tag:blogger.com,1999:blog-110794142011-11-30T21:44:51.798ZClinical Associate, Pediatric Cardiac SurgeryLuis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.comBlogger341100tag:blogger.com,1999:blog-11079414.post-25274594783911606252008-11-26T06:39:00.001Z2008-11-26T06:39:31.601Z

I have always thought, and accepted, that waiting for healthcare services was an acceptable compromise for the public healthcare system in Canada, who tries to provide comprehensive services to all its citizens. This contrasts to the US system, which is able to provide nearly immediate service, but only to well-insured members of its society. I have not found the latter to be a “just”

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com7tag:blogger.com,1999:blog-11079414.post-88002094397430184362008-11-23T03:37:00.000Z2008-11-23T03:38:54.297Z

Recently, a colleague showed me a draft of an annual report of a cardiac surgical program. (The final product is unlikely to be substantially different than this draft.) It outlined the academic activities of the division. It looked quite impressive. However, on closer inspection, many of the publications, abstracts, and submitted publications were of work that was done at other institutions

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-12869646650633033132008-05-31T04:51:00.000Z2008-05-31T04:53:32.267Z

In my brief career in Thoracic Surgery, I have attended a few major meetings in North America. I have found the experience interesting often, rewarding occasionally, and disappointing sometimes. The purists would say that the original and true purpose of a scientific meeting is to communicate new data of ongoing or completed research. The objective here is to disseminate new information, as it

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-19026381931915698942008-02-16T03:53:00.003Z2008-02-17T01:27:10.781Z

What is the ideal number of cases a cardiac surgeon should do in one year to maintain competency? Estimates range from 100 to 200 cases. It may be argued that doing more cases will translate into better outcomes. However, I will question this assumption and state that there is a threshold above which improved outcomes and safety are compromised. I do not know what this threshold is, but I

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-91078013042681925232007-11-04T18:57:00.000Z2007-11-05T02:11:22.791Z

My last two weblog entries have created quite a hubbub. I will begin by saying that the opinions expressed in my weblog are my own and do not reflect the views of any institution with whom I am or have been associated. However, they are coincident with the views of some and are not exclusively my own. In addition, my writings reflect on my professional experiences over more that a decade. I

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-14949124285505232007-08-06T04:04:00.000Z2007-08-21T23:32:20.200Z

I believe that a well and appropriately trained cardiac surgeon is capable of delivering quality care in the adult CV ICU and that he should be primarily responsible for the management of these patients. The cardiac surgeon should not abdicate the care of his patients to the intensivist. The presence of an intensivist may be helpful in the CV ICU, but is not essential. It is erroneous to believe

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-84777898808239253002007-07-17T04:43:00.000Z2007-07-17T05:32:14.138Z

I am back in Canada. As I get accustomed to the system again, I see how much I have changed and how different things are to me now, after having been to the Mayo and Cleveland Clinics. Things that seemed normal during my residency bother and shock me now:The lack of professionalism (dress, informality/familiarity, impoliteness, disrespect); nurses calling in "sick"; intensivist that think

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-86227896458215686972007-04-23T20:00:00.000Z2007-04-24T02:18:26.175Z

Boris Yeltsin died today. You may wonder, what does that have to do with Cardiac Surgery? He was 76 years old. That is 10 years older than my father and 14 years older than my mother. Again you may wonder, what does that have to do with Cardiac Surgery? Our family lived through political persecution and threats of death. We have been political refugees and immigrants. And we have embraced

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-68911975383748494762007-04-01T17:53:00.000Z2007-04-01T18:20:23.075Z

I recently passed my Canadian Royal College of Surgeons Fellowship Examination in General Thoracic Surgery. I finished my training in the field in 2002 and after an interlude in Cardiac Surgery, I went ahead and sat the exams. That I passed is not remarkable or worth writing about. What is notable is that I studied, mostly, from the internet, as a matter of convenience and somewhat of a

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-15830649054971508462007-03-04T23:10:00.000Z2007-03-05T01:18:09.113Z

As a cardiac transplantation and ventricular assist device fellow I should be excited at the prospect of a new case of either type of surgery. For the moment, I can accept that transplantation is a good option for end-stage heart failure. However, I find myself questioning the wisdom of VADs as they exist today and in the foreseeable future.I would point out that if the supply of donor organs

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-33964785600718813622007-01-14T15:26:00.000Z2007-01-14T17:18:52.141Z

I have now moved to another major medical centre east of the Mississippi to do a clinical fellowship in transplantation and ventricular assist devices. Training 2.5 years at the Mayo Clinic was the BEST professional move I have made thus far (but I will address my experiences at Mayo in another entry). What I would like to write about now is the reaction I, and some others, get when mentioning

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com2tag:blogger.com,1999:blog-11079414.post-1167583460670528982006-12-31T16:31:00.000Z2007-01-14T16:17:44.376Z

