Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments.  Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing ...

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It’s been six years since I graduated from internal medicine residency. Enough time to give me some perspective, but short enough to still remember the highs and lows vividly. I recently had the opportunity to talk with a bright and energetic group of medical students. (Really, though, is there any other kind?) The conversation turned to any advice that I had or maybe I felt obligated to give some as part ...

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I find myself standing in front of six first-year medical students. They’re waiting for me to tell them something about how to become a physician entrepreneur. These students are now elite amongst their peers. They’re the ones who’ve had the courage to sign up for my course. And, perhaps unbeknownst to themselves, they’re also among the 1 percent of early adopters to lead the way for health care change. How do I ...

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All hopes were abandoned.  In theory, it was supposed to jump start medical care and provide access to the uninsured.  It was the promise of a new day. Every American would have access to good, quality (I really have learned to hate that word), affordable medical care. I’ll never forget that day.  It was raining hard, and my clothes were soaked through. The air felt particularly raw against my skin. The ...

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I was dining at a friend’s house recently after a long day in the hospital. He has just bought a beautiful new home with his rapidly expanding family, and like anyone who has just moved into a new house, his spare time is invariably spent working on getting everything in order and undertaking small upgrades to make the new place as perfect as possible. He’s quite DIY-oriented (unlike myself) and was spending a lot of ...

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It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor. For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis?   The chest ...

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Supply chains and other service industries, like telecom, worry about "the last mile" -- the final step in delivering a product or service to customers. Like other industries, health care must connect most meaningfully to the patient, and the nurse is almost always part of (if not the sole manager of) that last mile. The analogy of the last mile defines a deeply rooted issue about nursing’s criticality (and that ...

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The parental drive to protect your child is passionate, and learning that your child needs surgery is jarring at best and terrifying at worst.  As her guardian and provider, your instinct is to prevent harm to her at all costs, and even if you know that surgery is ultimately in your child's best interest, the thought of her going through an invasive procedure, combined with the presence of illness or ...

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Distinguishing between the terms "bully" and "bullying" is an important step that we can take in order to eliminate or at least minimize any disruptive or undermining behaviors that are often associated with bullying.  Yelling at, humiliating, excluding, gossiping about others are a few of ways we humans cleverly demonstrate disrespect for others.  And we all know that lack of respect is a persistent and pervasive problem in health care. As ...

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All medical students start out as the best of the best: You had to be to get into medical school.  So now that you’re in, what are some of the things you can do to attain the specialty you really want? How do you set yourself apart from your peers? 1. Get out of your head. Telling yourself you can’t achieve a competitive residency is your first barrier.  If you can’t even ...

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Women physicians are a testament to evolution; they’ve spent years, decades even, navigating through systems that do anything but cater to their unique needs, and actually find a way to thrive within these systems. My question is this: Why haven’t these systems really evolved with them? It’s now been 167 years since Elizabeth Blackwell became the first woman to graduate with a medical degree in the United States. Nowadays, just shy of ...

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Recently, the wife of a prominent Boston businessman -- one of my many wealthy, white patients at Massachusetts General Hospital -- greeted me this way: “So what foreign medical school did you go to anyway?” For background, I’m a petite, Middle Eastern young woman with a headscarf, and I’m guessing I do not resemble her vision of what a doctor “should” look like. That image is probably taller, whiter, male and ...

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Without a doubt, parenting is simultaneously the most rewarding and difficult job we have as adults. As a child psychiatrist and mom, I am always asked if I find it easier to parent given my profession. I always respond by saying, "I was the perfect parent until I had children!" I am also universally asked about how to raise happy children. I always pause before I attempt to answer this question. ...

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I know we all bemoan the chief complaint of vaginal bleeding when it pops up on the board. Your heart sinks even more when it is followed by the dreaded home pregnancy test. No ED provider is going to love seeing patients with first trimester bleeding. More than anything, I loathe the drag it takes on my time and productivity. Labs, urine, moving them to the appropriate room for the ...

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In my practice of facilitating cancer support groups, all I do is listen to patients and their families. Consequently, I hear much about the nature of their care. They generally speak favorably about its technical aspects, and indeed these are often awesome. But when they complain, it's uniformly -- and I mean one hundred percent -- about communication. One man has been trying to get an appointment with a pulmonologist for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old man is evaluated for persistent right-sided facial weakness. Three months ago, he first noticed "droopiness" of the right side of his lower face, difficulty closing the right eye and wrinkling the forehead, increased sensitivity to loud noises, and occasional slurred speech. Bell palsy was diagnosed, and he began a 10-day ...

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We physicians live in the shadow of rising health care costs.  Hospitals want us to cut length of stays and somehow become more efficient.   Insurance companies ask us to accept less money for patient visits, forcing us to see more people in fewer hours.  The government wants us to check a slew of electronic boxes to prove that we’ve performed what they deem to be best practices, even though there is ...

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It will be six months since my mother passed away. I kept my mother’s illness a secret. Not because I was ashamed and embarrassed but I did not want to advertise to the entire world of what she was going through out of respect to her and my family. So you sit there, put on a front like everything is cool and continue on your daily routine, until one day everything ...

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Me: Hello Mrs. Smith, my name is [BEEP!] Dr. Gandolfo and I am a [BEEP!] gastroenterologist. [BEEP!] Your doctor wanted me to [BEEP!] talk to you about something that showed up on [BEEP!] your CT scan. Mrs. Smith: Who are you? I [BEEP!] didn’t hear your name? Me (louder): It’s Fred Gandolfo, I am the [BEEP!] stomach doctor. [BEEP!] I need to talk to you about [BEEP!] that CT scan you had.  You see, there was … [BEEP!] [BEEP!] [BEEP!] Can you straighten your ...

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As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it. Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths ...

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