All posts › medicine
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So you really want to take ER call?
A reaction to a BBC report about a surgeon held responsible for the death of a self-stabbing patient, arguing that removing a penetrating chest object is inherently risky and that personal responsibility should fall on the patient, not the surgeon.
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Gambling in the OR
A candid pre-operative reflection on the uncertainty of relying on a nuclear medicine GI bleeding scan to guide surgery for an AVM, with fingers crossed that the bleeding stops before the operation is finished.
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Breast CA for Cosmetic Surgeons
A recap of a breast cancer talk given to the American Society of Cosmetic Breast Surgery, covering three core points: refer cancer cases to specialists, investigate suspicious exam findings before any cosmetic procedure, and always obtain a screening mammogram first.
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Interesting Precedent
Responding to Aggravated DocSurg, the author argues that the FDA advisory panel overstepped its mandate by restricting silicone implant sales to board-certified plastic surgeons only, since credentialing is a hospital responsibility, and predicts the FDA will have to back down.
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Silicone Breast Implants Are Back?
An FDA advisory panel voted 7-2 to recommend lifting the ban on Mentor silicone breast implants with strict conditions, including a board-certification requirement the author argues constitutes an unlawful restraint of trade given the varied specialties of surgeons who routinely place implants.
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Bargaining with HMOs
Responding to a surgeon colleague facing an unacceptable HMO contract, the post argues that relentlessly declining physician reimbursement will turn most doctors into salaried employees, threatening professional drive and innovation, and predicts a major US healthcare collapse before things improve.
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JAMA article on CPOE
A JAMA study finding that a widely used CPOE system facilitated 22 types of medication error risks is highlighted, challenging the assumption that such systems reliably prevent errors, while the author notes he has been tapped as physician liaison for a Cerner Millennium rollout at his hospital.
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Consultants and Transfers
Building on a GruntDoc post about consultant rudeness, the author argues that calling surgical consults purely to spread liability -- rather than for genuine clinical need -- is neither efficient nor conscientious medicine.
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Surgical Education in the United States: Portents for Change
A Medscape article is highlighted that documents alarming surgeon shortage figures and argues that declining reimbursement, malpractice costs, and subspecialty migration threaten to strip general surgery of its professional identity.