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The Surgical Team: Meet the 5 superheroes of the OR

Being a part of a surgical team is much like being in the army: it requires preparation, discipline and cooperation.

Surgical team operating room

We all see surgeons as rock stars – VIPs of medical care, all-knowing gods that walk among us and see over our well-being. Doctors usually have this effect over us: you often feel intimidated around them, because disease makes you vulnerable. But this shouldn’t be the case and you should consider surgeons more like frontmen of their bands, not solo artists. They may be the ones that do the talking, diagnose and prescribe treatment, but they also have a team of professionals that tend to the patient’s every need and make sure the surgery goes smoothly.

As with any other professional lineup, the surgical team also relies on the technical competence and preparation of each member. The level of stress can be much higher than that of other jobs out there. This is why it’s important that each member cooperates, knows their role and behaves appropriately. Leadership is of high-value and the chief surgeon is regarded as a pillar of moral and ethical grounds. His or her behaviour and interpersonal relations have a high influence on the overall environment, performance and cooperation between each member of the team.

This is the surgical team structure:

1. The surgeon – Surgeons are medical school graduates that complete surgery residency and receive all certifications required for practicing general or specialised surgery. They often specialise in a particular area of study such as trauma surgery, colorectal surgery, breast, vascular, endocrine, transplant, oncology. Key requirements are the full knowledge of the instruments required, on-going training in new procedures, the ability to make close call decisions to save a patient’s life and the overall management of the OR.

2. Anaesthesiologist – Similar to surgeons, anaesthesiologists complete 4 years of medical school and 4 years of anaesthesia residency. There are certain areas of anaesthesia that require special certification and training, such as cardiac anaesthesia. They are present before, during and after the surgery. It’s necessary that they’re informed about the entire medical condition and history of the patient before the procedure, in order for them to choose the best anaesthetic option. During the surgery, he/she will monitor the critical life functions – breathing, heart rate, blood pressure – and take any necessary precautions.

3. Certified registered nurse anaesthetist (CRNA) – the nurse anaesthetist is an advanced practice registered nurse (APRN). In order to become one, he/she has to complete one year of full-time nursing experience in a medical or surgical intensive care unit, followed by a master’s degree in anaesthesia and/or nursing, with a post-masters certification in anaesthesia. Nurse anaesthetists work under the supervision of a licensed physician, dentist or podiatrist and assist in anaesthesia care before, during and after surgery, labour and delivery.

4. Operating room nurse – The OR nurses have various responsibilities in making sure everything is well organised and the surgery can be performed under the highest operating standards.
• Scrub nurses ensure that all instruments are sterilised and layered out for the operation. They provide care for the patient before and during the surgery, attach equipment and monitors and pass instruments to the surgeon.
• Circulating nurses take care of all the documents required before the surgery and handle the procurement of instruments and surgical supplies.
• Registered nurse first assistants play a higher role in assisting the surgeons during the operation: they administer medication, control the bleeding, suture incisions, monitor vital signs, perform CPR.

5. Surgical technologist – The surgeon needs to concentrate on the patient, not on finding instruments. This is where the surgical techs chime in: they’re trained in hundreds of types of surgery and are able to anticipate next steps in the procedure, in order to provide the surgeon with the required instruments and equipment. In the US, they are graduates of surgical technology programs and can specialise in a vast array of surgeries.

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7 sites that help you choose the best hospital

Finding the best hospital for any disease can be difficult, even in our times.

According to the most recent statistics, the United States is currently home of approximately 5,600 hospitals. This figure has been constantly decreasing over the past decades, contrary to the steady enlargement of the number of employees in the U.S. healthcare system.
For an accurate depiction of the situation, the graph below reveals the ratio for hospital beds per 1000 people. The data contains treatment spaces available in public, private, general, and specialized hospitals and rehabilitation centers.

hospital beds statistics

Source: http://www.nationmaster.com/

In 1975, the number of hospital beds in the US was exactly 1,465,828. This has decreased to approximately 924,000 until 2011. In 2015, the number fell to a historical level below 900,000, while the U.S. population has seen a steady increase. A comparison between countries and hospital beds per 1000 people places the US in the 80th position worldwide.

