If you live in southern California, you can’t miss the billboards advertising laparoscopic gastric banding at “1-800-GET-THIN” outpatient surgery centers.  They feature happy people who’ve lost 100 pounds or more, and urge you to “let your new life begin” by having a “lap band” inserted.  Fees at these centers are much lower than they are at university medical centers or other major hospitals. Recently, however, those surgery centers and their owners ...

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My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she ...

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ASA: The global anesthesia crisis in low income countriesA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, ...

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In these days of decreased reimbursement, increased workload, and non user-friendly EMRs, physician burnout rates can be quite high. Stress, depression, and overwhelming fatigue associated with burn-out can interfere with our ability to care for our patients. If we, as providers, are not emotionally healthy, we are not able to provide the very best of ourselves to our patients. When we allow ourselves to become over extended and over committed without ...

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The problem with phone medicine is that you have to trust what you hear and act accordingly.  Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses.  Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone. Patient’s mom: “My son is sick.  He’s throwing up and has a ...

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W. Edwards Deming is recognized as one of the driving forces that led the Japanese in the 1950’s to become a world-class manufacturing nation.  The Japanese through the implementation of his principals became leaders in the manufacture of automobiles and electronics.  One of his cardinal principles was that a company must delight its customers.  It is not enough for a company that wishes to excel to meet the needs and ...

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(All names and identifying features of characters in this story have been changed.) Nora, a third year medical student, came to me in moral distress. Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization. The first year doctor with whom Nora was paired, Dr. White, vented to her: “These patients come to us seeking our help and then refuse ...

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Since the America Society of Plastic Surgeons (ASPS) released their 2011 plastic surgery statistics, I’ve seen a lot of talk online about how, “despite the economy,” plastic surgery numbers are rebounding from the lows they hit in 2007 and 2008. People say this as if plastic surgery is—against all odds—somehow rising above the general trends and setting unprecedented records. I can see why it’s tempting to frame it that way—while the ...

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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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