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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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 marketplace,” said John Carlyle, Sheridan’s CEO, in a recent ...

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The latest salvo in the federal government’s war on physicians comes to us courtesy of the Veterans Health Administration (VHA), which is proposing drastic policy changes to expand nursing scope of practice in all veterans’ hospitals. A new draft VHA Nursing Handbook would eradicate all existing VHA policies concerning physician supervision, and would designate all advanced practice registered nurses (APRNs), including nurse anesthetists, as licensed independent practitioners (LIPs).  This means that ...

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10 questions to ask before anesthesiaA guest column by the American Society of Anesthesiologists. Not so many years ago, surgeons wouldn't operate on patients they considered too old to tolerate the stress of anesthesia and surgery.  Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures. Realistically, even if you believe ...

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Hand hygiene in hospitals has gone too far We’ve run amok with wearing gloves in the hospital.  And by “we” I mean every healthcare worker in sight.  I see people putting on gloves before they’ll give a patient a clean warm blanket.  This is not only ridiculous, it’s actually harmful.  Here’s why. We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the ...

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Burnout: The perfect storm of physician stress To the literal-minded, burning out is the fate of light bulbs and matches.  But whether you read the popular press or medical journals today, you’re likely to find writers who are deeply concerned about physician burnout. What defines physician burnout, and who exactly is suffering from it?  Is burnout an actual clinical syndrome, a slang term connoting fatigue and boredom, or a hazy ...

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Sedasys for anesthesia: Can a machine guide sedation? Movie buffs and science fiction fans certainly remember HAL, the computer in 1968’s hit movie “2001:  A Space Odyssey”.  Considered one of the greatest villains in film history, HAL was capable of reasoning and language processing to assist the astronauts on their space mission.  Ultimately, however, HAL decided that its best course of action was to kill all the astronauts. “I am ...

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