The OR Brain
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Diagnosed with severe dyslexia 20 years ago, Donald M. Kastenbaum, MD, learned early on about the importance of organization, preparation and checklists. Today, as medical director of Perioperative Services at New York’s Beth Israel Medical Center, he uses his knack for streamlined process design to transform the operating room.
On his early challenges. When I was in 7th grade, I wanted to be an orthopedic surgeon. Back then people weren’t so talkative about dyslexia. Finally, when I was in medical school, I went to the dean and said, “I’m really smart, but I can’t keep up with reading.” He looked at me and said I was doing so well. I went out, and I was tested. Typically you think of a person in medical school, law school or professional school as someone who’s a great test taker. But I just figured out ways to get through as best I could, and I always did.
On his attention to detail. I always try to make sure everything is in its proper place. My wife would probably say that I’m a little … OCD [obsessive-compulsive disorder]. It’s made me a terrific surgeon because as you are in an operating room, everything is about precision. I can tell you a mnemonic for every part of hip and knee surgery that I do. I try to take every process and break it down to its simplest component so it’s not only repetitive to me, but so I can teach other people to do it. I always thought the thing that made you really smart was being able to teach someone else how to do what you can do.
On checklists in healthcare. If you take the aviation industry, they did what medicine should have done years ago. They standardized checklists and they made sure it wasn’t only the captain who was in charge of the ship. Typically, medicine is still run in many ORs and hospitals as mom-and-pop shops.
On the importance of preparation. Mistakes are always going to happen. There’s always a human part to this, but you have to make sure that you’re always prepared. I work by the adage, ‘proper preparation prevents poor performance.’ When a patient enters a room, everything should be ready. All tests, X-rays, equipment and knowledge should be discussed by the entire team before the procedure begins. Everything should be sterile at the beginning. If something’s not ready, which can happen sometimes, don’t bring the patient in the room. In this day of cost containment, make sure that the nurses know what the surgeons need. If they’re doing the same operation 200 times a year, they’re probably going to need the same number of sutures. If you need five, don’t open 10. It may sound silly, but if you’re opening 10 every case when you only need five, you’re wasting a lot of money.
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