I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue ...

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Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get ...

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asco-logo When I was in medical school, I loved pathology. The visual learning and deep understanding of disease were attractive enough that after second year, I took an extra year before clinical rotations to work as a post-sophomore fellow, working as a resident cutting specimens and performing autopsies. I missed patient contact but it served as a great foundation for clinical medicine ...

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Q. Have you ever thought about doing a post on oversaving? I realize most docs probably have the opposite problem, but I bet there is a subset of the FIRE crowd that this may apply to. Does this ever come up in all the interactions you have? A. It was no surprise to see this question come in as a direct message on the WCI Forum, rather than an email ...

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You’ve probably seen it on the news – a rare, polio-like illness is causing cases of paralysis in children. Here’s the latest info, based on our best current knowledge from the CDC. Acute flaccid myelitis (AFM) is a sudden illness that causes weakness in one or more extremities – one arm or (less likely) a leg, or any combination of arms and legs. The words in the name express the key ...

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Disability can be a devastating outcome to a doctor’s career and self-image. Think about it: You busted your butt to learn how to do a Whipple procedure, end up getting into a skiing accident that ends your career right there. No worries, because you purchased the appropriate coverage of own-occupation disability insurance, right? Having disability insurance certainly provides a protective cushion, especially you are the sole breadwinner. This is a no-brainer, ...

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An excerpt from Leadership Lessons from History: A Study Guide Written for Physicians & Other Healthcare Leaders. In June 1812, Napoleon invaded Russia along with an army of 600,000 men; fewer than 100,000 made it back. During their ignoble military withdraw, in the middle of a terrible winter, thousands of ...

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I am a critical care physician and spend a good amount of time in the emergency room seeing consults. As an internal medicine resident, we were often in the ER, admitting new patients. In my three years of residency, we spent only two to four weeks working in the emergency room. It was the one time I had an insider’s view of life as an ER physician. And, man, was ...

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After my surgery rotation, I was in a very bad place. I felt like two months of grueling work hours and relentless studying were wiped away in an instant by a bad test score. That single number somehow mattered more to me than every positive comment I had received from my patients, colleagues, residents, and attendings. I felt like I had put my heart and soul into that rotation, constantly ...

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Recently, social media and news organizations have been awash in the physician-led backlash to the NRA’s now infamous “stay in your lane” tweet, and consequently, awash in images of the literal blood of seriously wounded or now deceased patients. Gun control is undeniably a cause near and dear to many physicians, who are duty-bound to try desperately, many times in vain, to save the lives of too many innocent Americans ...

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This article is sponsored by Careers by KevinMD.com. After spending a decade in college and medical school, followed by internships and residency, seeking additional guidance at the beginning of your career may seem excessive. You’ve already taken direction from dozens of leaders; isn’t it time to cut your own path? Yes and no. You’ll make plenty of your ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated during a routine follow-up visit. Medical history is significant for hypertension and chronic active hepatitis B infection. Her hepatitis B infection has been treated with tenofovir for the past 5 years with suppression of her serum hepatitis B DNA levels. She currently notes mild ...

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It’s that time of year again when retail outlets start counting down the days to Christmas and deck their stores with holiday cheer. For many people, this time of year feels magical. Yet for others, it is a consumer competition to buy the absolute best gift at the lowest price. While both these groups love the holidays in their own way, there is a third group for which the holidays ...

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Recently, a physician asked my opinion if a patient needed a colonoscopy. My partner was already on the case and I was covering over the weekend. The facts suggested that a colonoscopy was warranted. The patient had a low blood count and had received blood transfusions. Certainly, a bleeding site in the colon, such as a cancer, might be responsible. We do colonoscopies to address similar circumstances on a regular ...

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“Admission diagnosis: causa socialis” In my training in Sweden, it was not unusual to admit patients to the hospital for social reasons: an elderly person who could no longer manage at home, a person whose social network fell apart, and so on. “Social reasons,” causa socialis, was a legitimate diagnosis (Swedes used more Latin than Americans, at least back then). And it was used with only mild grumbling. There was a clear ...

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I enjoy talking to random people about their experiences with health care. As somebody who regularly travels all over the country, for both work and pleasure (I far prefer the latter), whenever I meet people in situations where you end up talking -- be it on airplanes, a guided city tour, or at a social function -- as soon as I say I’m a physician, the conversation invariably ends up ...

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STAT_Logo I have had the fortune — both good and bad — of being at the forefront of reforming physician reimbursement as an advocate for physicians. I’ve worked on models spanning private practice, group employment, faculty practice plans, and independent physician associations. It’s been a bruising journey. There were the old ways — relative value ...

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I like to think of myself as a relatively optimistic person.  If you have ever met me in person, you might think that I have a pretty sunny disposition on life.  And for the most part, I do.  Since I write every day, however, there are times when my posts may start going negative.  Not for an extended period, but long enough for my readers to wonder if am just a touch ...

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Another study reiterates what we already know: In droves, millennials are venturing away from the traditional model of securing a primary care provider and opting not to access health care “as usual.” Still, too many physicians do little more than shake their heads over this. We wonder when millennials will figure out they need a medical home for the best possible care – especially when a medical emergency occurs. But, guess what? ...

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On Wednesday, I did a gunshot-wound autopsy. On Friday, I was going into the morgue to perform another when I checked Twitter and saw this. Doctors across the U.S. and across medical specialties were already responding and sharing photos: their face shields spattered and scrubs drenched in their patients' blood; more blood on the emergency room ...

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