Comcast recently announced it is merging with Time Warner, the 2nd largest cable company in the US. Together, this deal nets Comcast an estimated 57% of the cable subscriber marketplace and heralds a new oligarchy in US media and entertainment. It’s big news for Comcast, but  aren’t as excited. Why? Because both Comcast and Time Warner have been consistently rated the worst providers of customer service in the cable industry. Now as they ...

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His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual. I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse's station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance ...

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Communication is critical to success in medicine.  Our patients depend on us to help them understand their disease and the risks that it may pose.  In previous blogs I have commented on how vital effective communication can be in determining outcome -- much of my writing has focused on the success associated with outpatient doctor-patient relationships. We now know that when doctors and patients engage, patients become invested in their ...

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Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come. The word “hospitalist” was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Back then, hospital medicine was a strange new phenomenon. Fast-forward to today, ...

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You may never have heard the name of Dr. Charles R. Denham until the Justice Department alleged he took nearly $12 million in kickbacks from CareFusion Corp. to influence a national guideline for a product hospitals buy to prevent infections during surgery. But you surely know the names the radiation-oncologist-turned-activist-and-entrepreneur rattles off as those with whom he has worked. They include organizations such as the Centers for Disease Control and Prevention, the Cleveland ...

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When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky.  And over time, I came to truly appreciate the small, rural hospitals that called us for help ...

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Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was inappropriate for your patient just to exit the screen? This is the situation with my local medical institution's "DVT Advisor," a mandatory decision support screen for all patients. DVT Advisor was implemented ...

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It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has ...

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8:00am Sunday: You glance over and notice an email from your boss while you’re eating breakfast and reading the paper. Ok, you think, I’ll respond later, maybe after my run. 8:10am: Ping! A text arrives. "I have a question about the project." Ok, you think, it’s Sunday, but sure, I’ll get back to him after breakfast. 8:20am: The phone rings. It’s him. "I’ll need that slide for tomorrow’s presentation. How soon can you get it to ...

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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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