Why Wonder Woman Matters

Since her debut in All Star Comics #8 released in 1941, Wonder Woman has become the most famous and recognizable female superhero in the world. This feminist icon is a warrior princess and a United Nations Ambassador. She displays extreme intellect and compassion. Princess Diana of Themyscira has also become a part of pop culture. She has been featured on countless merchandise, toys, comics, animated movies and television shows. For some reason (and Im still scratching my head on this one), it took DC Comics 75 years to bring her to the big screen. Wonder Woman starring Gal Gadot is currently filming and slated for a 2017 release. We will get our first look at Gal as Diana in Batman VS Superman: Dawn of Justice, March 25, 2016.







Wonder Woman has had a huge impact on men, women and children for 75 years. But why? What is it about her that we connect to? Why do we love her so much? This article of the Confessions of a Cosplay Girl Blog explores those questions and answers. Before I get to my thoughts and personal experiences, I want to share the thoughts of a fellow Wonder Woman fan. Cosplayer Candy Keane is also the owner of the Three Muses Clothing Boutique in Jacksonville, FL.


"I want to share My first memory of dressing up like Wonder Woman was around 4 years old, in my Underoos. Even then I dressed up my outfit with a lasso and paper tiara and cuffs. That could possibly count as my first “homemade” cosplay. The Wonder Woman TV show was my introduction to strong super hero women and I’m thankful for that role model. My love of Wonder Woman has stayed with me through the years and grown to include all of WW’s various incarnations, but my true love of all things wonder will always start and end with Lynda Carter."   ~Candy Keane (Visit her Official Facebook Page)

I want to say my first exposure to Wonder Woman was the Lynda Carter series but as of late, I find my memory to be a bit jumbled. Im not quite sure if it was the Wonder Woman live action series or the cartoon show Superfriends. In any case, I always found the character to be fascinating. She was beautiful, independent and strong. She was graceful  yet a fierce warrior. She was the most brave and powerful woman I had ever seen. She could hold her own, defend herself and fight along the side of heroes such as Superman. And she had black hair like me! LOL When I was a child I had a collection of Wonder Woman items such as action figures and pajamas. She was important to me because she was teaching me that a girl could be strong and change the world. Women were just as capable as men  and can make a difference.  Wonder Woman didnt just do good in costume. Diana Prince had a job, supported herself and took time out to help others.

Ive been a Wonder Woman fan literally my whole life. Whats great is that both of my parents and my youngest niece are fans too. Its awesome that we can share our love for the Amazon Princess. Witnessing Wonder Woman evolve over the years in media and pop culture has been amazing. I look forward to what the future brings.

Visit me on my Official Facebook Page

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OR delays Whos responsible and what can be done

Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda.

In my nearly 24 years as a surgical department chair, one or the other of these issues was investigated at least 10 times. We were never able to conclusively determine the exact causes of delays or solutions to the problem, and we returned to business as usual.

An article in Anesthesiology News about a paper that looked at causes of operating room delays in over 15,500 cases at a single hospital got my attention.

The number one reason for delays was that the nurses did not have the operating room ready for the patient. Nursing also was responsible for the third most common cause "preop prep (IVs, meds, etc.)."

Surgeons were the reason for the second most common problem, "notes, consent, patient marking not complete." A few more of the top 10 included surgeons running two rooms, surgeon unavailable, and my favorite, "last case ended early." I’m not sure how a case ending early causes a delay in starting the next case. Usually we are blamed for underestimating the length of time we need to do an operation.

Anesthesiologists were cited for only one of the 10 most common reasons for delays—placement of an IV line or regional block.

Not surprisingly, the study was done by anesthesiologists using data they collected.

When I expressed skepticism about this on Twitter, I was accused of implying the research was fraudulent. Not so. Some of my best friends are anesthesiologists. In fact two of my medical school roommates became anesthesiologists. Fraud is not the issue. Its a matter of perspective.

For example when the nurses investigate OR delays, the problem never seems to be nursing.

