As an internist, working in the emergency room feels at times like the dark underbelly of medicine. The frenetic pace, the need to make decisions within highly uncertain conditions, and reliance on technology all cut against the grain of the internists credo of “being a doctor’s doctor.” If internists are biased in how they arrive at diagnoses, emergency medicine doctors face such bias on an exponential scale. Clinical decision-making is ...

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Scalability is the end goal of nearly every tech start-up, systems innovation, and teenager you-tubing their cat -- it’s going viral, business-style. And traditionally, it’s been seen as a marker of relevance and success. Growth is good, right? But in health care systems transformation, do we lose something meaningful when we measure the value of our work by its national impact? Take Iora Health, a new health ...

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“It’s good to see you brother!” I had never met this man, but I knew exactly what he was talking about. With a large smile on his face and a look of pride, he extended his arm to give me a handshake. “There aren’t too many of us doing what you do. I’m glad we got some representation in here.” I am a black man in the medical field. When I ...

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When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish? The California legislature is considering that question, and physicians will soon be asked to weigh in on it. Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors. Currently, however, enthusiasm in its favor is growing. What are the reasons given to justify this emerging practice? Do they ...

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Recently there has been a great deal of controversy surrounding the American Board of Internal Medicine (ABIM), and its board certification requirements. Currently, the board require physicians to take an exam and recertify every ten years in a process termed MOC, or maintenance of certification. The process is time-consuming and costly, and many physicians claim it does not improve their day-to-day practice. Doctors have become more vocal in their grievances ...

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One night while on call, I was sitting in a loud downtown restaurant when I received a phone call from the hospital. I didn’t think I would be able to hear the call, and so I scurried around to find a place to speak. The bathroom appeared straight ahead, so I rushed into the first empty stall, locked the door and took the phone call. After wrapping up with the ...

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To his credit, Mark Cuban, engaged on Twitter in response to my post.

Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me -- in that order -- if I didn’t get off Twitter instantly and get the groceries.

However, I caught the tail end of the Tweets. I’ll do my best to respond.

1. “Why is this contingency ...

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shutterstock_3101394 Do you know the difference between a surgeon and God? God doesn't think he's a surgeon. Everyone who goes into the study of surgery has ideas about what they're going to be. I would imagine that each individual has different expectations of what the future holds, though few find their future at all resembles those expectations. I recall when I started my surgery ...

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shutterstock_156842612 american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a physician, you never quite get used to being paged in the middle of the night. The shrill tones emitted via a radio frequency device that seems squarely stuck in the 1980s are almost always ...

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shutterstock_194789030 Dear drunk driver, Tonight, I am tired. Tired from lack of sleep, tired from the long hours, and tired from bearing witness to your destruction. Tonight, you caused an accident while under the influence of alcohol. And you are badly injured, requiring emergency surgery. Your liver is hard, cirrhotic, and unforgiving. Although I can get you through this first surgery, I know you will ...

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