Shortly before I went to medical school I came across a forgotten Chinese spiritual classic that provided numerous metaphors for meditation. A few months later, a passage from it about a dextrous butcher popped into my mind as I began working with cadavers in the anatomy lab and it dawned on me that its metaphors for entering the deepest aspects of our being also applied to the art of surgery.

Since then, I’ve come to appreciate how well it ties into not only surgery, but also the art of giving therapeutic injections and arguably the entire art of medicine. The verse (I’ve nicknamed The Dextrous Surgeon) goes as follows:

Note: Books (and hence much more than I can encapsulate within article) could be written about exactly what’s being described in that passage (e.g., living life through the spirit). I do however wish to mention that many of the most talented physicians I have come across agree this passage describes the evolution of their practice of medicine and likewise, that I’ve found it aptly summarizes exactly what happens when you connect with a needle and navigate exactly where to place it within the body (e.g., for prolotherapy).

The Art of Surgery

During my medical training, I spent a few weeks assisting a group of OBGYNs who did a lot of C-section surgeries and was able to observe the myriad of differences in their techniques. One surgeon, an older asian man caught my eye because of how graceful his hands were and how much smaller the injuries from his incisions were.

At one point, I talked with him in the break room and he shared with me that he was a lifelong Tai Chi practitioner and that this practice had caused him to become much more connected with his scalpel. In turn he said that anytime he cut someone, he always made a point to feel connected to each layer of tissue he was cutting and conversely lamented that he had seen numerous cases of a babies being cut (e.g., on the face) by a typical OBGYN who did not make the point to be continually connected with their scalpel throughout each C-section.

Note: facial lacerations are estimated to occur in between 0.7-3% of C-sections and are understandably more common in emergency ones (as you have to get the baby out quickly to save its life). 

That conversation really stuck with me and had a huge influence on my medical career.

Electrocautery

Two common methods exist to cut through tissue. One is to use a sharp blade (the scalpel) to directly cut tissue and the other is to use a blunt metal blade which (through electricity) is heated to a high temperature and then, due to its heat, causes the tissue it contacts to bubble and break apart.

Electocautery is often preferred because it cauterizes tissues and thereby solves one of the most common problem in surgery (blood loss). Because of this, a surgeon can be much less mindful or connected when they create an incision, proceed through the surgery at a much faster rate and not have to be anywhere near as worried about the blood loss which would result from a poor surgical technique.

Note: the amount of blood loss which occurs during surgeries varies depending on the skill (and finesse) of a surgeon— surgeons who have ‘good hands’ are both faster and lose less blood (e.g., they have half the blood loss and take a third of the time for a surgery), as surgeons who go slower are typically compensating for their less astute anatomical awareness. These are not absolutes however (e.g., a fast clumsy surgeon is a disaster, and certain surgeries like liver resections have to be done slowly to reduce blood loss).

I previous explored this because the mRNA vaccines have made many become concerned about receiving transfusions of vaccinated blood, and I believe you can significantly reduce your need for blood during a surgery if you pick the right surgeon to work with. Unfortunately the surgeon gets the final say on what the estimated blood was and is understandably biased to underestimate it (which we’ve both seen firsthand and what has been repeatedly proven in previously conducted studies). Because of this, a surgeon’s reported blood loss isn’t actually a good outside metric to assess their performance, and you must instead depend upon the perspectives of people who have been in the OR with the surgeon (which is understandably not something people outside the medical field have access to).

When I first was exposed to electrocautery, I notice that unlike conventional surgery (with a scalpel) it was as though I “felt” the pain of the body as its tissue was seared apart by the device. This in turn led me to wonder how safe electrocautery actually was.Note: I have since concluded the cervix contains some of the most “sensitive” tissues of the body as it was quite difficult for me handle being around it when a particularly intense electrocautery procedure was done. A particularly brutal form of electrocautery (known as a loop electrosurgical excision procedure) is done to approximately 500,000 American women a year to treat suspected cervical cancers, and for those who would like to see what it does to the body, a (somewhat graphic) video of it can be viewed here.

Since then I’ve investigated this more and found (like many of my colleagues) that the scars from electrocautery are significantly more traumatic to the body (e.g., they are more likely to create permanent health issues for the patient unless they are treated with neural therapy, which is discussed in more detail here).

