There’s no mystery about why the July 23 execution of Joseph Wood in Arizona took so long. From the anesthesiologist’s point of view, it doesn’t seem surprising that the combination of drugs used -- midazolam and hydromorphone -- might take nearly two hours to cause death. Here’s why. The convicted murderer didn’t receive one component of the usual mixture of drugs used in lethal injection: a muscle relaxant. The traditional cocktail includes ...

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When the Joint Commission is at the hospital, leave Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before. If you’re a patient who walks into a hospital for an elective procedure of any kind -- surgery, or a diagnostic test -- and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left. Why? ...

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The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively and not spend time on tasks that can be ...

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I give what could be lethal injections for a living. That’s right. Nearly every day I give someone an injection of midazolam, vecuronium, and an IV solution containing potassium chloride–the three drugs in the “cocktail” that was supposed to kill convicted murderer Clayton Lockett quickly and humanely in Oklahoma. Here’s the difference between an executioner and me. I use those medications as they are intended to be used, giving anesthesia to my ...

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Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government. There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict ...

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The creatures cause pain by being born, and live by inflicting pain, and in pain they mostly die. –C. S. Lewis The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God. The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem ...

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We hold these truths to be self-evident:

A hospital administrator with a clipboard is in search of a physician who isn’t following “evidence-based guidelines.” There are fads in medicine just as there are in fashion -- today’s ”evidence-based guidelines” may be tomorrow’s malpractice.
Did your hospital, like so many, abruptly switch from povidone-iodine antiseptic solution to ChloraPrep® for cleaning a patient’s skin before surgery?  If so, I’m sure the staff was told that ChloraPrep would ...

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We guard the privacy of patients in my hospital zealously -- we take care of a lot of celebrities since we’re right in the shadow of Beverly Hills.  And of course we live in terror of HIPAA violations, those federally mandated HHS rules that protect individually identifiable health care information and could bring down “civil money penalties” upon us if we don’t keep our patients’ medical records strictly confidential. But for ...

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Anesthesiologist assistants should be able to practice in every stateA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who'll be giving you anesthesia.  If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking ...

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An anesthesia practice is sold, and a warning to young doctors We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon. The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California ...

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