2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime. My first night in the unit and my first patient’s chart.  Papers spill from the accidentally opened binder ...

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Living in the fine city of Boston, I am fortunate enough to be located right in the middle of a medical hub. A place that’s full of exciting new research, developments, and ideas. Working at the front line of hospital care, also with a keen interest in quality improvement, patient experience, and technology, I frequently attend social and professional healthcare networking events around the city. While doing this, I’ve gotten to ...

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To my younger self, I remember how excited you were when you finally settled on medicine as the thing that you wanted to do as a career in your junior year of college. I remember all the questions you had about what the process entailed since no one in your family had undertaken this journey before. I even remember some of the doubts you had when you thought about how long ...

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A.J. Smith, a pseudonym of course, walked into my office today, unhappily.  Most of her topical medications for acne caused too much irritation.  The ones that didn’t, weren’t working.  The doxycycline caused photosensitivity in the past.  But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared.  As such, that’s what my patient demanded.  There was only one problem.  The degree of her acne didn’t warrant ...

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I was home free: in my final year of medical school, with one last rotation to finish. I had matched into a residency in obstetrics. The tsunami of stress that loomed over the past year -- choosing a specialty, interviewing all over the country, waiting for the life-altering but fickle match -- had passed. I knew where I was going and what I was doing. Our end-of-the-year show was fast approaching. ...

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It’s Friday afternoon at 4 p.m., and Mr. Anderson walks into my endoscopy suite as the last patient of the day. He’s a 65-year-old publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late, because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery. In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by ...

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Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day. My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing ...

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I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips. It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these ...

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Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable.  Did you notice a particular word missing?  Yes, I missed the word physician too, because they have been left out of the conversation entirely. Measuring quality health care by ...

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As an orthopedic sports medicine surgeon newly in practice, I read with interest Gina Kolata’s article "Why ‘Useless’ Surgery Is Still Popular." As a doctor with a research background, I often champion the importance of research and promote a practice rooted in evidence-based medicine. It also came to me as no surprise when my partner and several physician assistants in the practice pointed out the article to me. ...

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