Although statistics show a narrower palette of options compared to the ’70s or ’80s, this does not mean that deciding upon a hospital in which to have surgery or to be submitted for long-lasting treatment has gotten any easier for you. There still are a lot of options to choose from and the plethora of information available can make the entire process quite overwhelming. The increase in mobility makes it easier to travel to remote locations to find the perfect hospital, with enhanced facilities, renowned surgeons and good patient reviews.

 

Factors to consider when choosing a hospital

Surgery room

When conducting research for the best hospital for your disease, there are several factors to consider:

  1. Does the hospital have a special unit or floor for your type of surgery or treatment?
  2. Do they have a team of doctors that are specialized and renowned in treating your type of disease?
  3. Are the operating rooms fitted with special equipment required for your type of surgery?
  4. Are they invested in offering you every information you need in order to prepare for the surgery (by printing and giving you pamflets, writing a special section on their website)?
  5. How many patients have they operated on with the same condition as yours?
  6. How many auxiliary personnel such as nurses are allocated to that unit?
  7. What is the rate of success they report for this specific surgery? If possible, talk to other patients or check the testimonials on their website.
  8. Verify if there are reported cases of post operatory infections. A 2015 study at John Hopkins, on patients undergoing colon and rectal surgery, showed that hospitals that focus on quality-improvement solutions (such as getting patients to take antibiotics, encouraging them to drink fluids, cleansing their skin with antiseptics before surgery) report less lengthy recoveries and lower rates of surgical site infection by more than a half, as well as shortened hospital stays.
  9. Search for photos online of their private rooms, waiting areas, cafeteria, bathrooms, as you and your family will spend at least a few days in there;
  10. Has integrated an Electronic Health Records System (EHRS) that can track results of lab tests, diagnostics tests or patient referrals.
  11. Check to see if they have sufficient on-call assistants on holidays, especially if your surgery is planned during that period.

 

Sites that help you find the best hospitals

Finding-best-hospital-room

Gathering all this information on your own can prove to be overwhelming. Luckily, there are scoring systems put in place that help you quickly analyse one hospital over the other:

  1. Medicare.gov  – the US government provides information and reports on hospitals and doctors, as well as a list of all hospitals in your area (based on ZIP code, city or state). The site also facilitates comparison of 3 hospitals at a time, based on quality measures, distance from the city centre, emergency services, EHRS integration and a safe surgery checklist.
  2. The Joint Commission Quality Check – is an independent, non-profit organisation that accredits and certifies nearly 21,000 healthcare institutions and programs in the US. Their platform allows you to check if a certain hospital adheres to its performance standards, committing to deliver safe and effective care of the highest quality and value.
  3. The Leap Frog Group  – is also a non-profit organisation that aims to protect patients and their families from errors, injuries, accidents and infections. It reports data on more than 1800 hospitals in the U.S., having programs that regularly survey and grade hospitals for their quality care and procedures.
  4. US News – reviews hospitals’ performance in clinical specialties, procedures and conditions. Their site has a comprehensive rating system that helps patients identify the top-ranking hospitals and doctors for their disease. You can also find out what insurances each doctor accepts, their experience and affiliations.
  5. Consumer Reports – this site rates each hospital based on their patient safety score, as well as on measures relating to patient experience, outcomes and certain hospital practices.
  6. Health Grades – Provides statistics on clinical quality for each specialty (incidence of mortality during and after surgery) and patient experience (in terms of overall feedback, cleanliness, staff, doctors, facilities).
  7. Why Not The Best – tracks performance on various measures of health care quality. Their tool permits comparison of process-of-care measures, patient satisfaction, readmission rates, average reimbursement rates and mortality rates. It also includes data on the incidence of central line-associated bloodstream infections (from over 1500 hospitals), the adoption of electronic medical records, as well as population health, utilization and costs.

Another offline resource you could turn to is your health insurance company. Many insurers have ratings on how hospitals perform the type of surgery you’re having. Ask them if they have a ranking system for trustworthy healthcare providers and, if so, use the information provided to find the best option for your surgery.

