I practiced surgery for many years in a very large hospital.  In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.”  About the same time, two of my colleagues created the Hernia Institute, sensing gold in them them groins.  They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs. These initiatives had two things in ...

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The real problem is not whether machines think, but whether men do. - B. F. Skinner When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a general surgeon and gynecologist in Georgia had performed gallbladder surgery with a laparoscope. “Stupid stunt,” I snorted, or something equally derisive and all-knowing. Some weeks or months later he returned to the topic, telling ...

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"If you can’t do this drunk, you shouldn’t be doing it at all." The eminent professor was speaking to a friend of mine about heart surgery. He was not supporting operating under the influence, or am I. The point is that the technical component of surgery -- the cutting, the sewing, the rearranging -- is very easy. It is true that in the OR, as on the golf course, some are more ...

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Not long ago, Secretary of Health and Human Services Sibelius and US Attorney General Holder issued a stern warning to healthcare providers who are using electronic health records (EHRs).  The federal officers maintain there has been an alarming increase in the charges to Medicare in institutions where EHRs have been implemented, and they warn that those behaviors will be treated as “fraud,” an illegal gaming of the system to increase ...

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She was in her late thirties when her medical oncologist asked me to see her.  Five years before, one of our community surgeons had removed part of her colon for cancer.  She also had a recognized, single metastatic tumor in her liver at the time of that original surgery. The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance ...

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Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who: 1. combine the MD with a JD or PhD; 2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums; 3. are named Michael Crichton. Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery ...

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We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from. Let’s deal with ...

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