An excerpt from The Night Shift: Real Life In The Heart of The E.R. ©2010 by Dr. Brian Goldman. Published with permission from HarperCollins Publishers Ltd. All rights reserved. Fear and Loathing 12:47 a.m. Two police detectives were waiting for me near the main triage desk; one was a tall male in a sleek black suit, probably in his early forties. He was ruggedly handsome in the manner of Jean-Paul Belmondo, the ...

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A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP The Annals of Internal Medicine recently published an article by Mullan and colleagues on the social mission of medical schools. In the article, medical schools were ranked on their record of educating and training physicians to care ...

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The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well. The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement. According to the terms of the new ...

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Radiation is emitted in various forms. Recently, CT scan radiation has preoccupied (or “absorbed”) the attention of the public and media. As explained: “X rays, γ rays, and neutron beams are considered ionizing radiation. Ionizing radiation may break molecules into pieces, creating ionic free radicals that can be very damaging to tissue.” For this reason, it is imperative that the use of radiation is only by highly trained personnel and that ...

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There are things we (the providers) do to health care that are hurtful. We make protocols and rules that divide us from our patients. Protocols that sometimes make patients feel alone, distant, and disconnected from their doctors. I don’t mean algorithms of care (safe, standardized ways of how and why to treat pneumonia, for example), I mean clinic rules for helping patients schedule and get in to see doctors appropriately. Triage ...

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When I went into medicine, I had clear goals in mind. Helping people. A stable income to provide for a family. I grew up under the spotlight of my father, who is a neonatologist, and lived in awe of his work. I remember being in restaurants with my dad - people would come up to him reverently and sing his praises (to his obvious embarrassment). Talk about their son or daughter ...

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In addition to providing those incentive dollars for meaningful use of a certified EHR, the Health Information Technology for Economic and Clinical Health Act (HITECH) significantly strengthened aspects of the HIPAA security rule, including the penalties imposed under HHS and the Office of Civil Rights. If you are a "Covered Entity" (CE) or "Business Associate" (BA) it's time to get serious, the deadline to be fully compliant with these final HIPAA ...

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I recently finished reading In Their Own Words: 12,000 Physicians Reveal their Thoughts on Medical Practice in America. It is a summary of a 2008 survey from the Physicians Foundation. I vaguely remember filling out this survey. I was interested to see what my colleagues had to say. Many physicians describe themselves as at the breaking point. "I am so mired in this mess that I can't see clearly enough to give ...

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St. Augustine: “Fallor ergo sum”

When I was in charge of the medical residency programs in Grand Rapids, Michigan, David Leach introduced me to the expanded Dreyfus Model of how physicians can progress from beginners to masters. I was always struck by how master physicians freely admitted their mistakes and used them as a teaching tool.  As a young surgical and cytopathologist, my sanity was saved more than once by University of ...

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It’s been more than a decade since the seminal report “To Err is Human” by the Institute of Medicine.  The report made waves when it estimated that 1.5 million people are affected by medical errors and that nearly 100,000 die annually as a result of medical errors. Some of those numbers have been debated, but there is no doubt that medical error is a significant issue in medicine that needs ...

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