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Good Physician-Patient Communication – Why is this crucial?

Excellent communication is learned and developed over time, and it plays a vital role in understanding the patient’s suffering, establishing the correct diagnosis and prescribing the right treatment which will essentially cure the patient’s illness.

rgetgrYou may be inclined to think communication between two people is something natural and you don’t need specialized training for doing it well. But still, a lot of physicians are struggling with proper communication between them and their patients. Focused on their work with a high attention to details not to miss anything, doctors may overlook the explanation part of their jobs and give the patient an incomplete talk about their condition.

First consultation

The quality of the information obtained by the doctor during the first consultation is closely related to the ability to ask questions and create a relationship with the patient.
Studies show that between 60% and 80% of the information needed to establish the primary diagnosis are obtained during the interview with the patient.

Physician-Patient Communication

Why proper communication is crucial:

  • information exchange;
  • mutually accepted decisions;
  • better understanding;
  • building trust.

The physician is obligated too:

  • concentrate this whole attention on the patient;
  • creating an environment that protects the dignity of the patient;
  • confidentiality (non-disclosure of intimate patient information to others);
  • permanent concern for the well-being of the patient;
  • respecting the rights of the patient or his / her family.

Patient Obligations:

  • establishing a list of specific questions he/she wants to ask the doctor;
  • if necessary, designate a family member or other trusted person to represent him/her in discussion with the doctor;
  • open dialogue with the doctor;
  • presenting as objectively as possible the symptoms he/she experiences;
  • be utterly truthful in everything the patient is information the doctor off.

When all of the above obligations aren’t respected by either of the parties involved and the overall physician-patient relationship is deficient so of the consequences may include: frustration, anger, accusations, an increased number of tests or even getting a different opinion from another doctor.
And not only the patient can experience feelings of frustration or anger, but also the doctor who fails to achieve the patient’s healing.

Online communication and information

The Physician-Patient talks shouldn’t stop only with the traditional face-to-face discussions at the clinic. It can also include e-mail exchanges, phone talks, but also direct online chats via messager apps.
Doctors may also suggest different online resources where the patient can read more about specific conditions and even join special forums and online support groups where people with the same illness can help and support each other.

Until recently, during the consultations, the doctor was solely responsible for holding the scientific information. Now, with the ease with which such information can be obtained, patients can play an active role in the decision-making.

Of course, there is enormous concern over the certain accuracy content found online may have from a medical perspective. But this is why your doctor needs to play an essential role in all of this right from the start, guiding you into the right direction and helping you with approved online information.
Leaving everything in the hands of the patient regarding medical information can have disastrous consequences like scaring the patient or even giving the patient false hope.

Communicating the diagnosis

Disclosing the diagnosis to the patient, especially when it comes to incurable illnesses, is one of the problematic aspects of communication between the doctor and the patient.
Many doctors still believe that being faced with a grueling diagnosis, many patients may stop fighting the disease, getting depressed and overall losing the battle with the illness.
So, in the end, it is all about the doctor’s ability to sensitively attenuated the mental collision such a diagnosis can have on the patient while staying truthful.

Before communicating the diagnosis, it is good for the doctor to know as much as possible about his patient, about his life, his values, his abilities and his mental strength. Thus, when dealing with a terrible diagnosis, the news should come encouragingly, emphasizing what the patient could do to improve his condition.

For most doctors, it is all the more difficult to talk openly about when the diagnosis and the prognosis are reserved, and the patient is very young. Of course, the doctor can call on a psychologist to help with a communication strategy.

Lack of information creates confusion

One of the most significant issues with all Patient-Physician relationships is the lack of communication and how this void of knowledge creates confusion for both parties, but it can be especially bad for the patient.

When the patient does not receive the desired information, different reactions can be expected. The patient may be unhappy and then call another doctor. There is a category of patients who are “shopping” for doctors, gathering multiple investigations and a massive file of different treatments and test results.

