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Dr. Ramshaw
Recently I came across a rebuttal to Dr. Ramshaw’s article about his surgery error. I looked around the internet to see what he was up to and find that he seems to have left the work of the physician behind. His new effort is focused on creating an equation-based care system that somehow turns the patient’s welfare in to just another variable , to be minimized or increased as appropriate to make the “system” more efficient..
It’s interesting reading, especially the chapters of his forthcoming book (he’s an author now too), in which he discusses hernia repair in great depth without mentioning long-term or chronic pain once.
If you decide to look through these links, recall that Dr. Ramshaw was once known as an expert in hernia repair, renowned on the hernia industry presentation circuit. Strange to see how he is dissociating himself from the personal doctor-patient relationship.
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12 Replies
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I highly recommend viewing the HerniaTalk LIVE Q&A I had with Dr Ramshaw: https://youtu.be/cvmLowkvg3Y
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I think common sense often goes a long way in solving a problem. Addressing the pain from mesh as seen by the brain sounds like propping a three pillar building with another bigger one next to it, rather than adding the extra pillar instead.
As for the doctors being under pressure and often criticised by the patients, I think part of this would be solved by at the very least acknowledging that hernia surgery while common is also at higher risk of complications than normally explained/sold to the patient (this point is the one that most angers me actually)…
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I think the idea with regards to CBT and pain is that given that the perception of pain (and intensity) actually comes from the brain, there are ways to address pain with things like CBT. there is a whole school of thought that has investigated pain that is completely or almost completely independent of existing physical damage or other physical processes. look to John Sarno and his work with back pain, and those who’ve come after him who call this “TMS”. pain pathways can be created by physical problems, but then persist long after an injury has completely healed. they can also be reactivated after a long dormancy, as those connections usually remain even if they’ve been deactivated. the brain can reinforce those pathways and prevent the natural course the body normally takes to turn off those signals. the brain can also prime a person to anticipate pain, and then create expected pain, or intensify it, even if there is nothing wrong. it is even thought that emotional circumstances and tension can create pain as a distraction in the absence of anything physically wrong.
but all that having been said, we also know that in many cases mesh absolutely can cause persistent pain of it’s own that has a definite origin, and sometimes removing the mesh or doing some sort of other revisional surgery is the only way to address the pain. and surgeries of other kinds can create pain for a variety of reasons, usually related to nerve damage.
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Here is his LinkedIn page. No signs of medicine, I think that he has moved on. He teaches business courses at the University of Tennessee now.
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The correct term is Cognitive “Behavioral” Therapy. One area of focus for its usage today is in depression, or suicidal thoughts. The “Behavior” therapy is in helping the patient stop the thoughts that lead them to feel suicidal. Controlling the behavior of their own mind.
Of course, it’s easy to see how this is not the same as stopping physical pain. One originates in the mind, the other originates in the body. It’s actually somewhat ironic that Dr. Ramshaw is focused on CBT to help patients with physical pain. He could probably use it himself to change his thought processes to accept the true source of the physical pain.
Unfortunately, for whatever reason, he has put great effort over the years in to avoiding the possibility that the foreign object itself, the mesh, is the cause of the physical pain. It is the simplest explanation, learned over millennia by humans, that foreign objects in the body – splinters, teeth, knives, needles, bullets, etc. – cause pain and must be removed if the pain is to be relieved. But, somehow, this possibility just seems to be unacceptable to him. It’s hard to understand how he can think this way, as a physician.
Dr. Ramshaw’s case is especially fascinating because he seems to be very intelligent and capable, with high energy, but his focus is on making mesh “work”, so that the “system” can continue. His approach is like that of a farmer tending to his livestock. Keep the animals functional and working, so that the farm can continue to function.
It will be interesting to see how far he gets with his efforts. At this time it looks like he is giving up surgery and developing a new profession. He went on sabbatical quite a while ago and does not seem to have reappeared as a surgeon.
https://adventhealth.cloud-cme.com/assets/AdventHealth/Uploads/42988/Documents/42988_Bio.pdf
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@mitchtom6 thanks for bringing up Dr Belyansky’s situation. When surgeons choose to perform higher risk operations that no one else offers, it is stressful when patients don’t have the best outcomes. Then, to get sued for it is even more stressful. As a result, you have highly talented surgeons that will no longer be offering their skills. And now hundreds and thousands of patients are negatively affected.