Im not saying that surgeons dont cause delays. A task force once found that one of my surgeons was late for his first case every time he operated because he had to take his kids to school.

Another surgeon would disappear between cases and was always late for his next one. No one knew where he went. Some thought he may have been calling his broker or perhaps having an affair.

Here’s what the anesthesiologist researchers may have overlooked.

In effort to avoid delays, I would often ask for an anesthesia consult on complicated inpatients booked for surgery a day or two later. On nearly every occasion, the anesthesiologist who saw the patient was not the one assigned to do the case. The consulting anesthesiologist never said a certain lab test was necessary, but in the holding room, the one who was going to put the patient to sleep said it was. A spirited discussion, phone calls, and a delay ensued.

Sometimes a day surgery patient who arrived 2 hours ahead of schedule wasnt interviewed by anesthesia until the scheduled time of the case.

Then there was my patient whose operation was postponed for 6 hours because she had a piece of hard candy in her mouth when she got to OR. The anesthesiologist said it was the equivalent of having a full stomach. Read the full story here.

Can delays be shortened by working together? A 2014 paper in the Journal of Surgical Research by a surgeon and four anesthesiologists found that “various events and organizational factors created an environment that was receptive to change.” The authors were able to decrease their general surgery OR turnaround times from 48.6 minutes to 44.8 minutes, a statistically significant (p < 0.0001) but hardly clinically important difference.

Let me hear your experiences with OR delays.

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Become a certified website digital marketer or graphics designer in one month

In todays digital era, the way organizations do business is rapidly changing. Today, professionals help organizations to create their internet web presence, brand and flash adverts reaping huge profits for organizations by reaching out to more customers and spreading awareness of their products and services.

The training on Website Design will equip participants to create dynamic and interactive websites for companies, Government Agencies, NGOs, Schools, Churches, Oil & Gas,  Hospitals, Hotels, Telecommunications, Churches, Magazines, Forums etc.

The training on Graphics Design aims to educate participants who are creative thinkers, excellent practitioners, and who are aware of the commercial applications of the discipline, as well as its experimental potential, and contextualization across media.

The training on Digital Marketer is a full Practical Training specially designed to provide participants with a comprehensive examination of strategies across social media, mobile marketing, online analytic and search engine marketing aimed at fully leveraging the Internet for achieving business goals such as acquiring, converting, and retaining online customers this will certainly help you quadruple your sales and we have several video testimonials to this event.

The beauty of this training is that you can become self-employed and employer of labour, you can as well keep your existing job, work from home and still reap the benefits as any other Web-Developers OR Graphics Designers OR a Digital Marketer in the world.

At the end of this training, you will be able to design dynamic website, e-commerce, corporate site, social network, blog, image branding via logo creation, fliers, web banners, complimentary cards, letter heads and motion graphics, create a winning marketing campaign etc.

Below is the list of the Modules to be covered:
Web Design Modules:
1. Open Source Technology
2. Wamp Server
3. PHP/Mysql
4. Wordpress
5. Joomla
6. E-commerce Tools
7. Creating corporate emails and management
8. Domain name registration and Website Hosting
9. Uploading a website and Editing a website

Graphics Design Modules:
1. Basic Core or Color Theory
2. Graphic Design I
3. Digital Graphics
4. Working with Photoshop
5. Graphic Design History
6. Working With Fireworks
7. Working With CorelDraw
8. Image Compression and Management
9. Image Extension

Digital Marketing:
1. Introduction To Online Marketing
2. Analysis of Online Media
3. Digital Advertising
4. Other Online Marketing Techniques
5. Case Study of An Online Marketing Campaign

This training is a 100% practical, every participant is expected to come with a laptop, there will be an assignment at the end of each session.

