Ran into a radiology colleague today.  He will retire soon, and was happy to discuss the stress on radiology.  I have observed more interpretation errors (or at least I think I have) over the past five years.  We now strongly stress that the learners review all films and question radiology reads. My friend opined that volume expectations have become unsustainable.  We order too many imaging studies.  When you ask physicians to ramp ...

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This post is purposely controversial.  I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue.  This post is hypothesis challenging.  I may be right, or I may be wrong.  I hope we get some debate on my speculations. The latest blow to the cholesterol hypothesis: "Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart ...

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This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, "Culture eats strategy for breakfast." Look at ward attending physicians.  The same attendings have “good teams” every ...

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An anonymous medical student has this post on KevinMD -- A star medical student feels like he made a terrible decision:

And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where ...

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Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years.  I count him as a protege as we worked together during his residency.  As a clinician educator, we work with many interns and residents, and sometimes we develop lifelong relationships.  Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine.  We periodically communicate through ...

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I read and listen to much fiction.  While listening to a fantasy novel, one character verbalizes a most important concept.  Every action has consequences.  Those consequences are both expected and unexpected.  We might predict some unexpected consequences, if we only spend some time to think through the likely impact of that action. Bureaucrats and politicians have imposed a series of administrative burdens on physicians and patients.  We use EHRs that work ...

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Readers are slowly learning about my admiration for the Farnam Street Blog.  The about page describes the blog in this way:

My goal is to help you go to bed each night smarter than when you woke up. I’ll do this by giving you tools, ideas, and frameworks for thinking. I’m not smart enough to figure all of this out myself. I try to master the best of what other ...

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Clinician educators have the opportunity and responsibility to influence students, interns and residents.  While we can have some hubris in our education skills, we must always demonstrate humility in our patient care role modeling. Dr. Orhan Muren, one of my early role models, often told us to never be “cocky” when taking care of patients.  As I recall his admonition, I realize that he was urging us to have true humility. But ...

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During my training in the 70s, heroin use dominated our substance abuse horizon.  We saw many patients with IV drug-related complications.  We saw heroin overdoses. For the next 30+ years, we rarely heard about heroin.  Over the past 10 years we have seen increasing opiate abuse, but the opiates came from prescriptions.  Over the past 2 years, heroin has once again reared its ugly head. This article blames physicians for opiate addiction: ...

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Recently, I spent two days in Greenville, SC as a guest lecturer. During that trip, I had time to chat with some hospitalists. During our conversations, I explored a classic problem: the inpatient-outpatient handoff. Talk with hospitalists and you will discover their angst about getting outpatient information on their admitted patients. Talk with primary care physicians and they echo the angst when seeing recently discharged patients. Personally, I have experienced both sides of ...

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