provide some insight on this.
Michael, any thoughts?
I have been retired for years. I do recall a trend I read about that was seen in Chicago 20 years ago. The growth of HMOs as primary care was accompanied by a rise in the number of cases of appendicitis that were perforated at surgery. I dealt with something similar when I was still in practice. A local group started a PPO, a Preferred Provider Organization. The theory was that good doctors could band together to provide more efficient care. In fact. these groups were often organized by the worst doctors and other ethical docs had to join or be frozen out as insurance companies signed up rapidly. The appendicitis problem was that the decision to operate was delayed too much. In my own case, the chief of the local PPO never knew of a surgery that he wanted to see done. He required multiple expensive imaging exams before he would approve the repair of an aortic aneurysm. The traditional rule is that they should be repaired if they reach 5 centimeters diameter. That is double a normal male’s aortic diameter.
Some years later, I was invited to attend Grand Rounds at UCI Medical School and saw the love of technology in the young trainees. Every case of appendicitis had a “spiral CT scan” before surgery. When I was still teaching a study came out in the literature that 30% of cardiology fellows could not hear heart murmurs. These are graduates who are studying heart disease as a specialty.
I should add that I have a book that is on that very topic. It is a memoir called, “War Stories: 50 years in Medicine” It is a Kindle version only as I never found anyone who wanted to publish a paper version.
Seems to be a lot going on with endoscopy and laparoscopy. re the latter, I was surprised to learn that the laparoscope must be removed, sometimes several times during the course of an operation, for cleaning. This company thinks they have a better approach:
https://www.clearcam-med.com/
Windshield wipers for endoscopes, you’d think they would have thought of it sooner.
MK….also your other book seems relevant
I have never needed to remove the endoscope for cleaning in my approximately 1,000 lap choles and 500 lap appendectomies. I was an nearly adopter and had patients coming from other states for a while. I started in 1988 and retired in 1994. I did my first lap cholecystectomy the same year Eddie Jo Reddick, the pioneer, did his. I actually took the laparoscopy surgery class from McKernan that year. We did the surgery on pigs, which have similar anatomy to humans but much smaller. McKernan’s son had a pig farm and the operations were done under sterile conditions. The pigs went back to the farm.
Dr K, I want to say that I bought ‘War Stories’ and read it. Enjoyed it, particularly the story about the guy who burned himself the same way twice.
(I think I worked with him once…)
I’ve had a hernia operated on twice.
The first time was in-patient surgery, followed by a few days of bed rest at home, and several more days for full recovery.
The second time (many years later) was walk-in, walk-out surgery, with full recovery three days, IIRC.
So in my experience, surgical practice has improved a lot.