Limited seats available

The Advantage:

• No initial capital to start, all you need is the skills
• Work from the comfort of your home or office
• No fix price, there is no limit price to charge your clients
• You will also be paid annually for maintenance and renewal
• You don’t have to quit your existing job, you can do it at your convenient time

Course fee: N30,000 (Thirty Thousand Naira Only) for Website Design Training, N35,000 (Thirty-Five Thousand Naira) For Graphics Design, N40,000 (Forty Thousand Naira) For Digital Marketing.
Course duration: 5 Weekends (Lagos Only)
Date: April 2nd, 9th, 16th, 23th, 30th, 2016
Time: 10am to 3pm (Lagos)
Venue: Lagos: SAMAK Halls, Plot CL 2Akintan Estate, Behind Tantalizers Oregun, Adjacent Daystar Christian Center, Oregun, Lagos.
Award: Certificate of Proficiency in Web Development/Digital Marketing/Graphics
Resources: Free softwares and e-books
Register Now: http://ozmosisservices.com/

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Cute pic of Odion Ighalos daughter

Footballer Odion Ighalo shared this cute photo of his stylish daughter and called her his WCW

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Take lecture notes on a laptop computer or use old fashioned longhand

A paper published last year in Psychological Science suggests that taking notes in longhand is the better choice.

The authors, from Princeton University and UCLA, performed three studies on college students. They found that even if multitasking and distractions were eliminated, “students who took notes on laptops performed worse on conceptual questions than students who took notes longhand.”

Previous research has shown that note taking enhances learning by both providing external storage of information for later review and “encoding,” that is, processing information and reframing it in one’s own words.

Although significantly more notes were taken by laptop users, they tended to be more like transcriptionists instead of thinking about and summarizing what they heard.

When tested on standardized lecture material, both groups did equally well on factual questions, but those who used longhand for note taking fared significantly better on questions dealing with concepts.

Even when students using laptops were instructed not to transcribe lectures verbatim, they were unable to do so.

Subjects were tested with and without studying their notes. Without studying before a test, scores did not differ between the two groups, but when studying was permitted, those who took longhand notes again performed better.

From the discussion section of the paper: “Although more notes are beneficial, at least to a point, if the notes are taken indiscriminately or by mindlessly transcribing content, as is more likely the case on a laptop than when notes are taken longhand, the benefit disappears.” [That run-on sentence was probably typed on a laptop.]

The authors concluded that laptops in classrooms may be doing more harm than good.

This dovetails nicely with my previous post on live-tweeting of conferences and lectures. People who live tweet claim the tweets can serve as notes. I doubt that. The live tweeters are deluding themselves. They are simply doing “play by play” of a session and are not likely to retain the information.

From a Guardian essay on this topic: A linguistic professor "conducted a survey of reading preferences among over 300 university students across the US, Japan, Slovakia and Germany. When given a choice between media ranging from printouts to smartphones, laptops, e-readers and desktops, 92% of respondents replied that it was hard copy that best allowed them to concentrate."

According to an article in the Wall Street Journal, smart pens can record what is written in longhand and convert it to digital text albeit with some difficulties and inaccuracies. Using a stylus on a tablet computer can also be done, but not as quickly as writing with a dumb pen on paper.

Like reading a real book instead of a digital book, taking notes may be another area in which the gadgets lose.

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Externships or observerships Can they help an IMG get a surgical residency slot

A woman writes [some non-essential details have been changed to preserve anonymity. Permission to post this was obtained.]:

I am a non-US citizen medical graduate from The University of The West Indies in Trinidad and am currently an intern in a Caribbean nation. Although UWI has produced great students, you may not be familiar with it.

I would like to become a surgical resident in the US. I have no US clinical experience, but my USMLE Step 1 score was >235.

What do you think about my doing a post-intern year externship (hands on clinical) as opposed to an observership (just observing) in the US? I know that an externship carries more weight as far as applications go, and the only reason I would want to do either of these would be to get recommendation letters from surgeons in the US.

However, since I have already graduated from medical school, getting into an externship will be more difficult because this will no longer be a medical school rotation. I believe that observerships will be easier to get into but are they worth it?

Do you know of any IMG-friendly programs that facilitate this? Do you think that this is a good idea? Do you feel that I will be able to get an externship?

