The Wayne Gretzky of Vasectomies: 58,789 and Done Counting
April 1, 2023 6:53 AM Subscribe
For years, Dr. Ronald Weiss (archive.org) kept a rigid morning routine. He started his day at half past five with a series of push-ups and pull-ups, a workout he’d performed every weekday morning, almost without fail, since university. He ate a bowl of plain yogurt with granola and berries while reading the newspaper. He drank a single cup of coffee — with milk, no sugar. Then, a few minutes before 8, he walked downstairs to the medical clinic in the basement of his family home, where he performed 14 vasectomies, one after the other, before lunch. Then he had a nap.
If poking instruments into scrotums (scrutiny?) doesn’t spark joy, definitely don’t do it.
posted by GenjiandProust at 7:11 AM on April 1, 2023 [11 favorites]
posted by GenjiandProust at 7:11 AM on April 1, 2023 [11 favorites]
Slightly more seriously, apparently the single, overwhelmingly best predictor of the success of a medical procedure is how often the doctor/team has done it. Doing the same procedure over and over means you see all the variations and learn to adjust for them.
posted by GenjiandProust at 7:18 AM on April 1, 2023 [18 favorites]
posted by GenjiandProust at 7:18 AM on April 1, 2023 [18 favorites]
I'd been discussing getting a vasectomy with a friend in the fall and then this week he mentioned he had got it done and that there wasn't a lot of discomfort afterwards so I should really go ahead and book one myself.
A different friend was diagnosed with a glioblastoma in the fall of 2020. He wasn't given long to live but made it almost 2 years which was a blessing because we got to spend a lot more time with him. Weiss focusing on his happiness, family, and music, is a great decision as far as I'm concerned because none of us really know how long we have but he's got a concrete reason that he may have less time than he otherwise could have expected.
It's also interesting to note how meandering his early life was but he still ended up being a doctor. I think these days you have to be laser focused on med school from pretty early on to have a chance. We're probably missing out on a lot of very capable doctors because of how few spots we have and how selective the schools are.
posted by any portmanteau in a storm at 7:24 AM on April 1, 2023 [11 favorites]
A different friend was diagnosed with a glioblastoma in the fall of 2020. He wasn't given long to live but made it almost 2 years which was a blessing because we got to spend a lot more time with him. Weiss focusing on his happiness, family, and music, is a great decision as far as I'm concerned because none of us really know how long we have but he's got a concrete reason that he may have less time than he otherwise could have expected.
It's also interesting to note how meandering his early life was but he still ended up being a doctor. I think these days you have to be laser focused on med school from pretty early on to have a chance. We're probably missing out on a lot of very capable doctors because of how few spots we have and how selective the schools are.
posted by any portmanteau in a storm at 7:24 AM on April 1, 2023 [11 favorites]
I’m fascinated that vasectomies seem to lend themselves to this kind of specialized, high-throughput practice. I had mine done at a similar office in Seattle (“DrSnip”) that used the same technique, and iirc they had 20+ appointments per day.
Really good article — thanks for sharing, If only I had a penguin…
posted by learning from frequent failure at 7:27 AM on April 1, 2023 [1 favorite]
Really good article — thanks for sharing, If only I had a penguin…
posted by learning from frequent failure at 7:27 AM on April 1, 2023 [1 favorite]
Even for a tubal ligation I was in at 10, discharged by 4 -- and that was well over twenty years ago. I expect it's even speedier now.
posted by humbug at 7:34 AM on April 1, 2023 [2 favorites]
posted by humbug at 7:34 AM on April 1, 2023 [2 favorites]
Had one done in November - it was so fast, and painless, scalpel-free - when I was on the table, I asked him - jokingly… “so, how many people have died on your table?” He laughed, said none - he has performed over 4,000 himself.
Recovery was minor and essentially completely - nothing like many anecdotes I have heard over the years.
posted by rozcakj at 7:42 AM on April 1, 2023 [1 favorite]
Recovery was minor and essentially completely - nothing like many anecdotes I have heard over the years.
posted by rozcakj at 7:42 AM on April 1, 2023 [1 favorite]
I gotta say one of the joys of middle-aged dating is how many of the dudes have had vasectomies. Kudos to this guy! He's improved a lot of people's love lives.
posted by emjaybee at 7:48 AM on April 1, 2023 [7 favorites]
posted by emjaybee at 7:48 AM on April 1, 2023 [7 favorites]
Dr Weiss skips leg day.
“At a certain point in my career it became almost zen to do a vasectomy,” he told me. “There was an automaticity to my movements and my behaviour. In a way, it was almost relaxing to work.”
By gawd I’d love to find a job someday where I achieve a zen state.
posted by glaucon at 8:26 AM on April 1, 2023 [2 favorites]
“At a certain point in my career it became almost zen to do a vasectomy,” he told me. “There was an automaticity to my movements and my behaviour. In a way, it was almost relaxing to work.”
