A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection. But one of the most commonly reported allergies — to penicillin — often isn’t a true allergy at all. The urgent question that faces physicians every day in emergency rooms and operating rooms is ...

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We’re all human beings, but we’re not all alike. Each person experiences pain differently, from an emotional perspective as well as a physical one, and responds to pain differently. That means that physicians like myself need to evaluate patients on an individual basis and find the best way to treat their pain. Today, however, doctors are under pressure to limit costs and prescribe treatments based on standardized guidelines. A major gap looms ...

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Let me say first that any woman who has ever been harassed or assaulted should never be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can be toxic. I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve ...

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When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief. “But they can’t do that,” I’ve been told more than once. Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the ...

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No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice. I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in ...

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A commencement address delivered on August 5, 2017, to the 2017 class of anesthesiologist assistants (AAs), Emory University. Distinguished faculty, graduates, honored guests: It is a great pleasure and an honor to be here, and to congratulate all the graduates of the Emory University Class of 2017 on your tremendous accomplishment. Just think about all you have learned in the past two years. You’ve transformed yourselves into real anesthesia professionals, able to ...

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There are two schools of thought about how to extubate patients at the conclusion of general anesthesia: Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes!  Take a deep breath!” Or: Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence ...

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I wish I knew who coined the term “DRexit” so I could send flowers or a bottle of whiskey as a thank you gift. There couldn’t be a more perfect term to describe the growing exodus of physicians from our beloved profession, which is turning into a morass of computer data entry and meaningless regulations thought up by people who never touch a patient. The one bright note on the horizon ...

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My husband and I, both anesthesiologists, enjoy our Sunday mornings together -- coffee, the New York Times, a leisurely breakfast. No rush to arrive in the operating room before many people are even awake. Today, though, seeing reporter Jan Hoffman’s front-page article in the Times -- “Staying Awake for Your Surgery?” -- was enough to take the sparkle out of the sugar. Her article on how much better it ...

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In the interests of full disclosure, I acknowledge with delight that I have a non-time limited board certificate from the American Board of Anesthesiology (ABA), issued before the year 2000. I can just say “no” to recertification. The more I learn about the American Board of Medical Specialties (ABMS) and its highly paid board members, the more disillusioned I’ve become. It’s easy to see why so many physicians today have concluded ...

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