Tonight a 17 year-old boy came to the emergency room complaining of headache. As I entered his room, in my usual hurry to do an assessment as expeditiously as possible, so as to get on to the next case and attempt to avoid the inevitable backup of patients so common in our ER, I was struck by the vulnerable demeanor of the patient before me. The triage nurse’s report assured ...

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Suppose your malpractice insurance company wants to settle a medical malpractice case against you - even though the case has no merit. In many cases, insurance policy language may allow the insurance company to do just that. In the 2011 case of Mohan Papudesu, MD v. Medical Malpractice Joint Underwriting Assn. of Rhode Island, the Rhode Island Supreme Court allowed an insurer to settle a case on behalf of the defendant physician ...

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On the day we cure cancer I will rise in morning dark.  I will stand in last night cold, and watch stars fade.  The light will come and a following breeze blow.  On that incredible dawn, there will be brilliance.  I will make sunrise rounds on the day we cure cancer. I will stay late and breakfast with my wife.  We will talk about flowers, kids and books. I will stand ...

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A group of nine medical specialty societies recently announced the “Choose Wisely” campaign, targeting 45 commonly performed medical procedures and tests that offer little or no value in improving health. These interventions waste precious health care resources, lead to erroneous conclusions and/or false security, spur unwarranted additional interventions, and cause patient harm. Among the appropriately indicted procedures was cardiac stress testing of asymptomatic, low-risk patients. There is an old ...

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I was working in the Intensive Care Unit (ICU) the other day and as I counted, I found that more than half of the patients there, for lack of a better term, brought the condition upon themselves. I sound harsh, but there was no better way to put it. I was taking care of Mrs. B, a 60-year-old lady with COPD who called EMS for shortness of breath. As EMS readied ...

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When do I stop being someones oncologist?I recently talked about wondering how those I had met through my own patients were doing, especially after my patients had passed on. I wondered if they were all right and whether they were able to move on. Well, I've been thinking about it again, though this time in the context of cancer survivorship. The Office of Cancer Survivorship of ...

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Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most.  All doctors made a comfortable income; money wasn’t a primary motivator.  There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer.  Internal medicine was held up to us as the most prestigious and intellectually ...

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The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person. Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package ...

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Several years ago I was hired by a plaintiff's attorney as an expert witness on a personal injury case.  He paid the fee in advance but the night before the trial, his co-counsel called me to review the case.  It was clear that she did not have a thorough understanding of the case and I spent two hours with her on the phone trying to bring her up to speed.  ...

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As most of the electrophysiology (EP) community is aware, device and lead recalls are a reality in today’s EP practice. In the last 5 years, both Medtronic and St. Jude Medical have had significant lead failure issues. The public responses to these recalls have been varied and quite different. As physicians who care for device patients, we must learn to quickly sort through the rhetoric put forth in the New ...

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