In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn't relax, and I was always irritated. Even a few days off didn't help because of the mountain of phone calls and paperwork waiting for me upon return to work.  I asked myself, is this burnout? Coincidentally, I happened ...

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Want more evidence about how many people expect perfect outcomes in medical practice? Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro. As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and ...

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One of the curses of kalafong (hell) was that there was no neurosurgical service. This meant us mere general surgeons had to handle the many head injuries that came in. So, for example, when some guy decided to cave in the head of his so-called best friend with a five iron on the golf course because they had started with the nineteenth hole instead of the first, we ended up either ...

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After my recent blog posts, I was inundated with questions regarding how I would change the way I interact with my cancer patients if I return to work.  I’ve tried to chronicle my experiences – from diagnosis to death – in hopes that you will learn how you can interact with your patients more effectively. Diagnosis There was an undeniable shock that disrupted all of the carefully-constructed systems and routines with ...

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A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself. Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not. Many pundits have weighed in on whether the ...

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We specialists in infectious diseases love case conferences — especially those where the case is presented as an "unknown," and we try to figure out the diagnosis from the history. I suppose this isn’t very surprising, since ID cases in general are already among the most interesting in all of medicine. Those that are case-conference-worthy are particularly prime. “Funny bug in a funny place,” was how one of my colleagues characterized these ...

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Autopsies establish truth, detect change, provide hard data, instruct learners, and promote justice. Yet, they seem poorly valued in modern America except in many TV crime shows like "CSI." Dr. Donna Hoyert of the CDC, in August 2011, profiled the dramatic changes in American autopsy rates, noting that while forensic autopsies remain common, hospital autopsies for patients with diseases, especially in the elderly, have almost disappeared. In evaluating medical quality, ...

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There's been a great divide between the medical and surgical specialties ever since I can remember.   Surgeons believe internists perseverate too much when decisions need to be made.  Internists consider themselves the true intellectuals of medicine.  I suppose anesthesiologists like me fall somewhere in the middle--we work in surgery, but have to take care of all the medical problems the patient brings to the OR table.  Does that make us ...

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There was an exceptionally well-written piece published in the Washington Post recently.  I presume a hospitalist wrote it, which magnifies its significance.  In it, he describes the difficulties in caring for terminally ill patients. As I read it, it reminded me of a story my dad told me several years ago.  His friend, I will call him Steve, was experiencing a great deal of stress because of his dad’s ailing ...

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A couple of weeks ago, the New York Times published a story entitled I Disclose … Nothing by Elisabeth Rosenthal. The premise of the article dealt with conflicts of interests in several professions, including those in medicine. It got me thinking about whether or not the concept of disclosure can successfully manage conflicts of interest in medicine as much as people expect it to. The conclusion I came up ...

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