FROM SILOS TO SYNERGY
Surgery Is aTeam Sport
by Alexandra Maki, MD
Patient care is hard. Communication is not.
The electronic medical record was supposed to make communication easier, and in some ways it has. I can see care provided in multiple locations, review consultations from different specialties and get a much more complete picture of my patients. That’ s a good thing.
But I also think the EMR has undercut one of the things that makes medicine great: physicians talking to each other. I really enjoy hearing other doctors’ perspectives. The insight from a primary care physician who has known a patient for years can be incredibly helpful when that patient suddenly develops an acute surgical problem. Conversations with specialists and primary care physicians help me plan preoperative, intraoperative and postoperative care. Sometimes those discussions even influence the type of operation I perform.
One of my favorite groups of patients to care for is that of our transplant patients. These patients are often on multiple immunosuppressive medications. Some need to be stopped before surgery, some don’ t and some have nutritional considerations that can help us optimize healing. As a general surgeon who focuses heavily on hernia repair, I frequently see patients with large post-transplant hernias.
These hernias are often the result of immunosuppression interfering with normal collagen formation and wound healing. Many patients suffer with them for years because they’ re told,“ It’ s just a hernia,” or because they’ re afraid surgery will be too risky. Unfortunately, it’ s not always that simple. Large flank hernias and other complex abdominal wall defects can change a patient’ s center of gravity. They can contribute to falls, chronic back pain and limitations in everyday activities. Patients often adapt to these problems gradually and don’ t realize how much the hernia has affected their quality of life until after it’ s repaired.
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