Recently, a paper written by researchers at Johns Hopkins asserted that medical error was the third leading cause of the death in the United States.  This received -- as you might imagine -- considerable coverage in the media.  The researchers proposed that death certificates should include a qualifier or indicator that medical error was linked to the death, if in fact it was, so that better statistics could ...

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A nudge is a form of social engineering to make better choices. In the world of patient safety and medical decisions, it shares some of the concepts of  human factors engineering. Richard Thaler and Cass Sustein may be the world’s authority on the nudge concept, and have a great book by the same name. Nudges help people to choose their own best decisions by making the easiest, laziest choices -- the defaults -- ...

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Like many of you, I have a fairly long commute. Recently, as I was driving and scanning the channels on Sirius, I landed on a talk program hosted by Dr. Laura Schlessinger -- a certified marriage and family counselor (her PhD is in physiology) with many decades of experience, a stack of best-selling advice books, and a very long running radio show. The caller was a young woman with a cheating husband and a ...

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Recently, I read an article about a new mother’s experience taking her toddler to the emergency room after a face-first fall onto an iron table, bleeding profusely. After her child was evaluated, it was determined that no serious injury was sustained, and no further intervention (i.e. stitches) was needed, and the toddler was discharged home with some wound care instructions and a popsicle. When the mother subsequently received ...

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The best defense is a good offense. This is certainly true when it comes to online reputation and digital presence. Doctors should be using social media and other online platforms strategically.  Health care institutions without a medical professional as a social media strategist are taking a huge gamble. Imagine a politically polarizing communication related to your organization that was not intended to be public, but was leaked and widely circulated on the internet. ...

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I recently wrote about inter-professional hostility in health care.  I thought I would share some of the inspiration for that post here.   Is there really an escalation of scope of practice conflicts and a downward spiral of disrespect, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder to me. In ...

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The amount of hostility among health care professionals seems to be at an all-time high.  Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments and viral online posts?  I don't know for sure, but lately, the conversation seems louder and uglier to me. In medical school, I heard derogatory comments (“jokes”?) from physicians and nurses alike about pretty ...

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What should doctors disclose to patients in the aftermath of adverse events?  Does it matter if the adverse event was related to an error?  Does it matter if it was preventable or not, anticipated or unexpected? Recently, I was at the Carolina Refresher Course facilitating a session on adverse events in anesthesiology.   We touched on a variety of issues, but spent the most time discussing the importance of disclosure conversations, as ...

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cockpit_B777 With the crash of the Asiana 777, we're hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line.  This isn't a new concept, and isn't unique to aviation.  Many parallels have been drawn between aviation communication and healthcare team communications, ...

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These days, there is a lot of talk about expanding scopes of practice for the group of folks who used to be called physician extenders and then midlevel providers and more recently non-physician providers, many of whom are now getting degrees with the title “doctor” incorporated. While it seems to vary, these folks may include nurses, physician assistants (one day to be called physician associates perhaps), pharmacists, and more.   Lots ...

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