It’s 7 a.m. We sit down around a table in the physician's lounge to discuss and our patients.  I am a general and critical care surgeon.  Every fourth week I’m “on service” for the ICU.  This is my week. I was off over the weekend.  I’m refreshed and ready to go.  I’m excited.  I enjoy the challenge of taking care of critically ill patients. I get sign out from my partner. ...

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Good pain physicians are dying. Recently, Dr. Todd Graham was shot dead in a parking lot over refusing to prescribe opioids to a man’s wife. Physicians who care deeply and try to do the right thing are being murdered for not prescribing opioids. I prescribe very few opioids in my chronic pain practice. I do so in a judicious and safe manner for my patients. I have excellent training, and I ...

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At 3 1/2 years old, my son was the picture of health. I have an actual picture. He is in jammies, wearing my sunglasses, laughing and chalk coloring the driveway while the sun is shining on his blond hair. That picture frequently flashes in my mind. I posted it on Facebook, my happy, healthy boy. There was no warning and nothing to prepare me for the months ahead. First, it was ...

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I struggle with customer service. I truly never anticipated that it would be such a big part of my career. I never fathomed that it would be something that I struggle with on a daily basis. Well, honestly it does not happen every day and does not occur at every facility that I work at. Yet, it happens often enough that it has affected where I work, how I interact ...

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Competition often works. Competing dry cleaners or donut shops must either improve the quality of their product or keep their prices low, or customers will go somewhere else for their cruller fix. In time, the better businesses -- the ones that provide tastier pastries at a lower price -- will thrive, and less-good, more-expensive businesses will go away. In the long run, all customers benefit from competition between businesses. That’s how ...

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Recently, the Republicans’ health insurance bill was withdrawn, partly because of some Senators’ fear of underfunding Medicaid. The media and Democrats have clearly identified Medicaid as a wedge issue that divides Republicans. Unfortunately, those Republicans that have chosen to support conventional Medicaid, as opposed to supporting a much-needed revamp of this program, have succumbed to false advertisements. So let me review some facts, and suggest some common sense changes that ...

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I spent the week in meetings discussing logistics and hospital preparations for the alt-right’s “Unite the Right” rally to be held this weekend in my hometown of Charlottesville, VA. We discussed the likely injuries that would occur, how we were going to decrease the hospital census to deal with potential overflow, methods of securing the campus, and the latest police updates. On Friday afternoon I summed up our discussions with my ...

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Today, I hugged a stranger. And I didn’t know his name. We had just operated on a young man, probably in his late teens.  He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition.  When he lost pulses in the trauma bay, we cut his chest open and spread his ribs.   His lifeless body laid there as we held his heart in the palm of our ...

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An excerpt from The Other Side of the Bed: What Patients Go Through and What Doctors Can Learn. As soon as I’d opened my mouth, I regretted it. In the hospital, it’s bad luck to say “It looks quiet,” or anything to that effect. At the sound of those words, ...

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In his famous novel, Moneyball, Michael Lewis illustrates the phenomenon of professional baseball scouts focusing on all the wrong characteristics when looking at players. He describes how scouts focus on fastball velocity as a way to compare pitchers, despite the lack of correlation between fastball speed and the quality of a pitcher. As it turns out, the most important factor in a pitcher is deception, not a high-velocity fastball. The ...

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Victim: Female nurse, age 25 Time: circa 1980 Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary. It was an unusually quiet Friday night in this small emergency department. We all knew Friday was "party day": pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions. Not only did we cover the entire city, but we also ...

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On a normal Tuesday, one of my fellow residents did the same things we all do. She woke up before sunrise, put her best face forward, came to work, saw patients quickly, wrote notes, said "good morning" to everyone at morning conference, saw more patients, wrote more notes, then went home. She said "good night" to her loved ones  —  her parents and siblings at home  —  and went to ...

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My partner Judith had pain in her sinus cavity caused by a tumor called a plasmacytoma. After her biopsy, her surgeon called Friday afternoon with the results. She asked him to wait fifteen minutes until I could be home with her to get the news. He had no flexibility and said he could speak either then or Monday. She chose to speak with him then on the phone still alone. ...

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How does the EHR drive burnout? Let’s count the ways. By understanding this, we can develop countermeasures to lower the impact and reduce the risk of physician burnout. We’ve all seen the studies that show that for every hour we spend with a patient, we spend two hours on administrative work, and we take hours of work home with us each night. But as we’ll see, it’s not all just about ...

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Watch Dr. Vaughn Browne's emergency medicine journey. Courtesy of Black Men in White Coats.

We cannot let the anecdote rule over us.   We don’t make sound policy if we are swayed by isolated emotional vignettes.  Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy.  Consider these examples. If an expensive drug treatment program keeps five addicts clean for six ...

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Electronic health records (EHR) have been used for several years. It is the form that physicians use to login sensitive information about their patient. Security and confidentiality of such delicate, valued protected health information (PHI) has historically been a concern, and rightfully so. Over the course of a few years, hacking on broad scales have been common occurrence and PHI is considered a high priority target by such malicious actions. An answer ...

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American doctors are unhappy about a lot of things. Americans, in general, are unhappy about a lot of things. In many ways, both groups share similar concerns. But the road back to happiness may follow a similar path for both, as well. American doctors once felt part of something special. American health care, by reputation at least, was the best in the world, and we were its proud emissaries. We functioned ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. ...

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Do you ever have that “aha!" moment? That moment when a revelation hits you with such a level of intensity that your physical being is jolted. Attention is obtained as if a Louisville slugger or defibrillator pad made contact at an opportune moment. That moment of revelation when a crimson string interwoven through the fabric of your life makes a connection, transcending childhood, college, young adulthood, professional and personal relationships. ...

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