By gawd I’d love to find a job someday where I achieve a zen state.
posted by glaucon at 8:26 AM on April 1, 2023 [2 favorites]
Took a bit to dig out of the article, but he was trained by the GOAT of the vasectomy world: Dr. Doug Stein, a Florida urologist, said that when Weiss joined him on trips to the Philippines to run free vasectomy clinics, he was the guy you wanted on the team if you were behind.
Dr Stein’s website is the gold standard, anything you wanted to know about the procedure, right down to the cost of vasectomy ($500) and reversal ($5000) to show how easy one is and how difficult the other. If anything, it gave my urologist and I plenty of shop talk during the procedure.
posted by dr_dank at 8:39 AM on April 1, 2023
Dr Stein’s website is the gold standard, anything you wanted to know about the procedure, right down to the cost of vasectomy ($500) and reversal ($5000) to show how easy one is and how difficult the other. If anything, it gave my urologist and I plenty of shop talk during the procedure.
posted by dr_dank at 8:39 AM on April 1, 2023
A perfect Saturday morning read. Wish there had been a few more words about how he went from high school dropout to founding his own school.
(I'm also a Dr Snip alum, he gives out little swiss army knives to patients 🙂)
posted by rouftop at 8:42 AM on April 1, 2023 [3 favorites]
(I'm also a Dr Snip alum, he gives out little swiss army knives to patients 🙂)
posted by rouftop at 8:42 AM on April 1, 2023 [3 favorites]
They say what makes him so great is that he always points the scalpel where the vas deferets is going to be.
posted by Horace Rumpole at 8:57 AM on April 1, 2023 [15 favorites]
posted by Horace Rumpole at 8:57 AM on April 1, 2023 [15 favorites]
Metafilter: inclined to skip reading the article in their rush to share their own vasectomy experience.
posted by splitpeasoup at 9:08 AM on April 1, 2023 [8 favorites]
posted by splitpeasoup at 9:08 AM on April 1, 2023 [8 favorites]
...speaking of which, here's mine: the hardest part of a vasectomy is telling your neurotic Indian parents about it afterwards. My mother assumed that I had decided "suddenly" (I hadn't) and that I was suffering from depression.
posted by splitpeasoup at 9:13 AM on April 1, 2023 [2 favorites]
posted by splitpeasoup at 9:13 AM on April 1, 2023 [2 favorites]
when Weiss joined him on trips to the Philippines to run free vasectomy clinics, he was the guy you wanted on the team if you were behind.
if you're behind, you're doing it wrong
posted by chavenet at 9:37 AM on April 1, 2023 [14 favorites]
if you're behind, you're doing it wrong
posted by chavenet at 9:37 AM on April 1, 2023 [14 favorites]
Hopefully an actual doctor will chime in, but I don't see why we couldn't train surgeons to perform a single procedure a la Weiss, without requiring them to go through all of medical school. Obviously this model would have limited application, but couldn't we use it for common procedures like vasectomy, thyroidectomy, endometrial ablation, etc.? If all you're going to do day in and day out is vasectomies, why do you need to know about everything else?
posted by HotToddy at 9:46 AM on April 1, 2023 [3 favorites]
posted by HotToddy at 9:46 AM on April 1, 2023 [3 favorites]
I had my vasectomy done by Dr. Weiss some 23 years ago (I wonder what number I am?); it was quick and recovery was fine. The thing I remember most was after my initial consult, he sent me to the pharmacy next door; where I handed them my prescription, and they handed me a paper bag with the vasectomy 'essentials'...a razor, pain medication, some other stuff I can't remember. What I do remember is that the pharmacy had a shelf with all these brown bags lined up and ready to go; seems to fit in with the 'rigid routine' Dr. Weiss practiced.
posted by BozoBurgerBonanza at 10:33 AM on April 1, 2023 [5 favorites]
posted by BozoBurgerBonanza at 10:33 AM on April 1, 2023 [5 favorites]
My vasectomy was performed by one Dr. Seaman, the go-to guy in my NYC suburb. Of course, Austin's recently retired urologist Richard "Dick" Chopp is a cut above in the aptonym department.
posted by bassomatic at 11:02 AM on April 1, 2023 [7 favorites]
posted by bassomatic at 11:02 AM on April 1, 2023 [7 favorites]
…I don't see why we couldn't train surgeons to perform a single procedure a la Weiss, without requiring them to go through all of medical school….
