Smart Surgeons Sharp Decisions

Winner of a HIGHLY COMMENDED AWARD in the Surgery category of the 2011 BMA Medical Book Competition. A vital question that concerns many: how to make surgery safer? Is it by tightening the regulations and imposing rigid protocols or by empowering surgeons with the resources to help them make safer decisions? This is the book for those who would choose the second option. What do you think separates smart surgeons from the rest? Why, on the other hand, do surgeons make blunders despite having experience and knowledge? There is only one answer to both questions - it is decision-making. Decision-making is an art and is at the heart of surgery. It decides between excellent and poor surgical performance. Although a vital part of professional activity, surgeons are not generally aware of how to optimize decision-making skills. Making a good decision is a skill that, like any skill, needs to be developed and this book reveals how surgeons can sharpen these skills. Presented here are the findings from decision science that surgeons, irrespective of specialty or seniority, can apply to everyday practice. Surgeons are required to adapt new strategies throughout their careers. Ideas taken from this book will help to speed up the learning curve. It offers answers to the questions which experienced surgeons may find difficult to explain. Equally, it answers the questions that trainees may even find difficult to ask. You are expected to be cognizant of the knowledge behind making decisions. Nonetheless, no-one tells you how to access this information easily. This book is the key to that vital information. "This is a very helpful book, written in a friendly and accessible style. It provides many fascinating examples of the phenomenon which so interests us surgeons. Surgeons of all ages and specialties will find it helpful to know about themselves and how they are challenged." Mr Tony Giddings, Past President of the Association of Surgeons of GB & Ireland

Surgical Metacognition: Smarter Decision-making for Surgeons is a groundbreaking yet practical guide to learning and teaching expert decision-making for surgeons.

This volume presents novel concepts to help physicians and health care providers better understand the thought processes and approaches used in clinical decision-making and how we develop those skills as we transition from being a medical student to post-graduate trainee to independent practitioner. Approaches presented range from simple rules of thumb, pattern recognition, and heuristics, to more formulaic methods such as standard operating procedures, checklists, evidence-based medicine, mathematical modeling, and statistics. Ways to recognize and manage errors and how our decision-making can be improved, are also discussed. An Introduction to Medical Decision-Making presents several innovative techniques to allow the reader to use the principles presented and integrate the ethical, humanistic and social aspects of decision-making with the pragmatic and knowledge-based aspects of clinical medicine. It also highlights how our thinking processes, emotions, and biases affect decision-making. This invaluable resource will allow students and physicians to evaluate and critically discuss their decisions objectively to become more efficient and effective, and maximize the quality of care they provide.

Surgeons start their career in the expectation that it will bring personal satisfaction through an unparalleled sense of achievement and professional growth. Nonetheless, a career in surgery carries with it serious challenges: surgical training is rigorous, both emotionally and physically, and demands that the surgeon adjust to unpredictability. Chronic levels of stress can affect surgical performance, the quality of family relationships, and even the nature of the doctor–patient relationship. Unmanaged stress has been shown to contribute to physical illness, emotional problems, absenteeism, poor job performance, drug abuse, and negative social attitudes. With a background in both surgery and psychological medicine, Dr Shiralkar examines the psychosocial burden of being a surgeon and offers insights into the role of intra-human factors in surgery. He reveals surgical performance from a psychological perspective and highlights the factors that cause unsatisfactory performance. He also offers solutions to rectify the problem and prevent burnout. The book will be invaluable to all those embarking on a surgical career, as well as to established surgeons in all specialties who wish to understand how to identify and manage the factors that could lead to career-limiting levels of stress.

Despite diagnosis being the key feature of a physician's clinical performance, this is the first book that deals specifically with the topic. In recent years, however, considerable interest has been shown in this area and significant developments have occurred in two main areas: a) an awareness and increasing understanding of the critical role of clinical decision making in the process of diagnosis, and of the multiple factors that impact it, and b) a similar appreciation of the role of the healthcare system in supporting clinicians in their efforts to make accurate diagnoses. Although medicine has seen major gains in knowledge and technology over the last few decades, there is a consensus that the diagnostic failure rate remains in the order of 10-15%. This book provides an overview of the major issues in this area, in particular focusing on where the diagnostic process fails, and where improvements might be made.

Being a good clinician is not just about knowledge – how doctors and other healthcare professionals think, reason and make decisions is arguably their most critical skill. While medical schools and postgraduate training programmes teach and assess the knowledge and skills required to practice as a doctor, few offer comprehensive training in clinical reasoning or decision making. This is important because studies suggest that diagnostic error is common and results in significant harm to patients – and errors in reasoning account for the majority of diagnostic errors. The ABC of Clinical Reasoning covers core elements of the thinking and decision making associated with clinical practice – from what clinical reasoning is, what it involves and how to teach it. Informed by the latest advances in cognitive psychology, education and studies of expertise, the ABC covers: Evidence-based history and examination Use and interpretation of diagnostic tests How doctors think – models of clinical reasoning Cognitive and affective biases Metacognition and cognitive de-biasing strategies Patient-centred evidence based medicine Teaching clinical reasoning From an international team of authors, the ABC of Clinical Reasoning is essential reading for all students, medical professionals and other clinicians involved in diagnosis, in order to improve their decision-making skills and provide better patient care.

This book focuses on surgical decision-making, a key topic for both surgeons and emergency physicians who are faced with patients with acute abdominal pain. Providing easy-to-understand technical details and discussing the interpretation of normal and pathological images, it is a valuable resource for surgeons and emergency physicians who are not used to applying clinical US in this field, enabling them to shorten the diagnostic path and avoid unnecessary costs and exposure to radiation. It is also a practical reference guide for surgeons and doctors wanting to apply US as a decision-making tool in the context of acute abdominal pain.

A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine. Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is -- complicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives. At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor. Complications is a 2002 National Book Award Finalist for Nonfiction.