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This pastel drawing is Henry Tonks’ Saline Infusion—An Incident in the British Red Cross Hospital, Arc-en-Barrois, 1915.

As the Imperial War Museum writes, “During the war [Tonks] served as a RAMC doctor and worked with Sir Harold Gillies, one of the pioneers of plastic surgery. Tonks drew studies of facial injuries before and after surgery, requiring accuracy, attention to detail and emotional understanding.”

Here the blues, tans, and whites of his reduced palette imply a cleanliness, while the postures of the simplified, blocky figures convey sympathy and—in the case of the patient—pain.

There is something simultaneously gut-wrenching and surprisingly dispassionate to the work: vivid and painful, yes, but somehow a little bit distant.

Perhaps that’s to be expected from a man whose job it was to record war injuries in just such a manner as he records this surgery.

A Vital Measure: Your Surgeon's Skill // NYTimes

It has been clear for nearly 30 years that not all surgeons produce the same results. The reasons, however, have remained elusive. Most studies on surgical quality have focused on what surgeons do before and after surgery, practices that are easy to measure and analyze, like giving antibiotics to prevent surgical wound infections and administering blood thinners to guard against the development of blood clots.

But even with the most compulsive adherence to these pre- and post-operative protocols, and much to the chagrin of many a well-intentioned health care expert, payer and policy maker, significant disparities in patient outcomes after surgery have persisted.

The reason, observers have postulated, may be the one, obvious thing that most of these initiatives have scrupulously avoided: what goes on in the operating room.

Now an innovative collaboration between researchers, payers and weight-loss surgeons, the Michigan Bariatric Surgery Collaborative, has addressed that-which-could-not-be-named. And their findings have confirmed what patients have long suspected and trainees have long known – the dexterity of a surgeon’s hands can account for much of the differences in how well patients do. (» more)

It’s just an operation doctor…

Ok, does anyone else come across this odd attitude that people have when coming into ER/A&E as regards having or getting operations?

People seem to think that having an operation is an easy thing. I usually get told: “That it’ll be all ok because I’ll have an operation” or the most common comment “but it’s just an operation”! I also get asked to “just put me to sleep” for the tiniest wound that I might need to suture in A&E.

People do not seem to understand that one of the risks for ANY operation is death. Yes. Even those really simple operations. Of course, the risk is small and I don’t want to scaremonger too much but there is always a risk! Not so much from the surgery, but more from the anaesthetic. We do these things everyday, but medicine is not 100% predictable. Things happen and might go wrong. Patients might react differently and suddenly to different medications. It’s like riding a bucking bronco. Anything can happen!!

So remember, operations and anaesthetics are serious business.

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