Other than this idea for externship/observership, I am blank for ways to improve my chances of matching to a US program in surgery. Do you have any suggestions?

Thank you for writing and for reading my blog.

Your USMLE Step 1 score is excellent, but as you stated, the lack of any clinical experience in the US might be a problem.

Im afraid your plan to do externships may not work out. I do not know of any hospital in this country that supports externships for people who have already finished medical school. The issue is that once you graduate from medical school, you no longer have status as a student. There are medicolegal, educational, and funding considerations that I do not think can be overcome.

I am not sure about the availability or value of observerships. My opinion, which may not be shared by others, is that I see no value in observing. How could anyone write a meaningful letter for you if all you did was watch other people take care of patients?

I am also unable to tell you what a letter from a surgeon who works at a hospital nobody knows is worth.

I hope my readers will have some thoughts for you.

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The ultimate resident evaluation

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination.

According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies—medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and system-based practice.

The paper analyzed data for 150 residents at different levels of training over 4 years and also found that even faculty evaluations of the category medical knowledge couldn’t predict who would get a good or a bad score on the test.

It’s great to know that at the authors’ institution, the average annual evaluation scores ranged from just over 75 to 100 with means and medians both slightly above 92—like Garrison Keillor’s mythical Lake Wobegon, “where all the women are strong, all the men are good looking, and all the children are above average.”

Medical knowledge can be measured, but the other parameters are so subjective that they border on meaningless. They remind me of the infamous “smiley face” numerical pain scale that means different things to different patients.

Some examples. Earlier this year, I wrote about the difficulty defining professionalism. Using a numerical scale, how can you rate one resident as more professional than another?

And I always had trouble ranking one resident over another in system-based practice. It might be better to rate system-based practice on a binary scale; that is, can a resident define the term or not?

Big business is having trouble evaluating employees too. The evaluation process at General Electric was examined by Quartz. At GE, the annual review is not effective for managing people or improving performance. “It leads to a tendency…to focus excessively on process over outcomes” and is “an exercise in paperwork and bureaucracy instead of an agent of change.”

Note that the JAMA Surgery study accumulated 1131 evals. Even if that was only virtual paperwork, it’s much work for little value, but at least there was a lot of data to show a site visitor from the Residency Review Committee.

A New Yorker article noted that consulting firm Deloitte’s evaluation process involves consensus meetings ending with managers marking on a 5-point scale how strongly they agree with two statements: “Given what I know of this person’s performance, and if it were my money, I would award this person the highest possible compensation increase and bonus;” and “Given what I know of this person’s performance, I would always want him or her on my team.” And they must answer yes or no to two more: “This person is at risk for low performance,” and “This person is ready for promotion today.”

Maybe we should adopt a modification of Deloitte’s system for our resident evaluations. Faculty must respond yes or no to this statement: “I would let this resident operate on me.” If the answer is “no,” why should we let that resident operate on anyone?

This post originally appeared on Physicians Weekly.

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An intraoperative leak test should not be done or should it

Here is an abstract recently published ahead of print in the American Journal of Surgery. Please read it because a one-question test follows.

Introduction: Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0-8%. Many surgeons routinely test the staple line with an intraoperative leak test, but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak.

Methods: Retrospective review of all SG performed over a 7-year period. Cases were grouped by whether an intraoperative leak test (IOLT) was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed.

Results: 542 SG were performed between 2007-2014. 13 patients (2.4%) developed a postop staple line leak. The majority of patients (N=494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increased leak rates when a routine IOLT was performed versus no routine IOLT (2.6% vs. 0%, p=0.6).

Conclusions: The performance of routine IOLT after sleeve gastrectomy provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG.

Do you agree with the authors that the routine use of the IOLT was associated with a higher leak rate after sleeve gastrectomy?

I dont, and heres why.

As I tend to do whenever I criticize a paper, I begin with a confession that I have written a lot of marginal papers in my time. Its one of the reasons I maintain my anonymity.