To Calvin,There are no words that can express my gratitude to you, Calvin, for making my time at Mayo bearable and even enjoyable. In the path of life one develops friendships that transcend distance. As I am off to the "Other" Clinic, I hope ours is one such. I also hope we have the opportunity to work together, for I respect you as a human being and a surgeon. For these two reasons, and

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1162786794742148832006-11-06T04:18:00.000Z2006-11-06T04:24:20.980Z

A surgeon and research fellow discuss authorship of a manuscript, hypothetically speaking. It goes something like this: “Who should we put on the paper?”“What about Dr. ‘so and so’?”“No. They are already a full professor. Let’s add Dr. X. He is only an assistant professor.”The research fellow knows that Dr. X has not contributed to the paper but he is in no position to object.I do not know

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1157508031430299722006-09-06T01:03:00.000Z2006-09-06T02:23:15.486Z

I have delayed writing this post for a long time. I was waiting to get over the frustration about not being able to find a job in Canada, despite my qualifications. I am not over the frustration entirely, but I am trying to move on. The anger and the bitterness have been there for a long time. I am trying to change my sense of powerlessness into something positive, or at least into something

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1154904591689673652006-08-06T22:05:00.000Z2006-08-27T03:25:45.396Z

I have sent my CV and lettres of intent looking for a consultant's position in Cardiac surgery in Canada. After one e-mail follow-up I have received negative responses for 2/3 of all canadian centres that do cardiac surgery. The rest remain curiously silent. I want a job at any centre, community or academic. All I want to do is have the opportunity to practice independently. I am more that

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1154399554612151242006-08-01T02:22:00.000Z2006-08-27T03:27:17.013Z

What follows are the un-edited thoughts of a resident in cardiac surgery from a Canadian institution. The "rant" shows the frustration about the uncertain future of cardiac surgery and the difficulties faced by those trying to get a job today."While I applaud the recent focus of cardiovascular surgeons on the oversupply of cardiothoracic surgeons, I feel the need to express my viewpoint. After

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1147823515762355352006-05-16T23:30:00.000Z2006-05-21T22:22:22.996Z

During my two years as a fellow in Cardiovascular Surgery at the Mayo Clinic I have learned inumerable operative skills, advanced clinical decision-making, and advanced clinical judgement. However, this is only half the story. I have also learned about professionalism and have witnessed a culture of service towards patients that is not rivaled by anything else I have experienced before in a

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1139009922362400922006-02-03T23:37:00.000Z2006-02-04T15:10:55.246Z

Dear Dad,I have been very tired lately. I have been working long and stressful hours. However, I am trying very hard to spend time listening to my patients: On rounds each day, I shake their hand and sit at a chair or on the bed, as is feasible. These actions prevent me from rushing. I am trying to be a better doctor.When I was a medical student doing a rotation in Obstetrics, the hours were long

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com2tag:blogger.com,1999:blog-11079414.post-1116521758135828942005-10-25T03:55:00.000Z2005-10-25T14:45:06.183Z

Formulating a question is arguably the most important step in process of research. Unfortunately, it is the aspect in which the resident/fellow is least likely to be involved. The reasons may include: He is not familiar with the field to a degree that would allow intelligent or relevant questions to be formulated; he, of necessity, is in a corrupt relationship where the research interests of

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com3tag:blogger.com,1999:blog-11079414.post-1124685261792293432005-08-23T00:20:00.000Z2007-03-06T05:09:25.557Z

Doing a fellowship at a world renowned centre has made me aware of the desire of some patients to know institutional and individual results. Some have 'shopped' around and have done extensive research (usually on the internet) on the experience of an individual surgeon, or that of an institution, for a particular procedure. This is not new. Volume-based outcomes have interested insurers (public

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1118607878380144352005-06-17T21:30:00.000Z2005-06-17T21:26:55.126Z

If a trainee is fortunate enough to find a consultant's position, usually they will be ill-equipped to deal with the difficulties and hazards of starting a practice. Very little is taught in this regard during training. If you are fortunate enough to work in a group, salaried practice, most details may looked after for you. The reality is that most will go into some sort of "private",

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com2tag:blogger.com,1999:blog-11079414.post-1118085148677413002005-06-12T19:36:00.000Z2005-06-12T19:29:36.306Z

Here are some "do's and dont's" when a patient is seen in an outpatient setting. In-patient encounters should ideally follow the same principles, although the circumstances may dictate the conduct of the interview and the examination.Do'sDo arrive on time for your appointment.Do dress professionally (see previous weblog for details).Do review all the relevant notes and investigations PRIOR to

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1111438758716733702005-05-19T16:55:00.000Z2005-05-19T16:54:13.466Z

Residents in cardiothoracic surgery are highly encouraged, persuaded, pressured, or even mandated to do some form of research during their training. From my inexpert and inexperienced perspective, "doing research" means: formulating a question; critically appraising the relevant literature; designing the best protocol to answer this question; executing the protocol; analyzing and interpreting the

