Starsky Cardigans For Sale

Full interview Medical Journal: Chapter II

Well, this is the second and final installment of the answers to the questionnaire used for the interview published in the Medical Journal on 25 April.

How often do you update your blog?

I have no specific deadline I write as issues arise, some are current, others are part of the manual residents, or really the antimanual because treatment issues are not in any standard manual

I've also started two new chapters of entries: clinical cases power-point attempt in which to disseminate knowledge about surgery, and photos history is a section for the memory of some patients who have had powerful stories and also a new experience trying to humanize the image of surgery, usually perceived as unpleasant.

- Is it possible to know the number active fan having your blog?

E l number of followers is hard to know because many people read but is not a follower, so if you know the number of visits and which pages are the sources through which is traffic. Since I began to count the visits in April 2010 to 25000 pages were viewed approximately and received 140 comments and as many messages and queries. Keywords used were surgery, patient, MIR, surgeon, medical. Most traffic comes from blogspot , Directorioplus, wordpress, networkeblogs facebook and twitter (@ fjaviherrera).

most visited entries have been, you can see them in the right column, "popular entries

Choosing the wrong specialty ambulatory surgery.

health Hyperspace

medical Guards: a "slavery" of our time

My recipes to choose from the MIR space

The worst call of my life

For medical students and new MIR

MIR exam answers 2010 general surgery (complete)

- What is your specialty? What age?

was born and studied medicine at the Medical Faculty of the UPV in Bilbao I have 52 years and 28 professional. I'm the surgeon general and digestive system, I did the residency at the Hospital Puerta de Hierro in Madrid (1983-88) and work in liver transplantation to 93, since then I have worked in the Hospital de Navarra in Pamplona, \u200b\u200bI am currently Head of Hepatobiliopancreatic Surgery Unit of the Hospital de Navarra. My career has focused on Hepatobiliopancreatic Surgery and Oncology, did the thesis in 1988 at the end of the residence on liver transplantation.

Why did you become a doctor?

chose to be a physician and surgeon since childhood, I have no idea why, I had no family history, perhaps the number of doctor Ganon (Medical Center) marked me XD.

I do not regret the surgery is a very important part of my life and my passion but I never thought I would have to exercise a monopoly in the public health enterprise. In short I like what I do but not where I have to do-I mean the current public health-and what I do I can not do anywhere else.

have you thought about working abroad?

I have not raised to go abroad for family reasons.

for you What are the defects and virtues of the Public Health System?

major shortcomings from my point of view are:

absence -based career is done, as is done and how. Perhaps the one size fits all policy is the most destructive of the company.

-absence of incentives for innovation and quality at work but otherwise is preached.

-absence of clear objectives of the company off the lists waiting and numbers.

instruments, lack of teamwork.

-political leadership, unprofessional management, lack of clinical management.

purely assistance-Objectives teaching and research remain upset and "productivity."

Virtues:

-as a citizen I believe that health care coverage and are a great social achievement as indicated by the parameters public health.

-public health specialists is good but then mistreated.

Obviously I have no solution for these problems but some steps are:

-generalize the clinical management of multidisciplinary units targeted to address specific problems. Recognize the teams end up with the constant changes of personnel.

-procurement system and pay much more flexible.

-mobility, the fragmentation of regional ministries of health have ended with mobility. Premium in the oppositions are locals only 1 of every 10 seats out to regional transport. If you leave your community to internal, as I did, go back home is impossible or requires a long journey.

-integrate teaching and clinical research in everyday work. It is painful to the low scientific level of some services and how proud we are their managers because they have no waiting list.

-implanted quality programs led by doctors. If the politicians only care about the quality perceived by the patient, they call it customer, and where is the scientific-technical quality?. A patient with a good deal and a pat on the back is left happy but may not have done the right thing.

- provide digital tools including social networks to improve internal communication with patients. Hospitals are a breeding ground for gossip, jokes, gossip or slander: lack visibility, communication and plenty of gossip.

-participate in the design of strategic plans investment and health. The doctors are not consulted to design the health strategy, a seudogerentes the design and some have never seen a patient, that explains the medical-management disagreement.

-have a trade union dialogue own doctors and recruitment conditions specific to each job with productivity linked to results. In many communities and in Navarra our labor issues are negotiated at a table in the health sector that are numerically minority groups-all health of hospital doctors is the smallest.

