I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, ...

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I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy. Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill ...

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At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor. Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data. Leapfrog’s top 98 included 62 urban, 24 rural, and ...

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Dear health care administrator, I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the ...

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I just finished reading a very delightful A Piece of My Mind essay in JAMA.  JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is ...

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A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized. My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible and ...

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“Son, just let me die.” Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited -- the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and ...

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asco-logo She had been admitted overnight: a previously healthy 62-year-old woman who had been blindsided by acute onset of abdominal bloating and pain 6 months prior. A flurry of tests showed she had pancreatic cancer, and that it was advanced. She had started chemotherapy, but the regimen was so toxic; she suffered from unrelenting nausea and fatigue to ...

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There’s been a lot of talk for quite some time in health care quality improvement circles about why health care can’t be as safe as airline travel. Some of the reasons behind asking this question are very valid, as there are many things health care can learn from the aviation industry. Others, however, are complete fallacy; because on so many levels, it’s like comparing apples to oranges. Over recent weeks, I’ve ...

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This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, "Culture eats strategy for breakfast." Look at ward attending physicians.  The same attendings have “good teams” every ...

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