I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today. Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a history of coronary disease and had an intracoronary stent ...

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What I love about being an anesthesiologist I wear a lot of hats in my job.  Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table. Many days I spend in an administrative leadership role or conducting research studies.  These functions support the best interests of my patients as well as the science ...

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Happy BRA Day! October 15 is officially Breast Cancer Reconstruction Awareness Day. It’s a natural time to discuss commonly-asked questions about breast reconstructive surgery. Breast cancer is a devastating diagnosis and the treatment tends to have a direct impact on a woman’s self-esteem, especially if there has been a mastectomy or partial mastectomy. Just knowing breast reconstruction is an option is consoling; it offers hope for many patients. Yet physicians and ...

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In August, I posted this: "A paper of mine was published. Did anyone read it?" A recent comment on it raised an interesting point. Dr. Christian Sinclair at Pallimed said the site had received almost 2 million views since 2005. He then made the following calculation: Two million views with an average of 1:30 minutes on a page = 3 million minutes = 50,000 hours = 2,083 days = 5.7 years ...

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Outpatient anesthesia in elderly patients: What to watch forA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More than 75 percent of operations in the U.S. occur in an outpatient setting. Outpatient, or ambulatory care, can take place in a number of different settings, including physician offices, outpatient surgery centers, or hospital or non-hospital-based outpatient clinics. With more and more elderly patients undergoing outpatient ...

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The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public -- and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed. As a result, the responsibility ...

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The outrageous $117,000 bill from an assistant surgeon Recently, I wondered why Medicare could not control its costs using the investigative power of the federal government instead of releasing physician payment data and relying on journalists to do the work. Two stories that appeared within days of each other raise a similar question about the private insurance industry's methods. An article in Modern Healthcare described the impending closure of ...

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Joan Rivers death: What went wrong? The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews. With a physician who is an expert in airway anatomy at her side, and all the technologic advantages ...

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Part 2 of a series (read part 1). I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper before anyone had had the decency to contact me. What kind of people act like that? Civilized behavior, respectfulness -- in short, all the ways in which you'd think nice ...

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“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds. Mr. Jones just had a transhiatal esophagectomy (THE).  The esophagus is the muscular tube that connects the back of one’s throat to their stomach.  It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed. A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up ...

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