pinto
Forum Replies Created
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Whoa, whoa 😀 😀 I just saw your closing comment, Chuck:
“Second I simply dont believe only pain for a week…I have never heard anyone who had a tissue repair say all their pain was gone in one week,,,that is simply not feasible…I wish folks would endeavor to be more honest here.”Excuse me I have to laugh 😀 😀 . What I said is true I had and have no pain. Of course there can be some unusual sensation but it’s not pain. And most often both sides of my pelvis feel equivalent in feeling or condition.
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Chuck, here again when doing critique we need to be accurate—-make sure you know what you are talking about. You claim I’m not being “entirely honest.” Your assertion is false and attributable probably to not reading all I wrote or possibly misinterpreting something.
Yes I had some friction with the “hospital” but was resolved in my favor. The friction did not change my “great hospital experience,” as it referred to my time inside the hospital. If you had read all my posts, you would know the friction was due to the frailty of human communication. Such happens. The wonderful thing is that such can be solved.
True, and I still live by my words, I experienced much frustration, justifiably so. However to the credit of both Stephen and Dr. Kang we eventually could see how email is not the best means of communication. Again, I repeat: no doctor in the world is perfect. Dr. Kang gave me a sincere apology to my face. Would your California doc or your Maryland doc do that? 😀 Responsibility is the true mark of a man. I repeat something else: more than any statistics or anything else is trust. I trust Kang.
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Chuck, get ready coz I’m gonna screw up your statistics. You apparently overlook a very important difference between Kang and the other docs, which in effect skews the data—patient intake. Kang virtually takes any patient in need but not the other docs, surely not Shouldice. If true, Kang’s open policy disadvantages him against the other docs. If he were like them, he might even have a lower recurrence rate than it is.
Why did I go back to Kang? First I had a great hospital experience and very importantly I wasn’t maimed. If the doc is expert, then it makes sense to go back because the doc would be familiar with my condition and anatomy. Finally, he convinced me that despite the previous problem he was sure he could successfully repair it while showing me his data, as well as that for similar cases. Both times I have not had any pain beyond the first week. Probably thousands of patients wish they could swap their experience with mine.
Good luck with your planning. I know it’s not easy. I’ll be rooting for ya. -
Opinions will differ all long the way about each “advancement” but only time will tell how much they truly were. Although some advancements are more significant than others, medical practice has advanced steadily over time. In hindsight some may have proved false but the totality of medical practice over the past century has surely improved the lives of many lucky enough to access it. In thirty years time surely surgical practice changes in some ways, presumably for beneficial reasons. Someone here reported that Bendavid changed from steel to polyester sutures. You might not agree with him, but he and others of the same mind very likely saw the change as an advancement. Ultimately only time will tell truly, but change occurred nonetheless.
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“I’ve also never brought up my experiences there (30yrs and ~20yrs ago) to ‘equate’ them with recent surgeries, but rather to speak to my experiences at the time, my outcomes (flawless in all respects, to the present day), and what someone might generally expect after a Shouldice repair in terms of a ‘standard’ recovery, to ease their concerns over the unknown.” (MarkT)
In our discussion I granted you that while pointing out that you unwittingly were equating “old” Shouldice with the “new” Kang—that I believe were your two surgeries, the former decades ago and the relatively recent one. Apparently you didn’t realize that your thread came off as comparing Kang with Shouldice—a new with the old.
I well recognized that you wanted to help people with your experiences—-again, I granted that. What you don’t recognize are nuances that are emitted—intentionally or not—in one’s communications. How you couched your thread and presented it appeared to have other purposes. Even if you didn’t intend it, readers could glean it so.
Another point you make rather naively: “keep in mind that “decades of medical advancements” would not seem to apply much to Shouldice Hospital, if you understand their model.”
Right there you conceded Shouldice decades later is not absolutely the same as before (by saying “apply much”). Subtle enhancements can make a great deal of difference for surgery outcomes. Surely there were major personnel changes in the hospital decades hence. What you don’t recognize is the difference between model and application.
Models are one thing; applications, another. That’s just about technique. Then there are materials! At least some Shouldice surgeons changed from steel thread suturing to polyester! You kindly credited me, in that earlier thread, for helping you recognize that the occasional twinge you feel is likely from the steel suturing. On principle alone there is no way you can discount decades of medical advancements. So incredibly shortsighted your argument. Thus it was necessary, as is now, to caution your apples-to-oranges writing—if not your thinking.
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I’m sorry for you too @Jtk2. It’s one of the most awful stories I’ve heard how the surgeon brushed you aside not once but at least twice. Just awful. Surely the work of surgeon is demanding and we patients as well, but there’s no excuse for his behavior. If any doc who would happen to read this and I’m wrong, I’d be happy hearing about it.
