“I have a 20-year-old with what I can only describe as a poorly repaired heart defect and, uh, suboptimal follow-up,” the cardiologist’s voice was rushed. “That’s no good,” I said. “Yeah, well, it gets worse. She had baby two years ago. Went into heart failure around 36 weeks. I’ve got the records. I have no idea how she made it home.” And then he added, “She had a c-section, but no one ...

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While the typical physician is now accepting of the IT changes that are intruding into their work environment, he often does not understand the reasons or the strategic underpinnings for the push for the digitalization of healthcare. Being a typical modern consumer, he understands smartphones, online shopping and email, but doesn't understand concepts such as clinical data repositories, data warehouses, decision support and business intelligence.  Analogies can help, but carts, ...

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The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term. DNR: "They withholding a medical intervention" (evoking negative feelings). AND:  "They are giving care that ...

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Really, sir.  What were you thinking? I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol.  Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow. I would insert the link here, but the ...

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There are about 27 million visits by children to America’s emergency departments each year. About a quarter of those are to rural EDs or ones at some distance from a dedicated children’s facility, such as a children’s hospital. Over the last decade or so it’s become clear that, for critically ill children, early transfer to an advanced pediatric facility improves outcomes. The children do better if they can be transferred ...

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While new doctors in Europe "enjoy" 50 to 60 hour work weeks, doctors in the US work up to 80 hours a week, and sometimes beyond that. But the situation is changing. One year has passed since new limits on the number of hours doctors can work in their first job. For first year physicians, shifts are limited to 16 hours, and in other years, the limit is 28 hours. There has ...

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Last week I went on my first outreach visit to the homeless. In preparation we stocked up on water, gloves, gauze, and medications, put on our sneakers and headed out to the streets. We exited the front of the building, turned right and walked three blocks until we reached the corner with the highway on-ramp. We started crossing the street and about halfway, just past the service road and before ...

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Dear NP student who rotated through here back over the winter: You probably don’t remember seeing this particular woman. I sent you in to do a well-woman exam on her; everything was completely normal. There was nothing particularly memorable about her, either clinically or personally. Just another nice lady coming through the office; just another physical. You asked her a question, though: “How are things in the bedroom?” She was too shocked ...

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If you want to succeed in academic cardiology, get a federal grant for research. Better yet: get a few well-paid industry grants, too. These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight.   For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts ...

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In early 1996, I sat down at my computer looking for help. My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will be shorter, we were told. He will have seizures and other problems, they said, but it’s hard for us to say what or how bad those problems will be. We were ...

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