A "trend" has no scientific validity. A comparison is either statistically significant or it is not. Many scientists and statisticians have rightfully criticized our blind faith in p values, but they remain a standard way of comparing research results. That discussion is for another time. Let’s face it—p values will be around for a long time.

The claim that there was a trend toward an increased leak rate with IOLT was based on a difference of 2.6% among 542 subjects. Even if one believed in trends, the p value of 0.6 clearly indicates that there is no difference between the two percentages. Many authors get away with stating that trends exist when p values are 0.051 or 0.06. Thats still debatable, but at least close to the magic p of < 0.05.

I was never a big fan of intraoperative leak testing and agree with the authors finding that postoperative leaks can occur when the IOLT was negative. As they mention in their discussion, leaks often present long after the date of the operation and may be caused by ischemia, cautery injury, or other factors not readily identifiable by an IOLT.

Because the authors didnt find a single leak by doing the IOLT in 494 cases, they suggest that an IOLT is not necessary. But what if they had found one leak and fixed it. Would that have changed their conclusion?

I wonder if everyone at their institution has stopped doing IOLTs.

PS: Don’t just read the abstract; read the whole paper.

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So Many Scams So Little Time! by Marc Charles

So Many Scams -- So Little Time!

12:04 PM
Owls Head Maine

 

Question from a subscriber: 

Im frustrated.  Ive spent a small fortune on every conceivable home business opportunity and online money making deal. 90% of them are a joke! Most Internet marketers are nothing more than shills and hucksters. I value your opinion and insight...and every time youve recommended something its been valuable. Is anything legitimate these days?


Dear Friend:


Wow.....I enjoyed your email! If you apply this attitude to business youll make a fortune!

But first I need to defend my fellow hucksters and business opportunity salesmen.

Im serious.

Yes......there are cons, shills, crooks and everything in between in the world today. I could devote a dozen books to all of the crooks Ive met in my life and in business.

Ironically, it was one such con artist where I had the most fun in business. I was young entrepreneur but I couldnt believe how resourceful this guy was. In one business venture this guy started offering handguns as premiums! And it worked! The stupid phone rang off the hook for two weeks straight.

Anyway, the problem is not finding legitimate business opportunities or money making ventures.

You could STOP ordering books, courses, tapes, DVDs, special reports, newsletters, conferences, eBooks, webinars and everything in between today, and you would have all of the information you need to run a profitable business and make money.

Im not kidding.

You need to stop looking for "the secret" formula. The "secret" formula does not exist. There is NOTHING new under the sun.

What you need to acquire is wisdom and understanding.

95% of what you buy from someone else will not impart wisdom and understanding. This is a BIG lesson to learn.

I encourage people to look for the "essence" of a business opportunity or money making venture.

The "essence" is what you really need to make a business go.

And ironically...."essence" is the one thing which is not available when you buy or start a business.

Now...this doesnt mean people cant or wont help you.

This blog is a good example. Im not charging a nickel for this wisdom. Im also willing to help almost anyone who has PROVEN they have a passion to learn.

But when you order information products, books, courses and the rest......look for the "essence".

When you understand the "essence" of a business or money making formula, and YOU APPLY this understanding...you will gain wisdom.

Its a big deal.....and this is 100% true and accurate.

I hope that helps!!

I look forward to hearing from you.

Regards,

Marc Charles
Fellow Huckster

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A medical riddle Where do incident reports go

Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have.

Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all.

In fact, I don’t even know where they went or who dealt with them. When I was a department chairman, I sat on quality assurance and risk management committees. Yet we never discussed individual incident reports.

The original intent of incident reports was to identify patient harms and increase patient safety.

According to a 2009 post by patient safety expert Dr. Bob Wachter, hospital incident reports are a spinoff from the Aviation Safety Reporting System which had successfully used them for identifying potential safety issues such as near misses.

At Dr. Wachters hospital, San Francisco General, about 20,000 incident reports were filed every year. That is about half of what the Aviation Safety Reporting System receives per year, and San Francisco General Is only one of about 6000 hospitals in the United States.

