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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My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010. There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go ...

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Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense?  But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences? A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, ...

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Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families -- and don’t have any fun at all. It doesn’t have to be ...

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Here’s a little story from the early days of my first job as a chairman of surgery. Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger ...

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