The other day Atul Gawande tweeted the following:

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and ...

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It is so nice to be right. To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they'll get an accurate diagnosis. A recent study validates that opinion. MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries ...

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Live tweeting from conferences has become very popular, but I'm not sure why. The biggest problem is this: Lucid communication of a point made by a speaker using more than 140 characters at a time is difficult to capture in a tweet. The tweets tend to be filled with obscure abbreviations and references to previous tweets that may seem quite clear to the tweeter but not the tweetee. Some also post ...

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Google Glass has a long way to go in the OR The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion. Here is what I thought about the event. The case started about 30 minutes late, which is similar to what would have happened in any ...

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Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones. As I stated before, I will not ...

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Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery. The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients. Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis ...

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As everyone knows, residents are now restricted to working 80 hours per week. One of the lesser known side effects of this work hours limitation is the drastic loss of educational conference time. Since at least one third of the residents must now go home after morning rounds, afternoon conferences are no longer possible. Most residency programs now devote part of at least one morning per week to dedicated educational time. JAMA ...

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A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren't all board recertification examinations given orally. She correctly asserts that oral examinations are better because they assess how people think rather than how much they have memorized. Here's why it would be difficult to do. The initial surgery board exam is given in two parts. First a written ...

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A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools. In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical Education ...

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A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things. This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I ...

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