A surgical resident is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training. The St. Louis Post-Dispatch article about this has a link to a 42-page PDF describing the details of the suit. Because I suspect you won’t read that PDF and maybe not even the article, I ...

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I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause. To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information. A 
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An article in Newsweek magazine says, “Artificial intelligence will cure America’s sick health care system” using data and automation to “drive down the costs of health care while increasing effectiveness.” According to Newsweek, it will work like this for diabetes. A company called Virta Health has come up with a smartphone app that is like “a live-in doctor and diabetes coach.” Type 2 diabetics who enroll will enter data such ...

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The New York Times says nonadherence to prescribed medications is “an out-of-control epidemic” in the U.S. and quotes a review in Annals of Internal Medicine, which found “20-30% of medication prescriptions are never filled, and approximately 50% of medications for chronic illness are not taken as prescribed.” For example, “a third of kidney transplant patients don’t take their anti-rejection medications, 41% of heart attack patients don’t take ...

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Here's a question that has been debated for several years: Should radiologists talk to patients about their imaging results? Citing several issues, I came down solidly on the "no" side in a 2014 blog post. Two major radiology organizations have committees looking into the concept, and New York Times article said, "they hope to make their case [for it] by demonstrating how some radiologists ...

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A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment. The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes -- ...

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I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.

I'm a third-year medical student at an allopathic state medical school. I've always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn't failed anything else throughout first ...

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And if they can, should they? In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices ...

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After writing my 21st post about appendicitis back in November, I swore I would not write about it again for the foreseeable future. Well, the future is now because investigators from the United Kingdom and Canada just published a meta-analysis including ten papers and 413 children about the efficacy and safety of nonoperative treatment for appendicitis in children. They concluded that nonoperative management is effective in 96 percent ...

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A study of over 890,000 Medicare beneficiaries shows that states with malpractice environments unfavorable to physicians do not see improved postoperative outcomes for 11 different types of mostly elective major operations. States with higher general surgery malpractice insurance premiums had significantly more episodes of postoperative sepsis, pneumonia, acute renal failure, and gastrointestinal bleeding. Those with higher numbers of paid claims per 100 physicians had more postoperative myocardial infarctions, surgical site ...

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