Regarding Cognitive Brain Therapy: Dr Ramshaw has shown that CBT prior to surgery can improve outcomes after surgery. It’s incorrect to assume that he was offering CBT because he thinks your pain is all in your head. What his research has shown is that if you can control how you perceive pain, after months and years of being exposed to chronic pain, then your revisional hernia surgery will be performed with less pain and you are more likely to remain pain free from the surgery. Think of it as physical therapy of the brain. You would never guffaw at your orthopedic surgeon if he/she offered you physical therapy prior to your hip surgery, would you?
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Oh yeah – one more thing. It is a shame that Dr. Belyanski is getting out of the mesh removal business. Many people sung his praises after having problematic mesh removed by his hands, and he has lots of great testimonials, and I personally visited him a few years ago when weighing my options. Yet, I know that one of the forum members (who I suspect has multiple accounts on this website) sued him after he was unable to cure his pre-existing chronic pain by removing his mesh. Perhaps that was the “straw that broke the camel’s back.” Can we expect physicians to keep practicing these sort of procedures when they stick their own necks out every time? What a lousy scenario. I don’t think there is a great answer with respect to that question.
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One of the more interesting aspects of this forum is seeing things from “both” perspectives – that of the patient, and that of the physician. There is no doubt that both parties have valid concerns and vantage points, and it is here that we can have a dialectic.
With respect to Dr. Ramshaw, I have never met the man, nor interacted with him, although I did briefly research him when considering mesh removal. Right or wrong, I crossed him off my list, partially because I found out he required patients to undergo some sort of Cognitive Brain Therapy prior to their treatment, which implied an underlying assumption that the pain was/is a mental phenomenon to some extent. Now, perhaps it is true that a positive outlook can promote healing. I had to start taking anti-depressants when I injured my groin, due to a suspected mesh irritation, which led to nearly a year of intractable pain. The meds helped me to deal with my new reality and cope with things. Yet, on the other hand, I don’t want a physician who categorically doubts the validity of his patient’s testimonies about pain.
There is nothing wrong with data analysis, and I would argue that we need more of it w/ respect to the US hernia repair industry. Yet, a mechanized and numerical approach to medicine does sound alarming and off-putting from the patient’s perspective.
Anyway, this concludes my musings for the day. My participation in this website tends to be cyclical. Right now, I’m in a down cycle, having reinjured my groin and seriously considering another cortisone injection to try to find relief, as it hurts to even walk around. Take care everyone.
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I just read the Opinion piece by Dr. Ramshaw. From a surgeon’s perspective, I can totally relate.
Like Dr. Ramshaw, I left the volume-based practice that is imposed on so many of us who are (used to be) employed by an Institution. I used to be the busiest general surgeon faculty in my hospital, and I was being pushed each year to do more and more operations. I had to meet a minimum number of work units; that goal number was random and kept increasing over time. Meanwhile, similar to Dr. Ramshaw, because of my expertise in the field, I was attracting more and more complicated patients that required more of my time and skill.
The current US medical system is not made to meet the needs of complex patients. I left the volume-based system that Dr. Ramshaw describes. Now, as my own boss, I determine how much time I provide to each of my patients and how many operations I perform each day. I focus on quality, not quantity. I do not have a minimum number of work units I must meet each year. No one is punishing me for spending too much time with my patients. I am happier, and I am able to meet the needs of my patients.
Dr. Ramshaw has taken a different route in order to address the burnout that many of us surgeons experience. I know his story and why he has (for now) left clinical practice. The hernia specialty community can be challenging. Patients are in pain, some are suicidal, and they are seeking our help while armed with a lot of preconceived notions and ideas about what they believe is the solution to their problems and needs. Dr. Ramshaw has chosen to use his time and experience to help improve the system. He should not be disparaged for that.
I love what I do, and being my own boss has significantly reduced the burnout. Meanwhile, as have other hernia specialists, I have had death threats, personal attacks and harasssments by phone, email, and on social media. Some surgeons have required police or security involved or have changed jobs and locations to flee potential life-threatening actions.
As a direct result of these attacks and the stress of providing to complex patients with chronic pain (which most surgeons are not exposed to) in addition to the baseline stress of operating on patients and dealing with potential complications (which most surgeons are exposed to), we are losing many talented hernia specialists and at the end, less of us will remain to treat hernia-related complications.
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Sueing a surgeon in that scenario seems pretty scummy, unless there’s evidene that he did indeed commit a major error.
I’m actually in that situation, where I had mesh removed by a specialist and the pain is now coming back, but I would never think of sueing him, as he legitimately did the best he could.
But then again I don’t know that patient’s story.
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