There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but ...

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The safety concerns that keep clinicians awake at night often aren't issues that you could fit onto a safety and quality dashboard. They aren't the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so. This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based ...

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shutterstock_122907892 Is it just me, or is the world of medicine getting way more complicated? Sometimes I long for the good old days of practicing medicine. First, the hospital switched over to electronic medical records, which required us to to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery. Next, our office got an insurance memo ...

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Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. ...

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shutterstock_229011745People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments. These days, America's emergency rooms have filled ...

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shutterstock_145891352 Recently, allegations have been spread by women who claim that as teenagers, they were sexually assaulted by Bill Cosby. Some have not made any mention of these crimes until decades later; while others have said that they did report the allegations at the time of the assault, but were not believed. Due to Cosby’s notoriety as a celebrity, this has fueled ...

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shutterstock_69679648 I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes. I wasn’t ...

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shutterstock_168773126 Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or ...

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In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks. I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life. These are ...

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shutterstock_156017414 The conversation was almost comical, until I thought more deeply about it later.  Apparently I was on "the list."  Insurers make such lists for customers who are  searching for a doctor who accepts their coverage.  Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a ...

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