by Kristina Fiore Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found. When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues. But the three core infection prevention measures taken ...

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Recently, JAMA published a study concluding that doctors are hesitant to report incompetent physicians or those who were impaired. According to the article,

more than a third of docs don't think they're responsible for reporting those who aren't fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.
To those who advocate that the medical ...

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You've seen it, somewhere. Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of the best. Dr. Grumpy, for the record, is not biased against this. I've been named a "Best Doc" in my field several times. And I know most of the other neurologists on the ...

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If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice. Read part one here. My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since ...

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As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right? In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is ...

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A recent comment raised a minor controversy about the strategy of minimizing tests.  I actually do not think that the disagreement is that great, but I feel like exploring the issue. This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible.  No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always ...

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An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. by John Toussaint, MD, and Roger Gerard, PhD Admitting Error In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be ...

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As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”. Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your ...

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by Charles R. D’Agostino, MD It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent. It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need. To their credit, PAs are truly ...

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A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD. With medical students graduating, on average, with almost $160,000 of debt, it's a major reason why they're choosing more lucrative specialty practice, which can offer salaries multiple times more than those of primary care fields. In this clip from The Vanishing Oath, medical economist Amitabh Chandra, Professor of Public Policy at the Harvard Kennedy School of ...

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