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com3tag:blogger.com,1999:blog-11079414.post-1112640415629536752005-04-04T18:02:00.000Z2005-04-05T23:52:41.230Z

It is difficult to argue that being late to anything in any way is good, except perhaps to your own funeral. However, I have been a part of discussions about tardiness that have mentioned the potential benefits, mostly related to the cache that comes form others having to wait for you: For example, rounding on patients cannot start without you; surgery cannot proceed without you; the meeting

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com7tag:blogger.com,1999:blog-11079414.post-1111682667950696312005-03-25T20:40:00.000Z2005-03-25T20:37:44.933Z

What follows are my views on the organization and conduct of morbidity and mortality rounds.The principal reason to conduct M&M rounds is: To review an individual patient's poor outcome in detail with all members of the treating team and in this way try to determine what led to the poor outcome and discuss ways to prevent a similar event from happening again.In cardiothoracic surgery, the

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1111209716655651722005-03-19T03:24:00.000Z2005-03-21T02:05:31.266Z

I have watched with despair the little-to-no help some cardiothoracic surgical trainees are given when they approach the end of their training and it is time to look for help and guidance to obtain a fellowship and/or employment. Similarly, I have seen the way junior consultants are treated appallingly poorly by more senior consultants and institutions when starting out in practise. It reflects

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1110924922394737312005-03-17T10:23:00.000Z2005-03-17T21:14:31.803Z

As part of an ongoing discussion on professional behaviours, I would like to submit my views on what I consider professionalism when asking for, receiving and doing consultations. Not all consultations are the same. They may be formal or informal; urgent or routine; hospital or outpatient. I would like to address the various circumstances in which consultations may occur in cardiothoracic

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1110496889449673602005-03-15T19:20:00.000Z2005-03-15T19:24:53.023Z

Whenever I tell someone that I am doing a fellowship in cardiac surgery at the Mayo Clinic the first thing they ask is what is my area of subspecialization. It is difficult to answer this because at Mayo there is no such fellowship. The training is in advanced adult cardiac surgery, which means that you participate in all aspects of cardiac surgery. This includes, for example, valve repair,

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1110291272109632762005-03-11T15:25:00.000Z2005-03-15T01:54:20.040Z

"The best interest of the patient is the only interest to be considered.""The needs of the patient come first."Dr. William MayoOne of the things that I admire most about the Mayo Clinic is it's commitment to the interests and needs of the patient. The spirit of the aphorisms of Dr. Will is one of the founding principles of the Clinic and it is reflected in their mission statement. And it is not

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1110136258004293942005-03-10T05:10:00.000Z2005-03-09T17:10:22.706Z

This entry will be one of many addressing issues of professionalism in the practice of cardiothoracic surgery. It is difficult for me to define professionalism, however, I am able to recognize it. Therefore, I will attempt to describe behaviours that I believe reflect it. Choosing a particular appearance in the way we dress is one of these behaviours.I have come to believe that the manner in

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1109634013193866042005-03-06T04:15:00.000Z2005-03-15T01:08:20.506Z

Salary vs. fee-for-service. There can be much debate as to why one vs. the other. I have seen the debate get quite passionate, usually by those suspiscious of institutions and those that believe in free enterprise.Prior to completing my residency in Cardiac Surgery, I took some time off and was in private practice in General Thoracic Surgery (St. Joseph's Hospital, Hamilton, Ontario, Canada) for

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1109698652821425362005-03-01T17:12:00.000Z2005-03-05T04:03:59.716Z

The bonds of friendship during surgical training may be compared to those forged during military training or perhaps even armed conflict. My time at Mayo has had it's challenges. There have been high and low points. But I have had the priviledge of sharing this experience with two other fellows. As a trio, we have been frustrated and elated; we have been close to tears and murderous rages; we

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com0tag:blogger.com,1999:blog-11079414.post-1109388022390973932005-02-26T03:02:00.000Z2005-02-28T23:42:57.860Z

The original text for this idea was written in September 2003. It began a few years back and evolved during my residencies in general thoracic and cardiac surgery. Seeing the inefficiencies in thoracics, and the effective system of treating high volumes of patients in cardiac, allowed me to come up with a model of care for patients with lung cancer. I also drew upon my impressions of the Mayo

Luis G. Quiñonez, M.D.http://www.blogger.com/profile/05156746712131132891noreply@blogger.com1tag:blogger.com,1999:blog-11079414.post-1109356537338162142005-02-25T17:49:00.000Z2005-02-25T19:40:05.506Z

The main objective of my weblog is to share ideas on a variety of subjects related to cardio-thoracic surgery. I have developed a vision about the practice of CT surgery, which is unlikely original or unique, but it is highly personal. I feel this is one way to informally disseminate my ideas and open avenues of discussion.An idea is an organic beast: It changes and evolves. The simple passage of

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