I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick! The thing about the very sick patients I see is that they are generally what might be called medical "train wrecks." They are very sick because they have had interventions over the years ...

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There is little doubt that over the next few years we will see a wave of increasingly sophisticated point-of-care tools to help clinicians determine the costs and relative value of their medical recommendations. I welcome that day, but I do not intend to idly sit by waiting for it. Not all solutions need to be based on high-level algorithms or slick, user-friendly apps made for iPhones. Last month I came across a ...

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In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn't even the cheapest way to go to school...So the question is: why did we go? We went not because of the financial value of free--that is, zero tuition--but rather, because of the academic value of free. At Cooper Union ...

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When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.” Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop ...

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Hospitals need to overhaul their processes so they can help the un- and under-insured stay healthy. Many people running health care institutions tell me that they have been fighting the fight, learning to be nimble, transforming their cultures, making big changes as the landscape rearranges itself like a really bad day along the San Andreas Fault. But in comparison with the actual scale of the problems, most of the business models and ...

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There’s a piece in the Atlantic entitled "The Psychology of Lululemon." I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out -- that in some way, clothes have power over the wearer. Of course, I ...

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In retrospect -- always in retrospect -- it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right. In a remarkable number of cases of medical errors, it’s clear -- again, in retrospect -- that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want ...

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Two decades ago, a decision was made by Medicare policymakers that carotid endarterectomies would not be allowed. Their claim was too many were being done costing Medicare money. The following year, data revealed a sharp rise in debilitating strokes, so wisely, surgical criteria was developed recommencing the use of this quality-of-life saving operation. For years, there have been other misjudgments against Medicare patients that are only now becoming apparent. Let me clarify ...

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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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