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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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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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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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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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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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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I walk out of a room filled with emotion and despair.  A battle lost but the war rages on.  I’ve seen miracles, often only a daily basis.  Life is precious but peculiarly fragile while resilient and strong. Every emergency provider understands the feeling after a patient has passed.  It’s the unexplainable reverence and daunting silence as I put on the white coat.  It’s the echoing footsteps that never go away ...

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