According to the Residency Review Committee for Surgery, "A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care." In nearly all instances, resident "determination or confirmation of the diagnosis, provision of preoperative ...

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A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, "Virginia Mason Health System ... has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota." The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value. Attempts ...

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The wrong body was cremated by the county coroner’s office in Los Angeles. Jorge Hernandez died of an overdose, and the body of another Jorge Hernandez, an indigent patient, scheduled for cremation, was also present in the morgue. The distraught family of overdose victim Jorge Hernandez had planned a funeral with a viewing and were shocked when they were told his body had been cremated by mistake because a morgue attendant ...

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It was an interesting fortnight for the debate about the treatment of appendicitis. On November 1, David Agus, a medical oncologist, and director of the University Of Southern California's Center for Applied Molecular Medicine, had some thoughts about how appendicitis should be treated. He cited the Finnish randomized trial of antibiotics vs. surgery and said a 70 percent cure rate was good enough. In a brief article on the Fortune magazine website, ...

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What is one of the rules that medical people comply with the least? My vote goes to "translation." The rule is that you must use a qualified medical interpreter for any interview or discussion with a patient who does not understand English. How is “lack of understanding” defined? It is usually fairly obvious. If you aren't sure whether the patient gets it, he probably doesn't. Why can't family members act as translators? There is ...

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Speech recognition errors occurred in 71 percent of emergency department notes, and 21.1 percent of notes with errors were judged as critical with potential implications for patient care says a recent study in the International Journal of Medical Informatics. Investigators looked at a random sample of 100 dictated notes and found 128 errors or 1.3 errors per note. More than half of the errors were ascribed to speaker mispronunciation. Although ...

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A South Carolina jury awarded a woman $4,618,500 for a needlestick injury she sustained in the parking lot of a Target store. She had parked her car, and while walking to the store, her daughter picked up a hypodermic needle. As she swatted the needle out of the child’s hand, it punctured the woman’s palm. She went into the store and notified an employee. HIV post-exposure prophylaxis medications were prescribed which she ...

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By now you've probably heard about the hospital that charged $39.35 for a woman who just had a cesarean section to hold her baby. The baby's father posted a copy of the bill on Reddit, and it drew over 11,800 comments. The story was also widely circulated on Twitter. At least one labor and delivery nurse on Reddit and a spokesperson for Utah Valley Hospital where the baby was born stated that ...

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This foreign body was removed from a non-healing abdominal wall incision in an elderly lady with many comorbidities and previous operations. It was a rigid plastic tube which was 7 cm long and 2 to 3 mm in diameter. There were four transverse grooves at either end. foreign-body Physicians caring for her were unable to identify it. One of them emailed me the photos ...

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“The unintended consequences of these seemingly well-intentioned laws are doctors who can’t apologize for harming their patients even if they want to …” A recent JAMA article about disclosing medical error described a hypothetical situation involving a dermatologist who, after completing skin biopsies on two patients, discovered that the instruments had not been sterilized. He wondered if he should tell the patients and what he should say. The authors of ...

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"I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I'm disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, ...

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Can you trust online physician ratings? Many people believe you can. But here’s what a recent article in the Harvard Business Review (HBR) about the reliability of online user ratings regarding buying a product. The authors concluded that online ratings were generally not to be trusted for three important reasons:

  1. The reviews are usually based on a small sample of users. The authors said, “We can be more confident ...

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Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end). He pointed out that it ...

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Recently, the Joint Commission issued a statement written by its executive VP for healthcare quality evaluation Dr. David W. Baker, explaining why it was not to blame for the opioid epidemic. If you haven’t already read it, you should. Here is the first paragraph of that document: “In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, The Joint Commission’s pain standards take that ...

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On the morning of the tragic mass shooting in Orlando, a tweet by CNN stated, “The White House waived HIPAA regulations so that hospitals could talk with family members of shooting victims, says Orlando Mayor Buddy Dyer.” Many, including me, retweeted this thinking that it was probably unprecedented. Later that day, several Twitter followers informed me that HIPAA had been waived during Hurricane Katrina. Despite rumors to the contrary about 9/11, Katrina ...

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Ezekiel Emanuel, the University of Pennsylvania physician and ethicist, has written an opinion piece suggesting many changes in both pre-medical education and the medical school curriculum. He would do away with many of our hallowed medical school prerequisites such as calculus, physics, and organic chemistry, feeling that those subjects are simply used to "weed out" certain students. I confess I once believed that such subjects were worthwhile. However, Emanuel makes a ...

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"Was the delay in deciding to open influenced by the presence of an audience of 100 surgeons expecting to see a laparoscopic liver resection?" “In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.” As I predicted last year, it had to happen sooner or later. In that post, I wrote, “A major complication will inevitably ...

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A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any ...

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For the last couple of days, the Twitter medical community has been discussing the latest in a long line of papers attempting to estimate the role of medical error as a cause of death. A recent entry appeared in the BMJ and was by a surgeon at Johns Hopkins, Dr. Martin Makary, who claims that 251,454 patients die from medical error every year. Makary's review extrapolated that figure from three papers ...

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Almost every day over the last few years, someone has written about physician burnout or depression. The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself. peeing The paper equated faculty and residents supervising students ...

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