As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, "Where to teach?" I do not mean to imply a geographic sense to the word "where" (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a "level." What level do I teach our residents ...

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He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "hellos," "good mornings," and "any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He hurried upstairs to the conference ...

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"Dad, you have the nicest patients!" She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what's important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been over ten years since I had my first "bring your daughter to work" experience.  Her first time ...

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Recently, the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled "Skill Reviews Upset Doctors." While it is certainly nice to see an article reaching the main stream media concerning doctors' concerns with the MOC program, the issue with the MOC debate is not that doctors are upset.  The real issue is ...

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Disruptive innovation is competitive strategy for an age seized by terror. - Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong "What do you want me to do with all the stuff in this box?" my wife asked this weekend. I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations -- a ...

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It's one thing to ask a doctor to stay current on his knowledge, it's quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research. Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM's requirement for a practice improvement module worth a required 20 ...

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The health care industrial complex is stronger than ever Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn't help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by ...

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Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on "medical professionalism" was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:

  1. the principle of primacy of patient welfare
  2. principle of patient autonomy
  3. principle of social justice
The first set of professional responsibilities for physicians was ...

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If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly ...

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I have been a way from blogging for a a bit and tried to clear my head a bit with a vacation skiing.  I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint.  It was nice to notice that there's a whole world ...

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