I just got an insight—-by this example of Jtk2’s, Yunis needs to cut down the daily high volume of surgeries of his by dint of his apparent lack of patience for his patients. Maybe he’s doing too much, thereby lessening his attention given to patients. But not all ….
Another insight: Kang’s high volume and high attention to patients (in my experience) might be only possible by having mostly East Asian clientele, people maybe less demanding than Westerners. Expectations of doctors differ culturally. For example, Western doctors must answer more questions than their Asian counterparts. Overall the job for Asian surgeons might be less stressful.
So I see now this posting extends my previous post about “lining up your ducks” properly. Asian surgeons may be better positioned to do high volume loads than Western surgeons. You can’t say “all things being equal.” Avoiding apple-orange comparisons is vital. Was it Mike T who unwittingly equated Shouldice 50 yrs. ago with a recent operation, obviously benefitting by decades of medical advancements. As you can’t equate different times as the same neither can you about place: unappreciated cultural differences (or advantages) between surgery in different countries can greatly matter. Jtk2, I hope that somehow you mend well and possibly get better regard from Yunis, and well wishes also to Watchful that your recovery speeds up. -
@Chuck says “The Kang repair is … more likely to recur with time….”
Of course your statement is an opinion, a supposition. Do you any empirical study to support it?
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Nothing wrong with being Swedish if anyone would need reminding. Focus on this Swedish study inevitably puts a spotlight on a nation’s health care system. Although Sweden’s known as world class, one world ranking has it at number 23 (World Population Review 2023). That same index puts South Korea at no. 1. If so, it explains South Korea’s attracting a great deal of medical tourism, something apparent by the large “medical corner” at Seoul’s main international airport Incheon, and understandably the popularity of Dr. Kang for hernia repair. But I digress. This foray about Swedish health care system, while noting the unexpected less-than-stellar ranking, Sweden by the turn of this century had a national reduction of hospital beds of 50% across all medical sectors (Hamberger, 1998), the likely source for the hospital overcrowding in Sweden noted by The Local Europe AB (2018). Tibor (2018) calls the Swedish system in chaos due to funding and doctor availability.
Although Swedish citizens by law have a right for primary care, I wonder for elective surgery such as hernia, how much citizens really get to choose their own surgeons and even the surgical method. Implications for patients surely arise in the case of chronic pain. It reminds us we can’t take national research reports in isolation but rather ought to to place them in their proper circumstances. How much of the chronic pain rate grows out of a cultural milieu. For example some cultures can be distinguished by their members’ tolerance for pain; some others, less so. What about the stresses imposed by systems in “chaos”? Things to ponder about …
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Just saw @Alephy‘s post there, much appreciated advice, thanks.
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@SN, you ask a great question and Good intentions gives I think the best answer so far. GI, thanks for that.
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@Mark T, are you Swedish btw, is that why you’re arguing: “This study is therefore quite relevant to hernia patients in Sweden” (as you stated in a related thread).
The issue has nothing to do about relevancy within or for Sweden. Frankly I couldn’t care less. My point has been the researchers generally were vague by not providing information more fully and fail to pursue an important avenue: the relation between surgeon experience and outcome. They plainly state that nearly half of the 22,000 cases had surgery performed by a surgeon with a load less than 26 a year. That should raise a red flag. Apparently the researchers assume surgeon load is a minor factor as they provide no other information for the upper range of surgeon load. That raises an alarm because the database has all that info.
They describe pure tissue repair cases as outside of the framework of this study apparently because as they say “there were very few recorded in the register.” “Very few” of course is vague. Why not state the number? It actually could be nearly 2,000 cases based on their account how the cases came to total 22,000. Whether 500, 1,000, 1,500 tissue repair cases, outcome data at least would be of some use comparatively speaking; not definitively of course but possibly suggestive. Being vague about this invites thinking the researchers are biased against tissue repair. One bias can lead to others. Being cavalier with some aspects or details can suggest a lack of uniform consistency in method.
The upshot is that the elephant in the room is ignored by not considering the effects of surgeon experience. Well and good they only want to present the amount of chronic pains complaints by patients. However no reflection is made as to the type of hospitals or medical services involved or surgeon experience possibly involved. Given surgeon loads of less than 26 so widespread, I must think that most of the surgeries were at general hospitals—-not at independent hernia specialists. I grant that some general hospitals may have some amazing surgical wizards, my own direct experience with such hospitals, however, tells me not in the main. Even specialist hernia surgeons are doing other surgeries preventing them doing hernias exclusively.
Mark T, I hope this post satisfies your curiosity, for the trail is getting stale. From your concern that the study has value in Sweden or misreading/misquoting my “narrow” descriptor or falsely claiming I have disparaged the Swedish databank (Not. My concern is how used, presented), I believe it is plainly seen that the 15% chronic pain rate or whatever is compromised for the reasons stated. Thank you for your interest.
