When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice?  Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values? For many physicians, I suspect that the answer to ...

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In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery.  She hadn't lost weight and clearly was feeling discouraged about practically everything.  She was physically uncomfortable, couldn't even keep down her own saliva because her lower esophagus was obstructed, and was in tears. As her anesthesiologist, ...

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Really, sir.  What were you thinking? I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol.  Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow. I would insert the link here, but the ...

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Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, "Why Women Still Can’t Have It All."  The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two ...

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We’ve come to a sorry pass in American medicine when physicians are willing to spend a lot of money to attend conferences—not to learn how to become better physicians, but to find a way out of the pit of clinical practice. Few of us have the charisma (or chutzpah) to make a living in medical show business, like Sanjay Gupta or Mehmet Oz.  But apparently any physician today can be clever ...

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One morning recently, I found another physician standing morosely at one of the mobile computer terminals we refer to as “cows”—computers on wheels—that are everywhere now in our hospital. I asked what was the matter.  “Oh nothing, really,” she said.  “It’s just that I don’t feel I know the patients as well as I used to.” I knew exactly what she meant.  Things are different now that we have the EMR---the ...

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Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most.  All doctors made a comfortable income; money wasn’t a primary motivator.  There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer.  Internal medicine was held up to us as the most prestigious and intellectually ...

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If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained. Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for the Affordable Care Act, is the lead author of a startling opinion column in the March 21 Journal of the American Medical Association.  He argues that there is “substantial waste” in ...

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If you live in southern California, you can’t miss the billboards advertising laparoscopic gastric banding at “1-800-GET-THIN” outpatient surgery centers.  They feature happy people who’ve lost 100 pounds or more, and urge you to “let your new life begin” by having a “lap band” inserted.  Fees at these centers are much lower than they are at university medical centers or other major hospitals. Recently, however, those surgery centers and their owners ...

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There's been a great divide between the medical and surgical specialties ever since I can remember.   Surgeons believe internists perseverate too much when decisions need to be made.  Internists consider themselves the true intellectuals of medicine.  I suppose anesthesiologists like me fall somewhere in the middle--we work in surgery, but have to take care of all the medical problems the patient brings to the OR table.  Does that make us ...

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Back in the 1990’s, my husband and I spent a year working at one of the largest hospitals in West Virginia.  The patients were the nicest people in the world, and the hospital staff was terrific—kind, generous, and hard working.  Some of the surgeons were excellent, but others definitely were not.   My husband (a cardiac anesthesiologist) and I had to cope with surgical complications the likes of which we had ...

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The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us.  But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse. No one in modern America expects a child to die.  Children only die in nineteenth century novels and third-world countries, or ...

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No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use. What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was. The Centers for Medicare and ...

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