I am not a surgeon, but I am a physician without which surgeons would still be doing amputations with whiskey and opium (for the patients). What you are describing is basically the development of medical specialties. It still intrigues me, for example, that merely being an ophthalmologist is not specialized enough. Eye doctors commonly go on to specialize in corneal diseases, or retinal diseases, and so on. A good example of the type of practice you describe is the Shouldice Hospital in Canada; an entire hospital dedicated to hernia repair. But even within that level of specialization it is important to remember that the body part needing attention is attached to an entire person. A patient with a lot of anxiety may need a different approach than one who is calm. And then you add in medical conditions. Hemophilia and other bleeding disorders are obviously a concern whenever you start sticking sharp instruments into people. In some situations even an otherwise trivial amount of blood can be a serious complication. A patient with severe heart or lung disease is also at higher risk for severe problems from an otherwise minor procedure, especially if any kind of sedation is required. Even without sedation, most procedures are painful enough to require some local anesthetic. If you are using those drugs, you need to be prepared to to treat allergic reactions to them, or even more seriously, local anesthetic systemic toxicity which can result from either giving a relatively large dose of the anesthetic or inadvertently injecting it into a blood vessel. LAST is life threatening and needs to be treated appropriately to avoid a disaster. Additionally, while there are a lot of procedures that are performed commonly enough for a person to do that one thing over an over again for their entire career, there are many other procedures that are less common, and sometimes unique. Having a surgeon who broadly understands the anatomy (and often, the embryological development of the anatomy) and the physiology of the structures they are working on is important. Finally, specialization can be a real hurdle for patients and their families. We have all seen news stories of patients/families who travel great distances to find a surgeon who can fix their problem better than anyone else. But what about all the others who can’t afford that kind of disruption in their life? As good as the Shouldice Hospital is at what it does, can you imagine if everyone in Canada had to travel to Ontario (or a few other places) for a hernia repair? Much more disruptive than getting it done in their own town. And I can only imagine what a clusterfuck it would be here in the USA; I can see insurers paying for patients to go cross country to their designated hospital for surgery, but their family has to pay their own way. So it is a good question, but beyond a certain level of specialization and experience it would lead to worse outcomes and higher costs; and the overall knowledge gained in med school is important, even when not obviously so.
posted by TedW at 12:16 PM on April 1, 2023 [20 favorites]
I am not a surgeon, but I am a physician without which surgeons would still be doing amputations with whiskey and opium (for the patients). What you are describing is basically the development of medical specialties. It still intrigues me, for example, that merely being an ophthalmologist is not specialized enough. Eye doctors commonly go on to specialize in corneal diseases, or retinal diseases, and so on. A good example of the type of practice you describe is the Shouldice Hospital in Canada; an entire hospital dedicated to hernia repair. But even within that level of specialization it is important to remember that the body part needing attention is attached to an entire person. A patient with a lot of anxiety may need a different approach than one who is calm. And then you add in medical conditions. Hemophilia and other bleeding disorders are obviously a concern whenever you start sticking sharp instruments into people. In some situations even an otherwise trivial amount of blood can be a serious complication. A patient with severe heart or lung disease is also at higher risk for severe problems from an otherwise minor procedure, especially if any kind of sedation is required. Even without sedation, most procedures are painful enough to require some local anesthetic. If you are using those drugs, you need to be prepared to to treat allergic reactions to them, or even more seriously, local anesthetic systemic toxicity which can result from either giving a relatively large dose of the anesthetic or inadvertently injecting it into a blood vessel. LAST is life threatening and needs to be treated appropriately to avoid a disaster. Additionally, while there are a lot of procedures that are performed commonly enough for a person to do that one thing over an over again for their entire career, there are many other procedures that are less common, and sometimes unique. Having a surgeon who broadly understands the anatomy (and often, the embryological development of the anatomy) and the physiology of the structures they are working on is important. Finally, specialization can be a real hurdle for patients and their families. We have all seen news stories of patients/families who travel great distances to find a surgeon who can fix their problem better than anyone else. But what about all the others who can’t afford that kind of disruption in their life? As good as the Shouldice Hospital is at what it does, can you imagine if everyone in Canada had to travel to Ontario (or a few other places) for a hernia repair? Much more disruptive than getting it done in their own town. And I can only imagine what a clusterfuck it would be here in the USA; I can see insurers paying for patients to go cross country to their designated hospital for surgery, but their family has to pay their own way. So it is a good question, but beyond a certain level of specialization and experience it would lead to worse outcomes and higher costs; and the overall knowledge gained in med school is important, even when not obviously so.
posted by TedW at 12:16 PM on April 1, 2023 [20 favorites]
the GOAT of the vasectomy world: Dr. Doug Stein, a Florida urologist
Can't drive to Disney World without seeing his billboard. In fact I just learned he plays himself in a documentary.
posted by credulous at 12:23 PM on April 1, 2023 [2 favorites]
Can't drive to Disney World without seeing his billboard. In fact I just learned he plays himself in a documentary.
posted by credulous at 12:23 PM on April 1, 2023 [2 favorites]
Four month wait, incompetent office staff, top-rated surgeon complained bitterly throughout the procedure, golf-ball sized hematoma for two weeks, and a permanent (?) condition where, if I sleep "wrong", I feel like I've been kicked in the groin for a few hours.
Where do I sign up for the surgeons you folks had?
posted by SunSnork at 1:22 PM on April 1, 2023
Where do I sign up for the surgeons you folks had?
posted by SunSnork at 1:22 PM on April 1, 2023
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- He's a pioneer in no-scalpel vasectomies. (The work is done through a small hole instead of an incision.)
- He stopped doing vasectomies after a brain tumor diagnosis. He expected to die within six months but is still doing OK. "In the spring of 2021, Weiss came to a realization. It was foolish to keep working. He wanted to focus on joy. To spend time with his family, travel and make music. "
posted by Nelson at 7:03 AM on April 1, 2023 [10 favorites]