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gorskon's profile
David Gorski, MD, PhD
David Gorski, MD, PhD
David Gorski, MD, PhD
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@gorskon

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David Gorski, MD, PhDVerified account

@gorskon

Surgeon/scientist promoting science in medicine and exposing quackery. Editor of Science-Based Medicine. My opinions do NOT represent those of my employers.

Michigan, USA
sciencebasedmedicine.org
Joined October 2009

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    1. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      Sounds like HODAD is officially on Benzos. That's not OK. I feel guilty when I take Benadryl on backup call. And this will be the M&M episode! I was the M&M Czar for my residency program for my last 2 years, let's guess how far off it will be from reality.

      1 reply 0 retweets 4 likes
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    2. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      So, for some reason we are starting with a patient with atrophied testicle and they're suggesting removal. They declare it's not cancer (impossible to say without path), then say recommended treatment is removal because it hurts - even though the patient seems opposed. Hmm.

      2 replies 0 retweets 3 likes
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    3. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      2nd plot line, a kid lies about an illness to bring his mother into the hospital, and the nurse starts trying to scare her into staying. The nurse promises to get her "the best doctors". That's not unprofessional at all, suggesting you are the arbiter of access to quality.

      2 replies 0 retweets 7 likes
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    4. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      Who is York?

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    5. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      Ok, here's the meat, third plot line - now the decision for "concurrent surgery" is being pushed from above by administrators! This is bananas in so many ways it's hard to describe. For one, the reaction to this practice is a source of public hysteria, it sounds frightening.

      1 reply 1 retweet 5 likes
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    6. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      However, like many things in science, the "common sense" gut reaction is not supported by rigorous study. It turns out, the rare surgeons who coordinate overlapping surgeries studied their outcomes and, they weren't any different.

      2 replies 0 retweets 6 likes
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    7. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      A more recent analysis suggested that there may be a risk in for orthopedists performing hip surgeries, but, read the paper! The risk in elective surgery didn't increase until > 2 hours of overlap (hip replacements shouldn't take more than about 2 hours)https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2663757?redirect=true …

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    8. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      Are you measuring risk from overlap? Or are you inadvertently measuring complexity? The other key feature is that emergency surgeries with overlap had a much more rapid time to increased risk - this suggests overlap doesn't work well with complex cases.

      1 reply 0 retweets 2 likes
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    9. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      But in elective, planned cases, if the surgeon has a mature, efficient system and well trained support staff, senior residents and assistants, the evidence instead suggests the attending surgeon does not need to micromanage the less complex parts of an operation.

      1 reply 0 retweets 2 likes
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    10. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

      I have no dog in this fight. I do not overlap surgeries or have any interest in it.

      2 replies 0 retweets 1 like
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      David Gorski, MD, PhD‏Verified account @gorskon 27 Feb 2018
      Replying to @MarkHoofnagle

      Nor do I. Even if I did, given the staffing, the most I could do would be to move on to another operation while a resident closes. I do fantasize about having two rooms, so that I don't have to wait for the sometimes painful turnover time to move on to the next case.

      6:34 PM - 27 Feb 2018
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