A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis. It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made ...

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Recently, a Leonardo Da Vinci painting, Salvator Mundi (Savior of the World), was sold for $450 million, making it the largest fee for a painting ever sold.  Was it a good investment?  The painting was sold by Leonardo’s heir to King Francis I of France for 4000 gold ducats in 1519, which according to the American Numismatic Society would be equivalent to $575,000 at today’s price of gold at $1277 ...

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As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas.  After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have ...

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Mine was an unusually long hiatus from residency for research training. And in the rough readjustment to clinical environments and work processes, one forgotten element seemed glaringly problematic: “Have a plan,” said one attending, “If you don’t know, just guess.” And another, in a teaching session, “Just guess, even if you’re wrong.” From a chief resident during an awkward pause when a junior was put on the spot: “Just guess; it’s OK.” When ...

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As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I'd yearn for my pager to go off. I was always tired, too — but for a surgical resident, fatigue is a given. Sleep and eat when you can, get your work done and operate like a madwoman: That ...

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Having been surgically trained and surgically-minded, I've had expression ingrained in my psyche such as "a chance to cut is a chance to cure," "when in doubt, cut it out" and "nothing can heal like cold, hard steel." Indeed, as a surgeon, I see patients in my office and in the hospital with the specific question of whether or not surgery is indicated, what type of surgery and how urgently ...

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Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue -- a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer. Each surgery has its own ...

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Recently, I was challenged by the mother of a trauma patient. She had read about traumatic spleen injuries online and was concerned about the risk a hematoma presented and wanted the ultrasound to look at the hematoma. I found myself floundering around trying to explain how this study was unnecessary. In frustration, I turned to my nurse practitioner and said, “Heather, can you translate for me?” This is a common problem. ...

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In the movie Malice, Alec Baldwin plays Dr. Jed Hill, a surgeon who gives a famous speech during a deposition in a medical malpractice case. “”If you’re looking for God, he was in operating room #2 on November 17th, and he doesn’t like to be second-guessed ... I am God.” No one wants a doctor like that. And yet, maybe we do. We yearn for someone capable of healing all of our ...

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After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.”  Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?” After it’s told to you over and over again by your male co-residents and even some of my ...

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