The numbers haven’t changed significantly in several years -- only five percent of the U.S. population consumes a full 50 percent of annual health care spending, and just one percent is responsible for nearly 23 percent of spending. Within the top 10 percent of high spenders, most (nearly 80 percent) are age 45 or older. About 42 percent are persistent high consumers year after year, while the majority requires high spending ...

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I am an ENT surgeon, a friend of the author, the patient, and their daughter, whose intervention saved his life. This is a smart, loving family caught in a terrible vortex of terrible medical care until they pulled themselves out, and a story that physicians must read, as we struggle to reinstate humanity and humility into our noble profession. Here is Paul's tale, as told by his wife. *** On a mid-December ...

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The other day, I was operating on a little girl with a congenital ear abnormality. Not life and death stuff, but delicate surgery nonetheless. My surgical scrub technician was someone with whom I hadn't worked before, and I asked him if he was enrolled in the operating room nurse training program, as many of the new folks are. "No, I'm just a tech." I stopped what I was doing and replied: "You ...

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The brave teenager was sitting in the corner of the hallway away from other children.  A long, torn cloth covered his face, more specifically his mouth.  After slowly approaching him, I sat down right next to him.  He shifted slightly away from me with a sheepish wide asymmetric grin on his face.  As I began to converse with him through a translator, it became obvious he did not want to ...

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The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial randomized American surgical residency programs to one of two arms:

  • Standard group continued with their current standard restricted hours practice of 80 hours per week with time for breaks/rest and a limit to hours of work at any one time.
  • "Flexible" hours group removed current restrictions on hours worked at any one time and waived the need for breaks ...

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There are few aphorisms in medicine that stand up to reality. Here are two: Physicians get the patients they deserve, and we tend to die like we live. Paul Kalanithi’s posthumous memoir proves both: As a neurosurgery resident at Stanford, he took on the most challenging cases, and when diagnosed with terminal lung cancer, he lived and died pursuing excellence and truth. I read When Breath Becomes Air on ...

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Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda. In my nearly ...

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Recently, two states in India halted all use of Avastin for the treatment of eye disease following the report of 15 patients who underwent emergency surgery for potentially blinding infections at the C.H. Nagri Municipal Eye Hospital in Ahmedabad.  Though further investigations are ongoing, there is worry that the cluster of infections centered around a tainted lot of compounded Avastin. This most recent event serves as a reminder of ...

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In honor of Black History Month, the folks at Diverse Medicine created a new documentary series, Black Men in White Coats.  In this installment, we meet Dr. Brian Williams, a trauma surgeon at UT Southwestern Medical Center.

Today is a remarkable day for me. I’m officially leaving private practice after almost 18 years, to return to academic medicine with a faculty position in a highly regarded California department of anesthesiology. Why would I do that? There are many positive reasons. I believe in the teaching mission of academic medicine:  to train the anesthesiologists of the future, and the scientists who will advance medical care. I enjoy teaching. The years ...

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