"Does he speak English?" As I was busy working at my computer dictating on the last patient, I overheard the question posed to my receptionist.  The receptionist, unfazed, responded with a polite, “yes.” My medical assistant ushered the patient into one of the exam rooms where Ms. Smith proceeded to expound on how she had experienced some less than ideal interactions with Indian physicians -- they had seemed cold and curt; their ...

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“An expert is a person who has made all the mistakes that can be made in a very narrow field.” - Niels Bohr Five experienced, well-published, and widely respected head and neck cancer surgeons are sharing the dais at the national medical meeting to explore the topic “Can We Be Better?” The panel represents a spectrum of experts from around North America, and they have served as program leaders, department chairs, and ...

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In the interests of full disclosure, I acknowledge with delight that I have a non-time limited board certificate from the American Board of Anesthesiology (ABA), issued before the year 2000. I can just say “no” to recertification. The more I learn about the American Board of Medical Specialties (ABMS) and its highly paid board members, the more disillusioned I’ve become. It’s easy to see why so many physicians today have concluded ...

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I was sitting next to two of my co-residents during a break in conference this morning, answering emails on autopilot and half-listening to the buzz of conversations around me, when their muffled laughter caught my attention. “What’s so funny, guys?” I asked them, thinking that a good joke or funny story might break up the monotony of hours of lecture. The reply I got stunned me. “It’s man talk,” one of them ...

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A before and after study at the University of Vermont Medical Center found that a 24-item operating room checklist did not significantly reduce the incidence of any of nine postoperative adverse outcomes. More than 12,000 cases were studied, and outcomes included: mortality, death among surgical inpatients with serious treatable complications, sepsis, respiratory failure, wound dehiscence, postoperative venous thromboembolic events (VTE), postoperative hemorrhage or hematoma, transfusion reaction and retained ...

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Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire.  His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade.  However, I disagree with his latest initiative: to get hospitals who perform certain procedures at very low rates to stop performing them altogether. On the surface, it seems like a ...

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According to the Residency Review Committee for Surgery, "A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care." In nearly all instances, resident "determination or confirmation of the diagnosis, provision of preoperative ...

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Her voice cracked with strain. I could imagine the woman at the other end of the line shaking, overcome with remorse about the hospital where her husband had had esophageal surgery. Might he still be alive, she asked me, if they had chosen a different hospital? The couple had initially planned to have the procedure done at a well-known medical center, but when she went online to do her homework, she ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The possibility of anesthetic neurotoxicity in infants and children -- the supposition that anesthesia may alter normal activity in the nervous system - was first suggested more than 15 years ago with findings of increased neuronal cell death in the developing brains of rodents ...

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I had a familiar conversation the other day with yet another female medical student. “I really loved surgery!” she said, “but I was concerned about the lifestyle, so I decided on ______.” Lifestyle — it turns out — almost always seems to be code for having a family. Maybe it’s just the kind of students who seek me out. I have yet to encounter someone concerned that a surgical career will hamper their ...

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