FROM SILOS TO SYNERGY
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Historically, fixing these hernias often required large incisions and lengthy recoveries. With robotic surgery, we can now repair many large hernias through four or five 8-millimeter ports. That means lower wound infection risk, better healing, shorter hospital stays and often a smoother recovery.
When I evaluate one of these patients, the EMR becomes a tool for collaboration, not a replacement for it. I contact their nephrologist to discuss immunosuppression, kidney function and steroid management. I reach out to interventional radiology to determine whether the patient might benefit from chemical denervation. I spend a great deal of time counseling patients about the factors that affect wound healing and how we can optimize their health before surgery.
For complex hernia patients, I frequently engage their primary care physicians to help with diabetes management and weight loss. These are two pillars of successful hernia repair, and improving one often helps improve the other. I tell patients it’ s a“ twofer.”
Many patients have heard pieces of this information before, but they often tell me no one has explained it in a way that made sense. I use the analogy of an overinflated tire to explain pressure, tissue stress and abdominal wall mechanics. Patients leave understanding the physiology behind their problem rather than feeling blamed or ashamed for it.
Another group I love collaborating with is anesthesia. Surgeons and anesthesiologists like to blame each other for delays, cancellations and sore throats after surgery. All joking aside, neither one of us can do our jobs without the other. We are truly a package deal. I am grateful for my anesthesia colleagues every day. I’ ve seen patients develop life-threatening issues during induction and watched expert anesthesiologists recognize the problem and intervene within seconds. Their skill and calm under pressure are truly remarkable.
Communication between surgery and anesthesia is constant. During minimally invasive surgery, carbon dioxide insufflation can create challenges, particularly in elderly patients. We make adjustments together throughout the operation. Postoperatively, techniques such as TAP blocks( numbing the muscle layers of the abdomen via a Transversus Abdominal Plane block) can significantly improve pain control and reduce the need for narcotics. long-term outcomes and helps prevent small problems from becoming large ones. It also allows patients to regain confidence in their bodies.
Setting expectations is one of the most important parts of patient care. Patients deserve to know not only what surgery can accomplish, but also what recovery will realistically look like. When I discuss surgery with patients, I don’ t just talk about the structure I’ m removing or repairing. I talk about the surrounding anatomy and how everything works together.
Surgery is a contact sport, and medicine is too.
I worry that the corporatization of healthcare has contributed to a more siloed approach to medicine. Yet we all learned in medical school that neither the human body nor human beings function in isolated compartments.
One of the more interesting experiences in my career occurred when I practiced in a hospital system where general surgery shared office space with neurology and neurosurgery. At first glance, general surgery seemed like the odd specialty out. In reality, that proximity created conversations and collaborations that probably would not have happened otherwise. It was a random arrangement, but I think it benefited both physicians and patients.
I’ d encourage healthcare leaders to think more about how we bring physicians together. Sometimes better care starts with something as simple as sharing a hallway.
At the end of the day, I think we should make a greater effort to communicate directly with one another, by phone, text or even an old-fashioned conversation. Those discussions enrich our practice, improve our decision-making and ultimately provide better care for our patients.
So, call me. I look forward to talking with you about your patient!
Dr. Maki is the owner and surgeon at Louisville Hernia & General Surgery.
Open communication leads to better outcomes. It’ s really that simple. The collaboration doesn’ t stop when surgery is over. I often refer patients to physical therapy for core strengthening and rehabilitation. In my experience, helping patients rebuild strength after surgery improves
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