What is the level of surgery in Spain?

The level of surgery is generally good but not consistent in all hospitals and autonomy. Reference should be improved to expert teams in cases of low frequency and high complexity. Complicating autonomy. Mobility should be improved to enhance learning and reduce the number of MIR to improve the quality of their training. It is difficult to maintain a system which makes more money with simple procedures in private practice with highly complex surgery that is done in public. The younger generations learn that the effort is not rewarded.

improvement of anesthetic and surgical technique has eliminated the contraindications for age and reduced comorbidity related, I've always been concerned about the sense of proportion when making a surgical indication transmit it to future generations. View the blog entries: common sense applied to medicine, less is more , primum non nocere .

Garrett Popcorn Franshine

As a family facing troubled

Unfortunately it is increasingly common, especially resident, having to deal with patients' relatives conflict, assertive, rude, intrusive, violent, threatening or simply "tocapelotas" - or its female equivalent. To be sure, with most patients the treatment was correct but the situation is far from idyllic.

As in other aspects of this manual nobody tells you how to take on one aspect of our work that produces more frustration and impotence, making the brown to talk to a family conflict when the problem is company or other service or other medical or health: I feel that day has touched you.

Well the issue, try to tell you what I have learned based on years of conversations of this type. The most common scenarios are: emergency department, called the plant at night, go to visit the weekend or holiday. We're going to mess ...

Area emergency by far is where the resident is more exposed to the wrath family. The resident is vulnerable because he is alone, it looks like a girl and if it is woman, and as such, is considered by some men as a perfect target. How to avoid unpleasant situations, easy! prevention.

emergency preventive measures : prevents the examination room between more than one family, do not say never with a crowd, do not talk in the aisles with people around, if the patient is very complex for help before you speak, although the case-DESIGNED do not get caught in non-, do not talk of what could be and was not, no des explanations of care from physicians, non-judgmental about the actions of other professionals-remítelos to them for clarification, "in short, do not get in a garden or try to convince them, our job is to inform.

steer the conversation As : only two family members identified "best of the first order, friends or brothers etc ... are often the most impertinent", identify (name, specialty, year of residence), it is best to wear gown, avoid embarrassing mistakes, "the conversation should be short and clear.

never be heated, or raise his voice, or argue, or attempt to convince them they are wrong. Your mission is to inform with clarity and honesty, not convince them to have made things right, or justify what is wrong. If there has been some error or delay by poor organization first to disable the just anger of the family is apologize.

If you have completed all these steps the family insists on blaming, yelling, insults or put edge or irrelevant, it is best to terminate the conversation and leave, not without comment that when subside return to resume the conversation. If the second attempt can not take a polite conversation tell them to talk with them attached and terminates the conversation.

Night Calls : in these cases is added the night shift that alters patients, families and nurses. In this case the key is to see the patient before obtaining the maximum information from the story and nurses. If a chronic patient and the call is in despair, insomnia, fatigue for prolonged hospital stay, anxiety, the key is to quiet conversation with family members-usually relieve the pain and anxiety (see entry as attending a night-call guard). Never argue or issues of medical treatment, are those who know you best, if the patient is severe call your assistant, what are their complex patients negotiated.

visit passes weekends and holidays is typical that the family will spend the morning at the hospital Sunday or holiday. This situation, which everyone considers normal can have serious consequences for the doctor to check you have to swallow, usually after 24 hours. The fundamental cause is that the family has much time and want A summary of the patient's progress, and you just want to leave as soon as possible to your home. Also usually go the "smart guy" of the family who has read anything on the Internet or have a friend or seen any health television program that will magically become an expert. (See entry for enteraooos )

The weekend pass is to visit patients and see if there is any change to no diagnosis replated or making important decisions, except the patient has complications and required. These decisions are better than their doctors to take responsibility, guard making decisions about acute problems.

The family must inform in a concise and if you want further explanation refer to their physicians. never make summaries of developments or future decisions without consultation.

Chicken Pox Just On Limbs

New video section full interview

I could not resist putting the videos we've been recording over the years in our unit as we are dedicated to liver surgery, biliary and pancreatic will be the first video of a liver resection a bit special because it divides the liver into two parts left open like a book.

If anyone wants to share videos of surgery and has a platform to do so can upload to YouTube and send me the link or embed code and I will hang in the video section