The ambiguity of a discussion with a doctor can scare a patient. The patient may get a false impression that it’s something serious, maybe incurable, and the doctor hides it. The patient may start he can start looking for evidence to support his hypothesis and will interpret every symptom, every condition, and implement a self-diagnostic. All of this can be extremely dangerous. This is why physicians need to be very clear and leave no room for ambiguity when talking to the patient.

 

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Finding the right doctor: 15 traits you should look for

finding the right doctor

The process of finding my doctor was challenging both for me and my family. But now I know what to look for when working with a medic.

Reflecting on life, I’ve started realizing just how precious it is and how, in a split second, it can make a turn for the worst. One day, you can find yourself living a normal life and the next day, being diagnosed with a terrible disease.

I’ve lived my life by the books: college, marriage, kids, a satisfying career in engineering. Now, at 56, I was prepared to help my children with fulfilling their paths: my eldest daughter is getting married next year and we were in the midst of all that preparation, while my youngest is moving out of the home and starting her IT career in San Francisco.

When the news of my cancer broke out, all of these plans started to blur out. I’ve begun feeling like I was an audience member for the reality show that has become my life: my family was behaving all erratic – one minute they’re fighting with each other, the next one they’re crying and trying to be supportive. Each other day we met with another doctor that used to treat me like a case study, rather than a human being, and my symptoms aggravated mostly due to all the stress I was facing.

I’ve learned a lot from the journey of searching for the best doctor for my disease

I’ve started referring to that time as my roller coaster experience. Now, as a cancer survivor, I’ve realized that the winning combination of faith and finding a doctor that understood exactly what I was feeling and acted as a member of my family, rather than a medical doctor, helped me cope with my feelings and start getting treatment. After meeting with him, I’ve immediately begun to feel a sense of security which I thought I lost for good. We’ve had the appointment where he explained exactly what my disease was, how it manifested, what my options were, each possible side-effect and what to expect after the surgery. He was a professional, while, at the same time, he was being human: empathetic and supportive. He always says that recovery is a process as important as the treatment itself.

From the comfort of my house, I’m now feeling grateful that I had the strength of making an appointment with him (he was the 6th doctor I’ve seen). I’ve started thinking about other patients with a severe illness that are in the position of choosing the right doctor: doubting that you made the right decision, feeling like you have no other option, refusing to go through the process of meeting with another specialist. It can be daunting, but trust me: working with the right doctor is crucial for the success of the treatment. This is why I’ve compiled a list, based on the relationship with my doctor, that I hope will encourage other patients not to stop looking until they’ve met the right match. Maby you won’t be able to find a doctor that reunites all of these traits, but trust me: looking for someone that aggregates as much as these as possible is worth the waiting.

These are the 15 traits to look for in the perfect doctor:

  1. Find a doctor who is patient and thoroughly discusses your diagnosis, your options, treatment, and answers every question, however obvious the answer might be;
  2. Look for good recommendations from his patients;
  3. A dedicated doctor rearranges his schedule for your appointment, in spite of heavy patient load, if your symptoms require urgent attention;
  4. His office calls you to remind of regular check-ups and insists that you make it to your appointment;
  5. He provides you with as much treatment options as possible, not only the ones that he is most comfortable with;
  6. He is sincere and transparent and isn’t afraid to talk about complications, in a reassuring manner;
  7. He is friendly, jokes with you at times and speaks in a familiar tone, making it easy for you to understand all of the implications.
  8. Even on a day off, he can gather the surgical team upon short notice and open the surgical room. This was my case, as I had a vacation planned on Monday and, on the Friday before that, he noticed an issue with my bladder that required immediate surgical attention;
  9. Money is not the top incentive when treating his patients. Moreover, he makes sacrifices for patients whose insurances are on a normal fee;
  10. The good doctor surrounds himself with an excellent team that is caring, patient and empathetic towards the patient and the family;
  11. He goes out of his way to ensure that the surgery side effects are as minimal as possible;
  12. In case of hospitalization, he must facilitate you being near your family and getting support;
  13. A concerned doctor conducts regular check-ups when you’re admitted to the hospital and talks to you and your family;
  14. He receives public recognition for his contribution to the medical industry;
  15. He treats your family with respect and consideration, keeping them up-to-date with your progress during surgery.

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