What causes a doctor to commit suicide?A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in ...
Skeptical Scalpel, MD
Length of stay differences in the uninsured is less than you think
There was a bit of excitement on Twitter recently with a number of tweets about a paper published in the Annals of Family Medicine which shows that uninsured patients are being released from hospitals significantly sooner than insured patients. The numbers don’t lie.From the abstract: "Across all hospital types, the mean length of stay … was significantly shorter for individuals without insurance (2.77 days) than for those with either private ...
Why the future of medicine is not looking too good
Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?a. Feeling of insufficient medical knowledge b. Health system reform c. Educational debt d. Availability of free time e. Dealing with patientsIf you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey ...
The shortage of general surgeons demands attention
There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.Demand-side factsThe current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.As baby ...
New fields in general surgery and the rise of the surgical hospitalist
As medicine adapts to the 21st century, new specialties arise.General surgery is seeing two new fields emerge. One is "Acute Care Surgery," which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical ...
Think about medical school tuition debt before becoming a doctor
Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.Suppressing the urge to tell him not to even consider ...
Physician blogs, doctors on Twitter and a malpractice trial
You are in the middle of a deposition.Plaintiff’s lawyer asks, “Do you blog or tweet?” Before you answer, consider this. If you blog or tweet and respond in the affirmative, I believe anything you have ever posted would be subject to discovery by the plaintiff. Oh, you post anonymously? Would you then lie under oath and say you do not blog or tweet? For many physicians, admitting that you blog ...
Appendicitis in children and radiation exposure from CT scans
Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular ...
Advice for a second year medical student
A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai ...
Wound infections and the Surgical Care Improvement Project (SCIP)
The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised ...
Create a family practice mystique in medical school
For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of ...
