It's a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery. That's because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless ...

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"We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that's OK with you." This call, coming from the transfer coordinator, is emblematic of an insurance generated "medical care" coverage issue. I am salaried under the patient's insurance carrier so the insurer wants this patient back under its wing as soon as possible. The community hospital has been keeping Stella Norris (not her real ...

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Every illness is unique, and every person faces illness in his or her own way. Anna Deveare Smith, in her one-woman Broadway show "Let Me Down Easy," slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals. These individuals do ...

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As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule. The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the ...

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A reader recently asked, how does someone find a good psychiatrist? Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?
I typed the question "How do I find a good psychiatrist?" in Google and got almost half a million results from around the world. I find it hard to believe ...

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by John LaBine What are the root causes of communication inefficiencies in hospitals?  Hovering around any given patient/case are many players, each with a huge variety of demands for his/her time, attention and presence.  And they know there are costs of certain outcomes (medical errors, stress, wasted nurse/physician time, etc.). Each caregiver has his own long list of things to do, places to be, people ...

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Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem.  A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master. What do I mean?  Here are some examples from my field. Treating ...

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One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes. While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about
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There are many reasons to sell your practice. Physicians attempt to sell their practices for various reasons. Some physicians are reaching the age of retirement, while others are looking to add a partner, who, in time will take over the practice as a whole.  Whatever the reason, attempting to get a quality price for the practice can, at times, be a challenge in this current ...

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Implantable defibrillators are truly life saving devices that have prevented sudden death in thousands of patients. No bigger than an iPod nano, the device can sense when the heart is beating irregularly and deliver an electrical jolt that kicks it back into proper rhythm. But like so many of medicine’s miracles, defibrillators are not always used on the right patients. According to a study published recently in the ...

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