An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections. On the surface, it kind of makes sense – one should be punished for ...

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One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy. Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your ...

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I have been practicing medicine for 35 years and the great secret is that it just keeps getting better.  No day goes by without an important learning moment, a unique observation or just the satisfaction of making a difference.  Today I had one of those moments of revelation that will slightly change all days which follow. Stan is a 57-year-old man with curable colon cancer who requires surgery. Unfortunately, that surgery ...

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On a night flight from Boston to San Francisco a voice came over the loudspeaker. “If there’s a doctor on board, would you please identify yourself by pressing your call bell?” I reached up to hit the button, shrugging nonchalantly in response to my seat mate’s questioning look. “Duty calls,” my shrug was meant to convey. But I didn’t feel nonchalant. What I felt was approximately two parts excitement and one part ...

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One of the most difficult decisions that patients, families and physicians face involves end-of-life care. The advance directive or “living will” has become an accepted framework for patients to delineate their own preferences about what treatment they would or would not want when faced with a life-threatening disorder. But it was not always this way. In the past, physicians and families often shielded those with potentially fatal illnesses from candid conversations ...

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On a picnic blanket at Piestewa Peak in Phoenix, AZ, Rowena passed around orange honey almonds while Barbara read an Elizabeth Chase Allen poem to us. My friend Dosia pointed out the growing audience of curious squirrels hoping we would drop a few treats. The conversation turned to favorite springtime memories; our laughter cut through the quiet of the desert. Nadine brought out a layered chocolate cake for her boyfriend ...

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Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who: 1. combine the MD with a JD or PhD; 2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums; 3. are named Michael Crichton. Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery ...

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Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes. The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, ...

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“What we have here is a failure to communicate.”  A famous quote from the movie Cool Hand Luke.    As many know poor communication is common in healthcare. Consider the following examples. According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions.  It was the teaching hospital for Brown University and the only Level I trauma center in southeastern ...

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I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills ...

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