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Watchful, I love that expression, black art. Bravo. Interestingly the black arts ignored by the study could actually number 1,000 even more per the article. Rather than practical reasons, I bet the black arts were excluded for political reasons (in mesh). (Of course I estimated the figure because the authors did not disclose the exact number of tissue repair cases found; rather we must surmise them.)
Herniated, that’s useful information about Shouldice. We’ve also I believe heard Dr. T. say similarly for robotic surgeries. You need a highly, highly experienced surgeon. I shudder when I think how I might have gone blindfolded in allowing my local general hospital surgeon do one on me, someone I’m certain was a recently minted doctor. -
You misread what I wrote despite multiple mentions. I was not referring to the database per se.
As far as your 98% figure, apparently you do not know but it is an estimate made nearly 25 years ago (coming from a 1998 publication!). Such shows how the researchers you are defending have under-reported information, which entails yourself as well.
Let me point out also the database, though national, is purely voluntary and privately run (though having some national support). Its member medical units number approximately 90, which is only about 10% of the medical clinics nationally in Sweden. Thus we must caution the notion that nearly every hernia repair has been recorded. More importantly, we need to know whatever the percentage given what it actually covers.
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The study might be of much interest to people of Sweden, fine. But I presume HT Members are from all corners of Earth and the majority of which interested in high-surgeon load hernia specialists. You can quibble about the numbers all you want but it is very likely that a vast majority of surgeries done were by low-volume load surgeons, loads distinctly less than those of the specialist surgeons discussed at HT as choices for a surgeon. Given that the hernia specialist is relatively new as a field, there is likely a dearth of data based on high-load specialty surgeons. Again if Varn’s (2020) point valid, then a re-thinking of complication rates in hernia surgery is warranted.
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@Mark T, again if you don’t like the term bias as applied then the study is narrow for based on presumably general hospitals.
@Good intentions, you will need to elaborate because I don’t see any relation to my choice of Dr. Kang as surgeon nor to “the very common mesh repair methods.” Thank for such interest in my many posts here at HT but apparently you overlooked my reviews for Dr. Kang, which include my rationale. Thank you again for your kind interest.
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Mark T, I beg to differ with you variously: First contrary what you think—-we do know the distribution. The fact that the median surgeon load is 25 means that the range is zero to 50! From the perspective of HT all of the cases involved low-volume surgeons!
From that standpoint the study is quite biased in the sense the data is skewed by presumably based solely on general hospitals. (Because the surgeon load was so low, we can assume these cases came from general hospitals; thus the data skewed. Typically hernia surgeons at general hospitals even if “specialized” must also perform a variety of abdominal surgeries.) If you disprefer “biased” then the study is narrow by only including general hospitals ergo low-volume surgeons.
Relevancy? It all depends on purpose. This thread concerns rates of chronic pain and recurrence. Thus the study having excluded highly experienced surgeons (presumably), it hardly can be relevant for patients truely seeking hernia specialists, surely the purpose of most HT members. Usefulness? I will not say the study is absolutely not useful. Surely it is useful in showing research weaknesses or mistakes. It might even be used for baseline data.
I believe you picked up the fact that the study appears not to have considered (or did it?!) effects of surgeon load on surgery outcomes. It surely could have been done, so quite concerning that these researchers did not reveal that information.
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Would you wish to have hernia surgery by a surgeon who only does 50 surgeries or less a year?
Think about that.
What if your surgeon only did 25?!
You probably would say, “thank you, but no thank you.”
Well not for these 22,000 patients!! They apparently were ok with having a surgeon with such limited experience—-50 or less done a year. As I posted elsewhere, this study is biased in that it concerns a population of surgeries done at general hospitals. We (I presume) at HT consider a specialist, an expert surgeon necessary, one who has much if not great experience. I don’t think doing two or less surgeries a month cuts it!! (That is, for the nearly half of the 22,000 concerned)
In short, we must conclude this “research” study is irrelevant. -
@Alephy, very interesting finding about DHs. Mightily important. If you come across the source again please share.
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Watchnwaitin, thanks. Good to hear.
William, why do you think “the hole must have closed”? He just as likely been blessed by a stable hernia that hasn’t grown too large. I’m just interested in hearing verifiable evidence that herniae can heal naturally, something widely said doesn’t happen.
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GOT YOUR DUCKS IN A ROW?
You guys when talking about surgeon daily load might miss an essential element of comparison: Equivalence. Those load numbers come not from a vacuum but a sure context. But you likely assume that these surgeons all have equivalent surgery teams and process that might be untrue. Efficiency of scales might make a big difference for some surgeons. For example what practice does each surgeon follow to prevent surgical gauze mistakenly sewn up in the patient’s gut? Could certain surgeons have better practice than others allowing them to handle more patients? I’m not suggesting the issue is unimportant; only that the numbers are like icebergs, their unseen is as important as the seen. Maybe more so.