Questions such as this from proactive, increasingly knowledgeable patients place a physician on the horns of an ethical dilemma.  Although fellows are closely supervised and trained under a gradually increasing responsibility principle (based upon subjective evaluation), a time will come when there is no one available to back you up in the catheterization lab. Fact: Someone has to be a physician’s first case of any given type. However, no one really ...

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In my office, every new patient encounter starts the same way.  I walk in and say, "Hello."  Then I put down my computer (which I take from room to room), wash my hands (which I purposely point out that I do before I touch anyone or anything else), and then I turn to the family and greet the child first.  Depending on the age, I might be squatting and gently ...

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There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone. In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more. Then, in the 1970s, 80s, 90s, ...

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Janus is the Roman god of doors and gateways but also the god of beginnings.  Interestingly, good beginnings and required for good endings.  The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day.  Most statues of Janus show him with two faces facing opposite directions. The Janus principle in your medical practice is the idea of ...

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If you follow sports media, you have no doubt heard of PRP by now. Hines Ward made it popular in 2009 when he received PRP treatment for a knee injury just before the Super Bowl. Kobe, Tiger, A-Rod, and many other high profile athletes have reportedly received PRP treatments. But what is it? Why are these athletes receiving it? Can you get it, too? Let’s discuss. I'll begin with the basics. ...

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Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child's face. A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor. As such, the plastic surgeon is called in and sutures up the face beautifully. The child and family ...

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Many doctors are now getting into movie production and making videos that are loaded onto YouTube.  These videos are effective in attracting new patients and educating your existing patients.  There are a few guidelines that you can use to create an effective script for each of your videos.  These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in ...

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All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies. Why? Because they are the only games in town, and both security and safety are top Maslow imperatives. The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a ...

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Only trained physicians should provide interventional pain services A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most ...

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Really, sir.  What were you thinking? I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol.  Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow. I would insert the link here, but the ...

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