Last year I wrote about a few strategies for decreasing costs in the operating room.  Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical. In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives.  If you want to understand human behavior, all you have to do is identify the incentives that drive ...

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It is almost impossible for me to believe that my views on primary care in the United States have changed so radically in fifty years.  When I graduated from medical school in 1961, I was determined to become a primary care doctor. I completed residencies in both medicine and pediatrics to prepare for a career as a general physician in rural Vermont. That dream was put on hold by an ...

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My 6-year-old son is really farsighted, and I had no idea. I completely missed it. To be fair to me and my husband, the ophthalmologist (the esteemed and wonderful Dr. Hunter of Children’s Hospital Boston) said that Liam was compensating really well. And until his yearly checkup last month, he had been passing vision tests (which mostly test for nearsightedness). But in retrospect, there were signs we didn’t pay attention to. ...

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"I estimate these changes to your charting work flow will take only five minutes." Five minutes is fine if it happens for only one patient. But when it is multiplied by as many as forty patients in a day, the multiples get impressive. Five minutes x forty patients = 200 minutes (more than 1.5 hours a day). Minor five-minute changes to administrative charting requirements aren't so minor, especially when you add more ...

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"Traveling makes one modest – you see what a tiny place you occupy in the world. " -Gustave Flaubert We have come to Kenya, expecting to work outside of our "comfort zones." Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor ...

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The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first. Response to treatment of limited incidence and duration are accepted and deemed beneficial. ...

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As I walked up the stairs I thought about the history of the building I was about to enter. Although the foundation was the same, almost everything else had changed. The hallways were updated. The patient rooms decked out with comfortable furniture and fancy televisions. I even marveled at the bathroom as I answered nature's calling. I could have been in a fancy hotel. Yes. Things were different than when I ...

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No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use. What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was. The Centers for Medicare and ...

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Today, during my psychiatry rotation, a very grateful patient confronted my attending and thanked him profusely for saving him. The patient had been severely depressed and was at his wit's end before they met. The doctor listened to him, analyzed his situation, and came up with a plan to help which included involving the patient' family as well as using proper medication. The patient had a great response to this ...

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I was at the Walter Reed National Medical Center where I get medical care as a retired naval officer, and decided to use my time between medical appointments to get a much needed haircut. I walked into the barber shop, took a number, and sat down to await my turn. The three chairs were occupied by young men getting haircuts. Their chests and lower bodies were covered with long blue aprons to protect them from the ...

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