Dr. Wachter feels that analyzing incident reports is not worth it. He estimates that each incident report creates about 80 minutes of work times 20,000 reports, which equals about 26,600 hours of wasted time. He also estimated that about one fourth of US hospitals do nothing with incident reports. That saves time but renders the reports useless.

He says an even bigger problem is that incident reports in his hospital fail to capture most events that harm patients.

That has also been my experience. I think most incident reports were filed by people wanting to "cover their asses" and most of the reported incidents were minor. A reference in Wachters article states that most incident reports are submitted by nurses with only about 2% by doctors.

Incident reports can backfire too. From a 2002 Medscape article: "In some states, under certain conditions, the incident report is considered confidential and cannot be used against the nurse practitioner in a lawsuit. However, if copies are made or the chart reflects that an incident report was completed, the incident report can then be subpoenaed by the patient and used against the defendants in court."

And from the Louisiana State University School of Law: "The nonjudgmental nature of an incident report is very important because in most cases the incident report will be discoverable in litigation. An accusatory remark in an incident report may gain unintended weight in a legal proceeding."

Since incident reports generate a massive amount of wasted time, fail to identify most events that harm patients, are frequently ignored, and can possibly have a negative effect on lawsuits, why are they still being filled out by the thousands?

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Surgical training is different in Japan

Quite different than what we are used to in the United States as a paper published online in the American Journal of Surgery explains.

In the US, all residency programs are vetted by the Accreditation Council for Graduate Medical Education (ACGME). Japan has no central accrediting organization. Each hospital establishes its own training program without any national standardization.

Medical school graduates in Japan take a national practitioner examination and then complete a two-year rotating internship. Specialization in general surgery residency takes three more years after which the residents may obtain board certification.

The authors surveyed 76 teaching hospitals in Hokkaido, a prefecture in the north of Japan, and 49 (64.5%) responded.

Program directors were in place in 81% of the residency programs. Of that number, 79.3% devoted less than 5 hours per week to education [compared to an ACGME mandate that 30% of a program director’s time must be devoted to education], and 72.4% had dialogues with residents only when necessary.

Of those responding to the question, 31/36 (86%) "had teaching activities outside of clinical settings," but no program had protected time dedicated to teaching.

Fewer than half of the programs had skills or simulation laboratories, with 12.5% having formal simulation training as part of their educational agenda.

Only 55.6% of the programs evaluated the competency of their trainees in knowledge, skills, or scholarly activities.

Not surprisingly, only 8.6% of program directors were satisfied with the way their programs functioned.

To become board-certified in Japan, residency graduates must take a written exam for which the pass rate is 82.1% and an oral examination which has a pass rate of 100%. The pass rate for the oral exam has been an issue. A medical specialty board was established in 2014 and is preparing to oversee the quality of resident education and certification.

Lead author Dr. Yo Kurashima, Director of Surgical Education Research at Hokkaido University Graduate School of Medicine, answered a few questions via email. He said some of the hospitals limit resident work hours and allow residents to go home after call. However, "most do not define work hour limitations, so residents usually work from early in the morning to midnight every day."

No universal surgical residency curriculum exists in Japan, but a national surgical society recently listed criteria that must be achieved prior to board certification.

Dr. Kurashima did some training in Canada where he became familiar with North American residency methods.

For his next project, he said, "We are just starting a national survey which will investigate resident satisfaction regarding their residency.”

I suspect the residents might raise some concerns. I wonder if they will have time to respond.

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OR tech How do I deal with an abusive surgeon

Have you ever come across problems with rage and temperament issues in the OR. I have been an operating room tech for many years and have been in a variety of surgical settings.

A certain surgeon brings in a lot of money to the hospital, but he is terrible. I have been called things no one has ever called me. He throws instruments on my table and mayo stand, screams, and implies that I and my colleagues have no idea what we are doing. I have reported him to my manager and the OR director, but nothing ever comes of it.

