I just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old friend of mine ...

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A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons - principally money - that lead doctors to choose to specialize.” Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story. Recently I had ...

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Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book. In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the history ...

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Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Tube-feeding patients with advanced dementia -- a practice whose effectiveness has been questioned by two widely cited literature reviews -- is most common in larger hospitals and those run for profit, researchers said. The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater ...

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The ER is the portal of entry to our hospitals now, for better and for worse. On the plus side, this means that most patients being admitted to general medical and surgical services have a workup at least started and are triaged appropriately to their destination. A good ER evaluation should answer the following questions: 1. What’s the nature of the illness? Are we dealing with the heart, the brain, or an abdominal organ? ...

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The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I'm sure you have seen some of these: U.S. World & News Report, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals. My local magazine lists the "top doctors" along with full page paid ads and promos that are very compelling. The questions is, do ...

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Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them. More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the ...

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The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s ...

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According to a recent editorial from Emergency Medicine News, emergency residency programs are doing a poor job preparing their emergency residents for the real world. The authors note that a typical, large urban academic emergency department comprise less than 5 percent of U.S. ERs, and that "residency programs train physicians in some of the most inefficient EDs in the land. Relative value units of emergency medicine work per hour in ...

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New regulations to reduce wait times for medical care in California are due to take effect next year. Under the proposal, primary care doctors employed by HMOs are required to see patients within 10 days of the appointment request, and specialists must see patients within 15 days. Telephone calls must be returned within 30 minutes and patients needing urgent care have to be seen within 48 hours. But will these mandates actually ...

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