Will your anesthesiologist leave the OR? Patients deserve to know.

Physician
October 27, 2015

“For some must watch, while some must sleep.”
– William Shakespeare, Hamlet

I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under:  What can happen if your anesthesiologist leaves the room during an operation.”

It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, one …

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Why do never events occur? It’s because of the human factor.

Physician
October 26, 2015

Wrong procedure, wrong side/site, wrong implant, retained foreign object: big problem.  No patient should ever have to undergo these types of events, and they are therefore called never events. However, these events do occur and when they do they not only jeopardize patient safety but they also breach the trust between patient and practitioner, have financial implications, and reflect negatively on the entire health care system.

The good news is never events …

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Open your eyes. Look at each other. And make the connection.

Physician
October 25, 2015

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We’re not imagining it: We really are losing our connections to each other. It’s a huge problem. In fact, it’s life-threatening.

A recent Wall Street Journal article discussed the Brigham Young University study that found that social isolation increases our risk of death by 32 percent.

Duke University and the University of Arizona have been watching our connections go down the …

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Life and death are in God’s hands, and we are merely his instruments

Physician
October 25, 2015

I lost a very dear friend about a week ago.  She was my nurse, office manager, and friend. She was Ginny. Ginny came into my life about eight years ago as I assumed the responsibility of medical director for a multi-location clinic. I spent about as much time with her as I did my family, she was my “work wife.”

About nine months ago I became concerned with her rapid loss in …

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Should doctors be allowed to concealed carry at work?

Physician
October 24, 2015

One word: gun. That is all it takes to spark a debate between two very different camps. One end of the spectrum feels guns are an evil haunting the nation by their mere existence, and they need to be dealt with by restricting (or even eliminating) everyone’s ability to possess them. The other end believes it is a core right to keep and use firearms for sport, personal defense, collecting, etc., and that no …

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Is it time to take out your skeleton in the closet? 

Education
October 24, 2015

I have a skeleton in the closet.  I really do.  It is a human skeleton that I acquired when as a first-year medical student at the University of Sydney in 1981.

Back then, just about every medical student would own a half or full skeleton. They had to be real human bones as the quality of plastic models at that time were as good as useless as they often lacked many …

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Test your medicine knowledge: 67-year-old woman with increasing forgetfulness

Conditions
October 24, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old woman is evaluated for a 1-year history of increasing forgetfulness. She reports greater difficulty keeping track of upcoming appointments, recalling details of recent telephone conversations, and remembering names of new acquaintances. She has completed 16 years of formal education, currently works as a teacher’s assistant, and has noticed no change in her ability …

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Maternity leave for physicians is a disgrace. It’s time to fix that.

Physician
October 22, 2015

Netflix listens to doctors.  Google, Facebook, and Apple listen to doctors.  The United States Navy and Marine Corps listen.

The above companies have updated their maternity leave policies — lengthening them all past 12 weeks.  And all paid.

But yet, health care doesn’t listen to doctors.  And let me tell you how.

I am pregnant.  Which is a blessing in of itself.  In fact, this is my 4th pregnancy, but I only have one child living. …

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This epic EHR video may save our relationship with patients #LetDoctorsBeDoctors

Tech
October 19, 2015
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I have a love-hate relationship with the electronic health record (EHR).

To be precise, it’s 90 percent hate, 6 percent love. The missing 4 percent? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.

I’ve been in practice long enough to straddle the transition from paper … to even more paper (thanks EHR, you’re the …

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A medical student’s psychiatric hospitalization

Education
October 19, 2015

“You work here?!”

I nodded, a hint of a smile revealing my bemusement at his incredulity.

“Well … probably not after this.”

The other patients in the psych waiting area of the ER nodded in agreement. In my newly issued brown scrubs, stripped of my belongings, I was no longer a research coordinator at a top hospital, but rather one of them. And sadly, they believed being one of them meant you couldn’t …

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5 tips for physicians to achieve financial freedom

Finance
October 18, 2015

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In the ten years since I graduated from residency, I have noticed an interesting correlation between burnout and finances among my physician colleagues: The more secure we are financially, the more we enjoy our work. However, physicians working long clinic hours and moonlighting 15 times a month as a hospitalist in order to make alimony payments, boat payments, mortgage payments, or all …

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Lab coats and scrubs don’t make the physician

Physician
October 16, 2015

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …

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When doctors stalk their patients

Tech
October 16, 2015

I peeked. Several months ago, I met a 60-year-old woman with shortness of breath. Her hospital stay was a whirlwind. She had lost weight, and a test detected her stool had blood in it. This was an ominous sign. Within a few hours, she underwent a colonoscopy that revealed she had colon cancer. The colorectal surgery team whisked her away from my general medicine team. I soon left that hospital for …

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The day I went to work and met a real vampire

Conditions
October 15, 2015

It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress.

As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, …

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An emergency in public: When should doctors help?

Physician
October 12, 2015

Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …

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A young woman with anemia. A colonoscopy reveals a surprise.

Conditions
October 11, 2015

Overtesting and over treatment are big problems in modern medicine.  It sometimes goes like this: Have a minor complaint? It’s probably nothing, but we should do an exhaustive workup because there is a 0.00001 percent chance it could be cancer, maybe.

However, if you happen to be that one patient in 10 million that had cancer, and we actually found it early by aggressive testing, then you would be glad you went for …

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Why we need to stop calling physicians “providers”

Physician
October 10, 2015

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry — it seems that we are no physicians or even clinicians, but we have all …

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Test your medicine knowledge: 55-year-old man with elevated liver enzymes

Conditions
October 10, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.

On physical examination, vital signs are normal; BMI is 24. He …

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The aroma of medicine can be found everyday in hospitals

Physician
October 9, 2015

As a physician, you are required to have keen senses.  Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations.  I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia.  Olfactory is a Latin adjective from olfacere that translates “of or relating …

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A patient turns down hypertension treatment. What happens next is tragic.

Physician
October 8, 2015

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update.

Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …

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