Likewise, I’ve come to appreciate there are significant consequences with the dead (cauterized) tissue electrocautery leaves in the body. This is best quantified by the frequent observation electrocautery has a higher rate of post-surgical infections (as the dead tissue is easier for bacteria to colonize).

I’ve also seen a few cases where something much worse happens after electocautery. For example, the immune system is not only responsible for eliminating infections, but also suppressing cancer cells, removing debris from the body, and repairing damaged tissue. In turn, I distinctly remember a patient with a stable cancer who a mentor warned about getting an abdominal surgery (done with electrocautery) get the surgery and not long after succumb to the cancer (which rapidly grew out of control after the surgery).Note: a reader also reported observing this in an endometrial cancer that had been stable for years which then suddenly killed them shortly after they had a hernia surgery.

Modern Surgery

As technology has advanced, it has made many thing which were once impossible in medicine become possible. Conversely however, it’s taken away the innate skill many doctors used to reply upon and replaced them with expensive products which can be sold.For example, many common conditions patients come to the hospital with (e.g., appendicitis) can be diagnosed either with a thorough physical examination or with imaging (e.g., a CT scan). In turn, as time has gone forward, the standard of care more and more has been weighed towards those diagnostic procedures (which I’ve long suspected is in part due to the fact all of those procedures make a lot of money for the medical industry).

This has created the sad situation where the physical exam has become somewhat of a lost art, and in practice I frequently see patients who had conditions which were missed by each previous physician because while the patient got an extensive number of tests, they never got the detailed physical examination which was necessary to correctly diagnose them. Likewise, a certain percentage doctors who enter their post graduate training (medical residency) each year come from outside of the United States (12% in 2023), and we’ve repeatedly observed medical residents who went to medical school in much poorer countries (where they could not afford those expensive diagnostic tests) were dramatically better at physical diagnosis than their American trained counterparts.Note: many doctors try to move here because America pays its doctors 10-100 times as much as they make in many other countries.

In the case of electrocautery, since it makes it so much easier to do surgery (as you don’t have to have the finesse to feel exactly what’s going on under your scalpel), as it entered the training programs, I noticed the younger doctors who were primarily trained in electrocautery were much worse surgeons in the operating room. This was particularly true for doctors like OBGYNs for whom surgery was a part of their specialty rather than its primary focus.

When I asked James Miller (a surgeon) his thoughts on how electrocautery compared to traditional surgery, he shared the following with me:

James Miller

When I first started this publication, I connected with a brilliant trauma surgeon who had recently been kicked out of Washington because he had advocated for the unvaccinated when everyone else was actively discriminating against them and denying them essential medical care. From talking with Dr. Miller, it became very clear to me he had the rare capacity to see things for what they were and break from the crowd in order to do the right thing (a capacity which I’ve found characterizes the most talented doctors I’ve known). Because of this, when he asked me to help publicize his story, I was happy to, and before I knew it, he (and this Substack) ended up on national television.

Note: a longer interview about Dr. Miller’s experiences can be viewed here. 

In my correspondences with Dr. Miller, we discussed each of the previous points in, and recognizing his unique insights into these subjects, requested his permission to share them. I would thus like to share his thoughts on the Dextrous Surgeon:

Conclusion

In a recent article, I discussed the scandalous spinal surgery industry, where (owing to spinal surgeries being one of the most lucrative areas in medicine) patients are denied effective treatments for back pain and instead are repeatedly pushed into unnecessary and dangerous spinal surgeries. Sadder still, reckless spinal surgeons periodically pop up who significantly injure (or kill) large numbers of patients. Remarkably, when their honest colleagues (e.g., those who only perform spinal surgeries they know will help their patients) complain about the danger these surgeons present, again and again administrators chose to side with these reckless surgeons because of how much money their high volume of (rushed and improperly supervised) surgeries make for the institution.

Over the last few decades, we’ve seen a far reaching push to corporatize the practice of medicine and transfer the power doctors once had to decide what was correct for their patients to corporate administrators (which many of my colleagues believe was the single greatest mistake our profession has made). This loss of power was made clear to everyone throughout COVID-19, where countless doctors were forced to use deadly protocols for their patients (e.g., remdesivir and ventilators) while simultaneously being banned from doing things they knew could save their patients life.

