Confidence is contagious. So is lack of confidence. -Vince Lombardi “So, can you leave this here with us?" I was part of a group of U.S. surgeons traveling to Eldoret, Kenya, seeing patients and helping the Kenyan ENT surgeons learn surgical techniques. Our two week mission allowed us to work across-the-table from Kenyan colleagues, discussing surgical approaches, demonstrating techniques, and reviewing all aspects of surgical care. “I have never seen such a thing!” my ...

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A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things. This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I ...

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Where I’m from, you can have someone killed for $5000.  I will do it for $1110. I’m a hand surgeon. I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.”   Rather, the area isn’t, but the people I treat are.  I work in a large urban referral center that has a very high proportion of Medicaid as well as ...

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It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery. Do you know where you are right now? Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon ...

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The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status. While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon. Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering ...

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One of the hardest things about being a surgeon is the inevitability of complications. It's true for any doctor; but with surgery, it's as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big ...

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I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to Google me and have my blog come up on the first page of hits. Now that I've been retired for over a year, I still have not ...

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Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing "report cards" that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery. Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals. Has ...

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Is nerve block anesthesia better for surgery?A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More needles ... who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease your risk ...

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One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine -- putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle ...

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