A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked "white as a sheet", and a physician who was at the gym told him he must go to the emergency department. In ...

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Recently, getting dressed after working out in the gym, the guy in the next locker decided to complain to me about his recent surgery. Having lockers next to each other had led over time to "What do you do for a living?" After discovering that I was a physician he has occasionally asked some medical questions, and done what a lot of people do when they know you're a health care ...

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A few days ago, just after dawn, while I was out walking the dog, our home phone rang and my wife answered it. She's used to my pager, cell phone, and home phone ringing at all hours, and so she was not all that surprised when an unidentified voice said,"We're looking for the methadone dose for patient John Q. Smith." She told him I was out of the house at the moment, ...

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At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual? At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result ...

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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments. While we are a very busy practice, and this is not ...

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I recently took a three hour online course on something I learned to do when I was a medical student. And I thought it was something I had been doing fairly well for the past 20 years.

New regulations have come down requiring all practitioners to take a CME-certified course on safe and effective management of opiates for acute and chronic pain. This has clearly ...

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Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie. Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to ...

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The phones, the phones, the phones. Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can't lick, a continual thorn in the side of our practice, something that's hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without ...

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Long ago, before our hospital changed over to a nearly complete hospitalist model, the faculty at our internal medicine practice served as the attending of record for all of our own patients, as well as the patients of the residents we supervised, when those patients were admitted to the inpatient services across the street. When we would arrive in the morning, we would look at the admission list, note that one ...

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"I can do that?" During a recent morning practice session, a resident was presenting a patient who had had several episodes of syncope which culminated in a trip to the emergency room. She had a brief stay there, and on the discharge plan was written "follow-up with PCP and with cardiology."

We went through her history and physical examination, we talked about how to further ...

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