There are important medical studies, and then there are landmark studies–the kind of science that disrupts the entire medical community. The most recent game-changer was published recently in the Lancet. Well known surgeon and author, Dr. Atul Gawande and colleagues published this important look-back study on the intensity and variation of surgical care of 1.8 million elderly patients in the US. They put numbers to the well-known and ever-expanding problem of ...

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Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered ...

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For the last 3 weeks, I've been working as a sub-intern on the family practice inpatient service in one of the local hospitals. It's been quite a time! I've sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday. We're all familiar with the glamorous "saves" in medicine. It's the car accident victim that undergoes ...

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“I don’t need no doctor, ‘cause I know what’s ailing me. He gave me a medicated lotion But it didn't soothe my emotion” -John Mayer If someone asked you to draw your image of medicine, what would you sketch? Would it be a person wearing a long white coat with a stethescope? Would your picture be set in a hospital room, the ER or the office setting? Would there be any patients ...

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Dear future practicing physician, Choose primary care.  I know all around you there are pressures to choose to become a specialist.  I remember those pressures well.  In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him.  I still chuckle about that conversation to this day.  In residency, I remember several seminars for us built ...

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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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