"It is getting worse everyday." "Medicare fix at the last moment." "Too much paperwork not enough time with patients." "ACO’s and bundling." The headlines scream at us everyday. If we have one word that underlies the medical community it is fear. The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching ...

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Where is the physician outrage? Right. Here. I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics. I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins. I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as "rape." If I insert any ...

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As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much. Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, ...

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Recently there was a lovely story in the New York Times about a young couple struggling to navigate the complexities of a romantic relationship.   Both in their early 20’s, dating is a relatively new experience for them.  She likes physical affection; he prefers sitting alone on the couch.  She wants a pet; he is allergic.  They are learning to negotiate the small things while clinging to their common affection for ...

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A response to Why isn’t everyone excited about robotic assisted surgery? by Kelly Wright. Yes, it’s cool.  The surgical robot is every gamer-cum-surgeon’s dream. However, I, too, was a skeptic regarding incorporating robotic surgery into my practice.  I have been practicing minimally-invasive surgery for over 20 years, including residency.  I became convinced of the value of minimally invasive surgery after observing patients postoperatively.  I have laparoscopically repaired an obturator nerve transection, ...

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I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced. In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly ...

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Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI ... but not a single voice tells us how to do that. Let me give you a three part structure you can use in your patient conversations in the future - and some exact words to try out.  This structure is adapted from the Parenting literature, another role where boundaries and inappropriate ...

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I cradled my son's miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child. At the time, it hadn't sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing ...

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Unlike most other industries, safety in healthcare has a unique set of circumstances to overcome: 1) patients die from errors one-at-a-time, and 2) we rarely find out exactly why. The “sensationalism” from a front-page disaster is completely absent. And, due to a myriad of factors, the underlying hazards usually remain a secret. As we ride the crest of a current wave of interest in "patient safety," is the refreshing new focus blinding ...

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When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich). The more I learn as a physician, the more I realize how little I know. The ...

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