Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air. The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents ...

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One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts. I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and ...

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For the first time in my career I asked myself that question. Over the years, I’ve had more than my share of difficult cases. I’ve had patients with life threatening conditions whom I wished I could offer more than to just shake my head and speak empty words of encouragement. They stare back at me and I see their eyes full of hope. How many times have been forced to ...

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Today I had the displeasure of sitting in judgment before a modern inquisition at one of the hospitals I attend. Although the grand inquisitor lacked the trappings of a monsignor or bishop, and without a physical executioner in the room, I was subjected to  round after round of questions regarding my apparent disregard for system wide medical and post surgical protocols. Such protocols have been adopted by CMS (which oversees ...

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Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call. “Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message. Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him. So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, ...

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“Will this case take very long?” “If  the surgery gods are with me we should be done in an hour.” The above brief exchange took place between me and the anesthesiologist attending to my patient on a recent surgery.  The patient was a middle aged woman who was about to undergo surgery to relieve a small bowel obstruction. She had been visiting her husband in a distant city where he was working ...

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I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in ...

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Today I experienced another example of the growing efficiency of the healthcare world: The Steward of Scripts. First, a little background information is necessary. After I perform surgery it is necessary to perform a number of immediate post operative duties. The operative note must be dictated, a brief note is written in the chart, post operative orders are written and, for patients that are going home the same day, prescriptions must ...

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An excerpt from Behind the Mask. Why do you do it? Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter ...

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The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, but does take time away that could be better utilized caring for our patients. However, the last four days have demonstrated that the administrative ...

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