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Medicine is like blackjack: Physicians need to count cards
In the game of blackjack, players will attempt to increase their odds of winning by using the frowned upon method of counting cards. The basic principle is to add or subtract points to the cards dealt...
View ArticleThe problematic impact of To Err is Human
November, 1999 was a watershed for physicians. It is then that the infamous "To Err is Human" report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly...
View ArticleA physician’s last patient before retirement
Mrs. D was my last patient. I retired several months ago, and for some time prior I informed my patients so as to give them time to decide where they would like their follow-up care. Mrs. D was an...
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Physician ratings reward doctors in narrow practice
Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was...
View ArticleWhen going “by the book” hurts patients
I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast...
View ArticleQuality-based health care is based on false assumptions
Of all the radical changes affecting health care that have sent providers reeling, we are about to experience the knockout punch: the effort to change health care reimbursement from a quantity-based to...
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A tale of two surgeons: Which would you choose?
Let's face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience. The emotions run from...
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The future of physicians: Dr. Zhivago offers clues
There is a scene from the movie Dr. Zhivago that, no matter how often I see it, sends chills down my spine. Yuri returns home from World War I after the communist revolution in Russia and runs into...
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The day this physician was labelled as disruptive
There can be little doubt that these days that political correctness has run rampant. Terms like "racist," "sexist," or "homophobic" are thrown around so frequently and early now that one has to...
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The sad story of how “never events” prevent obese patients from getting new hips
Daytime TV advertising is dominated by two players. Pharmaceutical companies with direct to consumer pitches and the so-called "toxic tort." How confusing it must be to the average person to see a new...
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The patient experience: 4 observations from a physician
Last year, I retired from full-time practice and moved to a new area. At about the same time, my wife was diagnosed with breast cancer, and because she was in good health prior, she had relatively...
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Wise rules of medicine that doctors and patients should follow
Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments. Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are...
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Making pain a vital sign caused the opioid crisis. Here’s how.
I remember the first time I experienced the paradigm shift when it came to pain management. Sometime around the late nineties while I was on call, I received a phone call from a floor nurse stating...
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The night this physician was profiled. And he was OK with it.
One very late spring evening during my last year of residency, I was driving home and got stopped at a police DUI checkpoint. I was exhausted from being up all night from being on call the night before...
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Patients are in charge of their own health care ship
One of the latest trends in health care is “patient choice,” meaning the patient is in charge of their own care. Our job as a physician is to educate patients about the diagnosis, discuss the various...
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Get disruptive: 8 ways doctors create change at work
"If you do not cooperate, doctor, we will have no choice but to label you as being 'disruptive' and take whatever steps are necessary to remedy the situation." What physician does not dread hearing...
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This physician gives Trump some health care advice
Dear President-elect Trump, You have stated that one of the first things you will do in office is to overturn Obamacare. You state that you will keep coverage for pre-existing conditions and children...
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I’m retired, but I’m disgusted with medical schools. Here’s why.
The year was 1976. I was graduating from a small branch of my state university with a bachelor's in chemistry when I first applied to medical school. I was living at home and paying my own tuition....
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The legal system must change to protect doctors
Anyone watching daytime or late-night cable TV has to notice that every third commercial is for a toxic tort. As my wife had breast cancer, one, in particular, caught my eye. In it, the claim was made...
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Will we solve health care by blaming doctors?
I started my career in the late 1980s and retired just recently. I am very grateful that I caught at least a few years of the "golden age" of medicine because those years made all the difference. Over...
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