A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling ...

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The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice. Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any ...

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I have a love-hate relationship with the no-show patient.  Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my ...

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One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, ...

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This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital. I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and ...

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If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata.  You may find those colleagues revolting; I know I did.  I despised these physicians and felt nauseated even to be in the same room as them.  But as time went on, I realized that almost nobody starts a career ...

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21 minutes on the phone for a pre-authorization? Watch Dr. Ryan Neuhofel try to get a CT scan "approved." Take a deep breath, and press play. Want to escape pre-auth hell? Consider attending the Direct Primary Care Summit.

Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one. Unfortunately, many of the tactics used by administrators have done little to achieve that goal. ...

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Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty. “Once you ...

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“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public.  As a PALS instructor for more than a decade, I have always responded when possible.  In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies.  A week ago, I discovered the best reason I ...

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