I was very saddened to learn this past week of another physician who died by suicide.  This, the untimely death of a young and brilliant mother of two, is a horrifying tragedy. I do not write this to pretend I know anything about this recent tragedy.  I write this as a sort of case report on myself.  I was an at risk physician at one point. I’ll start where the problems most ...

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I burned out, big and bad.  I can see that now.  My practice environment had become gradually untenable and every attempt I made to change it was blocked.  My call schedule was inflexible and a lot more frequent than when I started my job.  The hospitalists and ED kept sending me cases I didn’t feel qualified to manage, but as it was usually the middle of the night and I ...

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"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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