Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who: 1. combine the MD with a JD or PhD; 2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums; 3. are named Michael Crichton. Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery ...

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Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes. The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, ...

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“What we have here is a failure to communicate.”  A famous quote from the movie Cool Hand Luke.    As many know poor communication is common in healthcare. Consider the following examples. According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions.  It was the teaching hospital for Brown University and the only Level I trauma center in southeastern ...

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I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills ...

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You are in charge of your own healthcare. Equally important is research that reveals that most women are in charge of their family’s health as well. But you’re not alone – you need a physician partner for you and your family, and sometimes, it can be challenging to find the right one. I always recommend doing your homework and researching the reputation of the physicians, surgeons and nurse practitioners who will ...

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Last year, Texas legislature attempted to pass a bill that would halt all funding for the Women’s Health Program, a Medicaid associated program that provides annual exams and contraception for all reproductive age women that qualify, simply because Planned Parenthood participated in the Women’s Health Program.  This puts programs such as where I work in a bind.   The funding is in serious jeopardy of being eliminated completely. According to the Texas ...

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As I contemplate retirement from clinical practice as a general surgeon, something I've been doing for over 41 years including residency, I've been having some unsettling thoughts. Like many physicians, I've tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long. I have written in a previous blog about the ...

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Are you familiar with the trolley problem? It is an ethics dilemma first formulated by the great Philippa Foot as a part of a series of such dilemmas. Her formulation goes roughly like this. Imagine there is a tram hurtling down a track. If it keeps going straight, it will hit and kill 5 people who are working on that track. The conductor is able to ...

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Despite the best evidence, oncologists cannot dictate treatmentDuring Multidisciplinary Gynecologic Oncology Tumor Board at Massachusetts General Hospital, a case was presented of an older woman with stage IV ovarian cancer who was deemed inoperable. Following review, we recommended a course of chemotherapy. I asked our fellow what treatment she would administer, and this sparked a discussion on how patients and providers create a treatment plan. We discussed options, ...

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What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients ...

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