I want to write a book about the modern intern experience, a successor to The House of God, if you will.  I’m going to call my book Seaport General.  It’s about a young intern named Troy, who is starting his internal medicine training at a fictional university-affiliated community hospital in Boston’s posh Seaport district.  In this book, set against the backdrop of a rapidly changing would, Troy learns what it ...

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It is all too common for a section in a progress note to look something like this:

# Aspiration pneumonia:
  1. Continue vancomycin 1 g bid
  2. Continue Zosyn 3.325 g q6h
  3. Follow-up blood cultures
  4. Follow-up sputum cultures
  5. MRSA nares screen negative
  6. Blood cultures negative
  7. Discontinue vancomycin
Yesterday, a version of this note (lines 1 to 5 to be precise) had my name on it. Today, it is signed by someone else. Read it ...

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For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors.  But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon.  This is our friend Clostridium difficile. According to the CDC, there are about ...

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