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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I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to Google me and have my blog come up on the first page of hits. Now that I've been retired for over a year, I still have not ...

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Should medical school be shortened to three years? I say, "no." Here's why. There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase -- residency training. I do not see how medical students can choose a career path before they have ...

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On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident. The fact is that we aren't really sure what the best way to choose residents is. First, here's what we really do. A 2011 
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A new paper says "metastasis of email at an academic medical center" may cost millions of dollars. A pediatrician from the Penn State College of Medicine kept track of all of his emails for an academic year and found that 2035 mass distribution emails were received. They originated from the medical center in 1501, the department in 450, and the university in 84. The emails were about information technology, academic and professional ...

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New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money. Authoring journal articles is not only enhancing to one's CV (the old "publish or perish" cliché), it is required by residency review committees as evidence of "scholarly ...

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The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise. Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US Supreme Court ruled that states could not prohibit advertising by lawyers. This opened the floodgates for all professionals. Soon advertising by doctors and hospitals became common. I don't know what it's like where ...

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The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published. Science Daily led with the headline "New Infection Control Recommendations Could Make White Coats Obsolete," which is rather misleading since the guidelines say no such thing. I won't reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments. The guidelines say that facilities may ...

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One of my Physician's Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training. Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking. Another commenter said, "We are ...

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An anesthetized patient fell to the floor headfirst from an operating room table during a laparoscopic appendectomy in Scotland. The table had been tilted into an extreme head down position to facilitate the operation. Fortunately, no injury occurred. The Edinburgh Evening News account says that there were 10 staff members in the room at the time the case started, but no one had placed a safety restraint on the patient. A follow ...

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