Dr Bruce Ramshaw – long time off!

[Good intentions]

Here is another of his recent endeavors. I read through the APCO pages and job listings and they never explicitly say what they do. They seem to be a management consulting firm.

https://apcoworldwide.com/people/bruce-ramshaw/

https://apcoworldwide.com/about/mission-values/

Many words, but they don’t say much. From APCO’s Mission page –

“Our Mission

In a rapidly evolving global context and a time of transformational change, APCO strives to add value to our clients’ enterprises and benefit society. We enable clients to achieve their objectives through insightful counsel, compelling narratives and creative solutions.”

[Good intentions]

Dr. Ramshaw’s career arc gets more fascinating. It seems that he no longer practices surgery and has gone completely over to something that looks like consulting in the business field. He is even teaching in the UT Haslam College of Business now, not the Medical school. His internet presence has become very self-promotional. Just a few short years ago he was a very vocal presence in the hernia repair world, helping to control the mesh-usage narrative.

Incredible.

https://www.linkedin.com/in/bruce-ramshaw-70195215/

https://www.bruceramshaw.com/about

[Good intentions]

It doesn’t look like Dr. Ramshaw plans to treat patients again. He has moved on to a different profession. Expert witness is one aspect of his new consulting business. Based on his history I imagine that the mesh makers will be using his services often.

https://www.generalsurgerynews.com/In-the-News/Article/07-21/Tips-on-Being-an-Expert-Witness/64041

“The work pays well, averaging $350 per hour for medical expert witnesses and $500 per hour for medical expert testimony, but this varies by degree and with experience.

“As I’ve gained experience and expertise in multiple areas, I’ve raised my rates,” said Bruce Ramshaw, MD, a managing partner at CQInsights, a health care data analytics firm in Knoxville, Tenn. “Consulting as a medical expert is one of the few areas for physicians in health care where you can be reimbursed what your expertise is worth, whereas most of what we do clinically is negotiate with insurers for rates based on negotiating power rather than expertise or outcomes.” “

[Luke]

Dr Towfigh that helped tremendously thank you!

[drtowfigh]

Dr Ramshaw is among the pioneers of laparoscopic ventral hernia repair. His practice slowly evolved into treating patients with chronic pain and mesh-related problems for both ventral and inguinal regions.

He is currently on sabbatical and it is not clear when he will start treating patients.

With regard to the % quote, it may very well be true that in your surgeon’s experience, their recurrence rate is 30%. These values are very surgeon and technique and patient dependent. To use your home construction analogy, it’s like asking what’s the square footage of the house you build? An average square footage may be provided, but the real number varies per builder.

[Alephy]

I watched the video, the first one, and I found it interesting. He mentions a pure tissue recurrence rate of up to 12%, depending on the method/individual etc. : this is in stark contrast with what some doctors quote i.e. I was told durng a visit that it is more than 30%. He also mentions the necessity to discuss the procedure with the patient, with the assumption that the doctor (who knows better) guides the patient, based on his/her goals: this part I also agree, with the understanding though that if the patient happens to know for a fact that something does not work, the doctor should not pretend to force it on the assumption that he knows better. As an example, years ago Asbestos was widely used in the building industry: now I am not an engineer, but if one told me they plan to use heavily Asbestos to build the house where my children will spend a good chunk of their lives, and that I should trust them, well I would first ask questions, then point to the facts, and finally get angry

[Good intentions]

Here’s the view on the psychosomatic angle. My mesh removal surgeon found that the mesh was surrounded by edematous tissue. I don’t think that my brain produced it. I felt great before surgery and expected a good outcome.

https://medicalxpress.com/news/2020-02-team-hernia-surgery-recovery-outcomes.html

“The predictive model suggests that the emotional status of the patient prior to surgery—levels of depression, anxiety, grief, or anger—influence recovery outcomes. Patients may experience less pain if their fears or emotional issues are addressed before surgery.

“If we begin prehabilitation, which includes a holistic assessment—not limited to physical and emotional condition—of the person prior to the intervention, then we may be able to affect outcomes,” Koszalinski said.”

[Good intentions]

And there is this. I have not watched it but it is probably informative. It’s the Herniatalk Q and A with Dr. Ramshaw from May 3rd.

https://www.youtube.com/watch?v=cvmLowkvg3Y&feature=youtu.be

[Good intentions]

Here are a couple more articles with his comments.

https://www.generalsurgerynews.com/In-the-News/Article/01-19/Surgeons-Call-for-Closer-Surveillance-of-Mesh-After-Implantation/53739?sub=6CB4505D3F4E7434F342E8CEDDD36EA48483E49B459AF20B8C3C8A9101426

“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”

Register for this newsletter and you can read this one –

https://www.generalsurgerynews.com/Opinions-and-Letters/Article/03-20/Value-Over-Volume/57512

[Good intentions]

Dr. Ramshaw is a proponent of mesh repairs. In some ways, he is a denier of the premise that mesh itself causes pain or discomfort. He has stated explicitly that “mash does not cause pain”. His arguments on that topic are kind of convoluted and weak. He has his patients take a psychological exam before surgery, I believe, to see if they will be able to deal with the foreign body feeling.

He’s an interesting person in the field, very popular and active. But he is firmly in the mesh repair camp, I think.

Here is a video from a couple of years ago.

https://herniatalk.com/forums/topic/mesh-must-avoid-or-must-have-2018-sages-meeting/

• This reply was modified 3 years, 9 months ago by  Good intentions.

Mesh: Must Avoid or Must Have? 2018 SAGES Meeting

[Mark]

Good intentions,

Amazing response and info…very thankful! I had no idea, I watched the interview on herniatalk and he is all about research rather doesn’t really talk about actual hernia surgery like the other guests. it was disappointing to say the least. If that is the case…I will rule him right out as I’m only considering pure tissue repair as this is a first time surgery for me. Thanks again!