Other surgeons have witnessed his behavior and have said something, but nothing was ever done. I understand the OR is a beast of its own, but the culture has to change with these newer guys coming out of residency. The mindset of the surgeon being our customer, which is being rolled out to us now, is not reason for us to put up with abuse. What have you encountered on a peer-to-peer level on how to handle such demeaning behavior? I trained and worked at a level 1 trauma center with emotions that constantly ran high, and still it was less stressful than this particular surgeon. Thank you for your advice. 

A recent paper in the American Journal of Surgery addressed this topic. The authors interviewed 19 OR personnel including nurses, medical students, surgical residents, anesthesiologists, and 2 scrub technicians. Dr. Amalia Cochran, the papers lead author, told me the reason there werent more scrub techs was that they were reluctant to participate.

This figure, modified slightly from the paper, describes the harm that disruptive surgeons can do and suggests some coping strategies.

Italicized items are discussed in the paper

I suggest you read the entire paper. Your hospitals medical librarian should be able to obtain a copy for you without difficulty.

Its a tough situation. When I was a surgical chairman, I had some experience with surgeons behaving badly. I always had trouble getting the nurses and techs to go on the record with their complaints.

If your immediate boss cant help, maybe you could try your hospitals risk management department. A surgeon who bullies the staff is a patient safety risk. Some hospitals have anonymous hotlines where complaints can be lodged.

The only other thing I can suggest is to get several other staff to join in the complaints. Administration can ignore one or two people but not eight or ten.

Can anyone else comment?

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Which is better—an electronic or a paper progress note

It depends on whom you ask.

A new study says internal medicine house staff generally feel that the quality of progress notes is unchanged or better since the implementation of an electronic medical record, but the attendings feel that progress note quality is unchanged or worse.

Over 400 interns, residents, and attending internists at four university hospitals were surveyed. The paper appears online in the Journal of Hospital Medicine.

Specifically, 50% of residents felt that the quality of notes was unchanged and 39% thought the quality was better or much better. Conversely, 39% of the attendings felt the note quality was unchanged, and another 39% felt that it was worse or much worse.

From the paper: Half of interns and residents rated their own progress notes as “very good” or “excellent.” A total of 44% percent of interns and 24% of residents rated their peers’ notes as “very good” or “excellent,” whereas only 15% of attending physicians rated housestaff notes as “very good” or “excellent.”

When the 9-item Physician Documentation Quality Instrument was used to evaluate notes, attending perceptions of housestaff notes were significantly lower than housestaff perceptions of their own notes, p < 0.001. One of the PDQI items asked for a rating of how succinct resident notes were. That feature was rated lowest by attendings and residents alike. I can think of a lot of words to describe electronic progress notes, but "succinct" isnt one of them.

In all, 16% of interns, 22% of residents, and 55% of attendings reported that copy forward [copy and paste] had a “somewhat negative” or “very negative” impact on critical thinking, p < 0.001. Auto population of fields in notes was judged similarly.

The authors felt that these differences could be explained because Attendings may expect notes to reflect synthesis and analysis, whereas trainees may be satisfied with the data gathering that an EHR facilitates. I agree.

Can all this be remedied?

Dr. Daniel Sexton, a Duke University internist, authored a three page guide [link is safe] on how to write effective progress notes. Here are just a few excerpts:

DO NOT TRANSCRIBE LAB DATA INTO THE PROGRESS NOTES UNLESS YOU INTEND TO COMMENT UPON IT. [All caps by Dr. Sexton]

It is often good and useful to explain your thinking in the chart.

Do not mindlessly repeat yourself in daily notes. [That goes for "copy and paste" too (my extension of this recommendation)]

LENGTH OF NOTES DOES NOT RELATE TO RELEVANCE OF NOTES. [All caps by Dr. Sexton]

I have written about the pitfalls of electronic medical records several times. In my blogs search field to your upper right, insert "electronic medical record" or "EMR" and click "Search This Blog" to see my other posts.

Its early in the academic year. Start writing better notes now. And please dont copy and paste.

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