At age 37, after a nearly 2-year battle with stage IV lung cancer, a talented neurosurgeon lost his battle. My oncology-related newsfeed is filled with stories this week about this brave and clever man’s recent passing. In a field where the recent tweets tout results of the latest clinical trials (overall survival prolonged from 2 months to 4 months!), it is sobering to be reminded of what truly matters to ...

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A big challenge facing academic medical centers is how to maintain a focus on patient care in an artificially divided environment.  Most academic medical centers developed in a system with abundant resources, cost-based reimbursement and a traditional academic departmental structure.  This led to individual departments growing as microsystems formed around particular specialties. The untoward effect of this is that the different silos within the system tend to operate with their own ...

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41NmPFjOxXL._SL250_ An excerpt from The Real Doctor Will See You Shortly.  Warning: Contains explicit language. It started with a banana peel. After years of quiet study in the libraries, laboratories, and lecture halls of Harvard Medical School, I finally made the tectonic shift to hospital life in the summer of 2006. The third year of medical school marks a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated for a 6-year history of typical gastroesophageal reflux symptoms treated on an as-needed basis with a proton pump inhibitor. However, the frequency of his reflux symptoms has recently increased and his episodes do not respond to treatment as completely as in the past. An upper endoscopy is ...

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The July Effect is a relatively well-known reference to the influx of new trainees entering hospital systems annually on the first of the month. Researchers have attempted to investigate the impact of the new trainees on patient outcomes with divergent conclusions. Despite the ongoing debate, educators in medicine recognized the need to prepare medical students for day 1 of residency training, by establishing core competencies to evaluate the preparedness of students. One such example ...

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The girl seizes. Her body torques and twists and jerks about like a snake trapped on an electric fence. She flops back and forth on the gurney before us, her pale forehead glistening with sweat, her brown hair wetted black from the effort of muscle contractions that threaten to tear apart her tiny frame. Trauma room two is silent save for the gluck-gluck-gluck of her gagging as jaw and teeth grind and bang together ...

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One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra at their favorite charity gala. These wondrous creatures, having pored over a few disjointed numbers selectively allowed to escape from our struggle with health care, are informing us that there ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated during a routine examination. He is concerned about his general health and risk of diabetes mellitus. He has no medical problems. Both parents and his sister have type 2 diabetes mellitus. On physical examination, temperature is normal, blood pressure is 130/79 mm Hg, pulse rate is 66/min, and ...

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Does the profession of medicine favor certain personality types over others? When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in ...

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As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and health care providers alike: nothing is as it seems. While the ACA has provided health care to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans.  Even those with ...

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The following article is satire. In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician.  Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the ...

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It came out of nowhere. One of those life lessons that I didn’t know I needed to learn. Until I did. There I was, at a weekend business retreat, hobnobbing with a group of women executives. Feeling only slightly out of my element. Trying to blend in. There was a break in the meeting. And what happened next made me rethink how I approached everything. Several of us walked to the ladies’ ...

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Behind every doctor is a little boy or girl who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet.  She swore that when (if) she got older she would protect the innocent from such things.  Her vow was the ...

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The other day some cardiologists on Twitter were discussing whether a patient should be blamed if a permanent pacemaker lead became displaced. The consensus seemed to be that it was probably poor placement (i.e., operator error), rather than patient behavior that caused leads to dislodge. The discussion reminded me of an attending plastic surgeon of mine during my resident days. He was one of the most obsessive-compulsive people I ever met. ...

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Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow? Consider:

  • Ten years ago, the EMR recorded the date you or your nurse gave Sam his flu shot.
  • Today, the EMR reminds you it is time to have your nurse give Sam his flu shot.
  • Soon, the EMR will order the flu shot that the nurse will give to Sam.
  • Tomorrow, the ...

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I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently ...

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How can physicians maintain a consistent brand online? With a hub and spoke strategy.  Watch the video above to see what that means. This is next in a series of short physician online reputation videos produced by The Doctors Company as part of their social media resources for physicians.  Enjoy.

The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues. Strange ...

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SGR has been the bane of my time in policy.  And I want it to be yours. SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good ...

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Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt.  Would the next organic chemistry exam eliminate my 3.99 GPA?  Would the MCAT decide what medical schools would immediately ignore me without ever meeting me?  Would the sheer volume of material weed out the persons sitting next to me in medical school or would it weed me out instead?  Would being yelled ...

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