I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the meeting. The topic was healthcare reform and its effect on hospitals and physicians. Included were discussions on patient-centered medical homes, accountable care organizations, bundled payments and physician integration and alignment with hospitals. The course director made it crystal clear that there will be no place in the future for ...

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As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career.  How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered. Precious little time is devoted to teaching this essential communication skill in the training of physicians today.  I can remember back to ...

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He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I thought the patient was dead. He was nearly the same color as the pale sheet covering his thin frame. His cheeks were sunken in and his eyes were gazing upward, in what I sometimes call the “death stare.” Then, surprisingly, he moved his arm upward to push his ...

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Diversity provides color to the tapestry of human experienceI was recently appointed the Assistant Director of the Yale Cancer Center with the portfolio of Diversity/Disparities. While I’m not sure I’m the most qualified for this, it has gotten me thinking a lot about diversity, disparities, and what it means to achieve health equity. Too often, I think, we are plagued by narrow thinking ... the impression that our ...

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How do you define a “good” doc?  I was reading the patient responses to an article here on KevinMD.com and was saddened by how many of the patients were angry with their docs.  Anger is an unhealthy emotion!  One of the respondents was particularly angry about the “unnecessary” tests her doc performed on her and her family. I have written about the vagaries of the term “unnecessary” in the past.  What ...

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The end of my residency and beginning of my practice was the most wrenching experience of my life.  I was woefully prepared for the transition.  Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes.  Things have changed considerably, but the psychological passage I endured still holds. I think my process of becoming a surgeon was fairly typical, with the exception that there was no one ...

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I believe the greatest challenge in medicine today is keeping the "care" in healthcare. One of the most frustrating aspects of practicing medicine for me had to do with how difficult it had become to incorporate caring into my practice. I am not necessarily talking about the kind of caring associated with having a long-term, close and mutually appreciated association with my patients: if that had motivated me, I would ...

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In his recent TED talk, Atul Gawande harkens back to the central thesis of his recent book The Checklist Manifesto: How to Get Things RightCan pit crews really heal medicine? that medicine has become too complex for physicians to act as cowboys and instead should adopt the paradigm of a pit crew, utilizing teamwork and the humble checklist to solve problems and avert emergencies. Is this really true though? Can "pit ...

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The art of practicing medicine is in realizing that there is an overlap between normal variants and pathology. Being able to tell the difference can be difficult, but this where the art comes in. However, as physicians we must realize that sometimes this can not be differentiated. Radiology is no different. Many clinicians and non-health care professionals believe that radiology is cut and dry. There is no art in radiology ...

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At no other time in my medical training was I as confident that, with hard work and dedication, I could master the field of internal medicine as when I was a newly minted third year medical student. Fresh from having taken the USMLE step 1, I interpreted my ability to recite the mechanism of penicillin resistance or the role of histamine in the immune response, and describe in great detail the ...

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