Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf.  It stems originally from a recent op-ed by Lucian Leape: "Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate ...

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Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical ...

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Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital's bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The ...

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The recent New England Journal of Medicine article, highlighting burdensome healthcare transitions in a subset of nursing home patients, is certainly of documentary value. However, for many of us with real-world experience in the nursing home medical care venue, the article certainly falls short of newsworthy.  Not even mildly surprising really. Too many of our nation’s nursing home staffs suffer from a lack of onsite MDs for evaluating acute ...

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We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It's time for a bold solution. We need a "VBAC Court." VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication ...

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Sexual harassment in the workplace is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly ...

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The art of practicing medicine is dying, soon to be replaced by the art of template medicine. Modern medicine is based on laudable terms: "quality," "outcomes," "cost effective," and "evidence based medicine," which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse. Each of these terms is intent on taking the human factor out of medicine. Each ...

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I mean it is kind of lonely being your doctor. I picture it as sort of a covenant. Between you and I. On one side you. And your family. And friends. Your house and your dogs. Your communities and lives. On the other side me. Alone. Of course there is always the hospital, but were really not friends. My partners and specialists. They all make an appearance. But when the going gets ...

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Science makes me a better doctor, faith makes me a better personSome have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic. A few months ago, at Schwartz rounds, a case of a pregnant patient who was being given chemotherapy was presented. When the nurse ...

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Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now.  But is it legal for doctors and dentists to advertise their services on these websites? Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies.  If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one ...

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