This tragic reality resulted in America having the second highest COVID-19 death rate in the world despite it spending more to stop the pandemic than any other nation. That, in turn, was a result of the fact the hospitals were financially incentivized to push the unsafe and ineffective COVID-19 protocols on their patients. As such, the hospital administrators were willing to go to extreme lengths to protect that revenue.

For example, Paul Marik (a world-renowned ICU doctor) was forced to sue his hospital after he was prohibited from administering lifesaving COVID-19 treatments. Likewise both Paul Marik and Pierre Kory were targeted by their hospitals (detailed here) because they advocated for off-patent COVID-19 treatments (e.g., Paul Marik lost his medical license). Similarly, numerous lawsuits were filed to force hospitals to administer critically ill COVID-19 patients ivermectin. In the 40 which were successful, 95% survived, while in the 40 that were not, 5% survived.However, rather than take this dramatic difference in survival as in indication the existing treatment protocols should be reconsidered, the hospitals realized they needed to invest in a far more robust legal strategy (as abandoning the heavily-subsidized standard protocols would cost the hospitals a lot of money), and through this investment, our hospitals successfully prevented any further lawsuits from going forward.

One of the things I find the most tragic about Kory and Marik’s situation is that both of these doctors embody the physicians each patient would want to have when they were in the ICU (e.g., Kory has had numerous challenging ICU cases he was able to solve which the other doctors had given up on). However, because they loved the art of medicine and prioritized doing what would be the best for their patient, they were completely incompatible with the managed care system that exists within our hospitals.

Those events (and later ones such as a private and corrupt speciality board taking away the ability of the COVID dissident doctors to practice in hospitals) forced Dr. Kory to transition to his own private practice outside of the medical system. While Kory is personally quite happy with this career change (as he has a much more freedom to do things which will actually help his patients), I think it’s a tragedy that the current political situation is preventing patients from having access to the doctors they most need at the hospitals.

As we conclude, let’s consider Dr. Miller’s situation. For the most part, surgeons can only perform surgery under the umbrella of a hospital and hence only under the dictates of their hospital administrators. Since, as mentioned above, Dr. Miller could no longer tolerate the ethical quagmires practicing under those administrators placed him in, he chose to leave the surgical field entirely and transitioned to working in primary care.

Dr. Miller is personally quite happy he made this switch, as he now has the ability to freely do things he knows will help his patients. At the same time however, that switch is an immense lost—it is a huge investment to train a competent trauma surgeon and when there is a shortage of them, there is no one around to fix the mistakes (like the previously mentioned nephrectomy) less competent surgeons make.

In a recent article about the highly unethical practice of releasing self-spreading technologies into the environment (e.g., so people who don’t want to vaccinate will nonetheless be vaccinated), I argued that the medical profession needs to seriously reconsider its profit-focused approach to medical ethics (much of modern medical ethics now amounts to whatever makes money is the ethical choice).

There, I argued that beyond it being the “right” thing to do, it was also in the industry’s self interest to do so, as if medicine repeatedly violates the fundamental tenets of medical ethics, this will lead to it losing the societal trust it depends upon to sell it’s products to the populace. In that article, I cited the discovery that COVID vaccine mandates had significantly reduced the population’s willingness to get a variety of other vaccinations.

In this article, I’ve tried to show how the public recognizing that the hospitals no longer prioritize patients over profits is undermining their willingness to seek out hospital care. In turn, I would argue that unless measures are enacted to show our hospitals will reward rather than punish doctors who strive to do the best they can for their patients, the hospitals will lose a lot of money, both from declining patient numbers and more importantly, from the loss of charitable donations to the hospitals (e.g., I know numerous huge donors cut off their annual donations to hospitals which continued to enforce the COVID-19 vaccine mandates on their employees).

Postscript: I received two comments from surgeons I wanted to share (along with a comment from a scrub tech I pinned that you should read).

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For those interested, a complete index of the articles published on the Forgotten Side of Medicine can be found here.