A few months ago, when I thought I should throw it all away and go to law school, an acquaintance who is a lawyer said something unexpected.  He said "law school is learning how to think like a lawyer and deal with the uncertainty within the law."  Uncertainty?  A law is a law right?  Don’t speed.  Don’t drink and drive. Write thank-you notes.  Turns out the law often requires interpretation, ...

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All professions need good communication skills. Obviously in healthcare the ability to communicate with patients should rank high in a physician's list of talents. These days that interaction occurs in a number of ways: face-to-face, direct telephone contact or though a staff member, via emails, patient portals, or even texting. Because the communication is in the arena of medicine, the protection of an individual's health information is paramount. Enter HIPAA, ...

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Physicians and the public are urging doctors to bring cost into consideration at the bedside when ordering laboratory tests and imaging studies.  Although diagnostic testing represents an important component of the rising cost of medical care, asking what a test costs is the wrong question. Cost-saving shouldn’t begin at the bedside, it should begin by training the next generation of doctors to think in terms of value; not bang-for-buck or potential ...

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In my medical practice, I've used note writing extensively, to communicate with patients, with families of patients and with referring physicians.  And yet, when I received a note, which is not related to patient care, it is always a little surprising and uplifting, and emphasizes why note writing (and note receiving) is so appealing. In this Internet age and the age of information, we are bombarded with electronically conveyed messages, television ...

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Belichick, Brady and what healthcare can learn from the Patriots It is always a treat, particularly when living on the West Coast, to watch the New England Patriots football team play on national television in their home stadium, Foxborough, Massachusetts. On Monday Night Football, the match-up was between the Patriots and the Houston Texans, which had the best record in the AFC and undefeated in all away road games. As previously ...

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When I heard in October that Superstorm Sandy was projected to make landfall somewhere in the vicinity of DC and Maryland, I prepared for the worst. I stocked up on non-perishable goods and evacuated to higher ground. (The rest of my family was already coincidentally out of town and harm's way.) I put fresh batteries into two flashlights and installed a flashlight app on my smartphone for good measure. Although I ...

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Medical malpractice: Equating standard of care to best practice I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I'm sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the ...

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“This could be big,” he said after I told him about the company who wants me to cover their 100+ employees.  I pay him to give me the stark reality of things, but his optimism made me uncomfortable.  ”You’ve got to go for this.  I know you don’t feel ready for it yet, but this could really be huge for your business, and I don’t think you should pass this ...

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Balancing honesty and optimism in critical care A recent little essay entitled “Do patients bond best with doctors who misinform them with optimism” got me thinking about balancing honesty and optimism in practicing any medical specialty in which patients not infrequently die. Tragic things can happen in the pediatric intensive care unit. Anyone who works there — doctors, nurses, respiratory therapists, and many others — see these ...

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One of the gripes that patients have about the medical profession is that we physicians don’t communicate sufficiently about our patients. In my view, this criticism is spot on. Patients we see in the office often have several physicians participating in their care. The level of communication among us is variable. While electronic medical records (EMR) has the potential to facilitate communication between physicians’ offices and hospitals, the promise has not ...

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