Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing at Blair General Hospital. Thanks to my mother, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B, and he was a legend in my home state of North Carolina. My mother was a ...

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It used to be that hospitals billed Medicare for the services they provided, and Medicare -- I know this is crazy! - simply paid the bills. Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare ...

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In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have ...

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Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know ...

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In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals:  “Isn’t it hard on your kids not to have you home on Christmas?”  Thankfully, I was always able to answer truthfully, “no.”  With consistent effort and a no-nonsense attitude, my kiddos either didn’t know the difference because they were ...

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For any health care professional, a typical day in the hospital brings about its unique challenges. Depending on the patients that we see, one second the situation can be routine, and the next second, it can become complex. In the midst of this flux, there is an expectation for us to make important decisions, with the speed of these decisions dependent on how a patient is doing at a given ...

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With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace:

Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back ...

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Nothing compares to the apprehension of starting residency. OK, that’s not true, but it’s really high up there on nerve-wracking firsts. I remember my first day as a resident. In a matter of a few hours, I went from being human furniture to being asked to make life-altering decisions. I was overwhelmed, to say the least. Here are some pieces of advice that I wish senior residents would have emphasized before I started this ...

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In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when I headed back home. I'd picked up the service on the cancer ward from an intern named Bob, and he left me six handwritten pages on the subject of Jim Franklin. This was the deal: Jim Franklin, thirty-seven years old, was in the cancer ward ...

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A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, "Virginia Mason Health System ... has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota." The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value. Attempts ...

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