When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be ...

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As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis.  His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and hepatic encephalopathy. It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service ...

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Physicians are accustomed to seeing patients at the end of their lives.  It is difficult to let families know they may lose their loved one.  Clinicians are often accepting of patients DNR orders before family members are ready.  This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention.  It taught me an unforgettable lesson. During the first ICU ...

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Twenty years of experience and research reveal two indispensable truths about hospitals and health care organizations that can no longer be ignored: Those institutions neglecting the basic fundamentals of patient care risk jeopardizing the quality and safety of care they provide. Nothing can have a greater short and long-term impact on the cost of delivering health care services than nurses. The central role of the nurse in patient care For more than 60 years, ...

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For the last couple of days, the Twitter medical community has been discussing the latest in a long line of papers attempting to estimate the role of medical error as a cause of death. A recent entry appeared in the BMJ and was by a surgeon at Johns Hopkins, Dr. Martin Makary, who claims that 251,454 patients die from medical error every year. Makary's review extrapolated that figure from three papers ...

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I received the sign-out from a colleague that he was to be transferred out of the medical intensive care unit to our service, as we were the team on call that evening.  My intern and I prepared to see him in the unit before he was moved to our floor, which involved reviewing his chart and having preliminary discussions about continuing his care. Soon after, we arrived to the unit, checked ...

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A few weeks ago, I woke up feeling under the weather. It was day one of seven consecutive shifts. I looked into the mirror. A sullen face with sunken eyes stared back. As I was getting dressed, I felt fatigue trying to triumph over my body. Next came a nagging and rude cough that kept interrupting my sentences. I started to feel feverish, and sure enough, I measured a temperature ...

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The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about the prevalence of serious medical errors and obscure the road to addressing the tragic phenomenon of death by medical error. The analysis cites four observational studies on incidents that occurred ...

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Recently, a paper written by researchers at Johns Hopkins asserted that medical error was the third leading cause of the death in the United States.  This received -- as you might imagine -- considerable coverage in the media.  The researchers proposed that death certificates should include a qualifier or indicator that medical error was linked to the death, if in fact it was, so that better statistics could ...

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Josef Stalin famously said: "One death is a tragedy; one million is a statistic." Perhaps 250,000 preventable deaths from medical errors, according to an analysis by Makary and Daniel in the BMJ, maketh a Stalin. The problem with Makary’s analysis, which also concluded that medical errors are the third leading cause of death, isn’t the method. Yes, the method is shaky. It projects medical errors ...

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