The Ledger
Every statement that passed quotation and attribution checks. Mix any filter with any other: certainty 1/5, debate potential 5/5, or both at once.
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Vorster: Neurosurgery must blend "eminence-based" historical experience with emerging data
“I like calling that eminence-based medicine rather than evidence-based. So eminence-based in my mind means if somebody with a lot of experience and skill did something, we can learn from that. We would be foolish to ignore that. On the other hand, we have to m…”
Vorster: Surgeons should leave residual tumor rather than risk patient harm
“Rather than harm this person, maybe we should pull back a little bit. Let's leave the last little bit of the tumor. We always say most accidents happen near home, you know, so don't go after that last little Just stop before things really get bad. And that's h…”
Vorster: Medicine has a firmer scientific foundation than finance and economics
“There was also perhaps a more accessible scientific base to medicine, whereas finance and economics are often based on theory and on retrospective type of analyses and long run averages and things like that.”
Vorster: Mandatory age cutoffs should not force surgeons to stop operating
“I wouldn't propose that surgeons should stop operating at 60 or 70 or 80 or something. You know, I have some colleagues that are amazing people near their eighties that are still doing smaller surgeries”
Vorster: Surgeons Must Guide Patients Through Decision-Making With Empathy
“You can't expect them to make the decision. So you have to guide them along with kindness and empathy to the point where everybody's on the same page.”
Vorster: Brain surgery cannot use double-blind placebo trials to develop algorithms
“However, data isn't always available, especially in brain surgery, because you can't do double-blinded tests, for example, where somebody gets a placebo and some don't, and so then you can develop Kind of an algorithm or a plan for your blood pressure medicati…”
Dr. Vorster: Studies Show Music in Operating Rooms Makes Surgeons More Effective
“So we play music, and it's actually been studied that makes surgeons more effective, and so it's not distracting, it's soothing.”
Vorster: Seasoned professionals cannot avoid or unlearn the adrenaline rush
“First of all, our emotions and our adrenaline rush and our adrenal glands and all of these things, the stress response, the fight and flight response, you can't avoid these things. So no matter who you are and how expert you are at what you do, you will feel i…”
Vorster talks to anesthetized patients during surgery to maintain focus
“Sometimes when I operate on people, I talk to them, even though they're asleep. So I'll say, come on, Ted, help me out here. Stop bleeding, or something. So it's just a, maybe a silly way, but to remind me that the patient that's there under all these drapes i…”
Vorster: The critical core of a four-hour neurosurgery takes thirty minutes
“Most of the surgery, if you say four hours, there's maybe a half an hour in the middle where the really the important things happen. So there's a lot of opening, and positioning, and all that, and at the end, there's a lot of closing again”
Vorster: Professional success metrics must align with patient expectations
“Because we do the surgery successful, but the point is to marry the success that you're measuring as a professional to the patient's expectation.”
Vorster: Two colleagues committed suicide following adverse complications in elective surgery
“I've had two colleagues who've committed suicide over bad outcomes on elective surgery where somebody Goes in and has some type of complication. Unavoidable, there's no real malpractice involved, but things happen.”
Vorster takes a five-second "mandatory walk around" to reset during surgery
“So I sometimes tell people, Okay, mandatory walk around. That's what I say, and then I step away from the microscope, and I walk around the room for what feels like an eternity, but it's maybe five seconds or something, you know, and then I just walk back.”
Vorster reviews brain scans and equipment with patients before elective surgery
“My approach once again is to get everybody on the same page and, you know, review the scans. I like showing people, nobody's really seen a brain scan. So I show them on the scan. I point out the abnormality and I point out, you know, how we would get there and…”
Vorster: Preserving Quality of Life Must Precede Deploying Surgical Technology
“So for us, I think protection of function and maintaining quality of life is really the first thing. Before we unleash all the wonderful technology and machines and medications that we have on a person, we really want to just come back to basics and say, well,…”
Vorster turns off operating room music during critical surgical phases
“When there's a serious part of the case, usually, for example, when we bring the microscope in, I would say, well, turn the music off. You know, let's just get everything ready now.”
Dr. Vorster: Introductions during surgical timeouts drive team ownership
“So I think the ownership of actually knowing who the patient is and introducing in the beginning, some of the timeouts we introduce This is Sally, she's the scrub dick, and this is John, the rep from some company, and this is Doctor, whatever, from China, who'…”