Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated during a routine examination. He has no symptoms or significant medical history. He is active and exercises regularly. He does not take any medications. On physical examination, blood pressure is 135/70 mm Hg, pulse rate is 82/min, and respiration rate is 17/min. Cardiac ...

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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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The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical ...

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The 2nd Annual Women in Anesthesiology Conference is taking place in October. Developing this organization has been a labor of, if not love, then honoring. We are honoring a value system that works to gives women the respect, autonomy, and power they deserve. There is an amazing power in gathering, shared experiences and decreasing isolation. Nobody has identical life experiences. But part of what informs our identity is shared experiences. As ...

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“It is not for me to judge another man's life. I must judge, I must choose, I must spurn, purely for myself. For myself, alone.” -Hermann Hesse, "Siddhartha" What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But ...

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Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that ...

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I remember the exact moment I realized the amazing power of women; that together, women can accomplish anything they put their minds to. I grew up in a household of women. I had no brothers to compete with, and my parents always encouraged us to learn and develop leadership skills. However, even growing up in an encouraging environment, I still developed an unconscious bias. In school and in college, I often ...

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Recently, Dr. Ashish K. Jha, a Harvard internist and health policy researcher, published an opinion piece in JAMA, advocating public reporting of individual surgeon outcomes. I have followed Dr. Jha for many years on Twitter and have enjoyed his blog posts and papers. However, I must respectfully disagree with much of what he wrote this time. He tries but fails to refute the arguments that critics of individual surgeon reporting ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide. On physical examination, ...

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It’s 3 a.m., and I’m wide awake.  I’m giddy with excitement and scared.  I am 41 years old and tomorrow feels like the first day of school all over again.  Only it isn’t.  Tomorrow is my first day back at the hospital where I work as a surgeon.  Tomorrow is also my first day back at work after chemotherapy. Two months ago, I was diagnosed with breast cancer.  I underwent bilateral ...

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