Clinical

Can we measure physicians and adjust pay according to their performance? – Part 1

We love ranking and rating things and have come to rely on them. What’s the highest ranked college that your kid can get into? Which restaurant has the best Yelp review?  Which beach did TripAdvisor rank as the best in the world? Rankings and ratings are increasingly permeating healthcare, too. US News and World Report already releases annual and ‘scientific’…

Eponyms and the Synthetic Genitive Case: How to Have Yours

By William J. Knaus, MD, Nicholas Caggiano, MD, and Matthew L. Iorio, MD Confusion regarding the appropriate use of apostrophes in medical eponyms is pervasive in medicine.  They are used to denote someone who had the disease (e.g., “Bennett’s fracture”), an occupation associated with the disease (e.g., “gamekeeper’s thumb”), or an homage to a description of the disease (e.g., “Dupuytren’s…

Reframing failure

Failure in life - no matter how great or small - can provide a transformational opportunity for growth. In fact, most if not all innovation is the result of trial and error, a consequential response or iteration, and so forth. Indeed, in medicine, progress has relied on the scientific method forever. However, our bad surgical outcomes are often stigmatized as…

Is the Current Hand Fellowship Interview Process Broken?

Fellowship training in hand surgery has become increasingly popular, resulting in a significant number of applicants failing to obtain a fellowship position.  From 2012-2014, 25% of applicants did not match.  In 2016, there were 199 applicants for only 166 positions; this left 17% of applicants unmatched.1  This competitive environment has led to applicants applying to an increasingly larger number of…

Do Your Part to be Lean and Green

It is well known that there is a substantial effort to reduce healthcare costs.  These reductions can occur by decreasing reimbursements to both the healthcare facility and directly to the physician. As many physicians receive direct benefit from the healthcare facility in the form of profit-sharing, salary, payment for call, etc., it is in our best interests, as physicians, to…

On Evidence-Based Medicine

A few weeks ago, I read an editorial in the JBJS that made me think of the meaning of the word “evidence” and how it relates to clinical practice in 2016. In their article titled “Level-III and IV Evidence: Still Essential for the Field of Musculoskeletal Medicine and Surgery” Drs. Sangeorzan and Swiontkowski argue that the “wholesale buy-in of statistical…

“Grantsmanship”: The Death of Innovation

I have had the opportunity to participate in several committees that review grants for large surgical societies.  During these sessions, typically two reviewers review each grant in depth and then present a summary to the rest of the committee.  Those reviewers give the grant a score from 1-10, with 1 being a grant that should definitely be funded and 10…

Who Needs a Thumb Anyway?

In my pediatric practice, I’ve often wondered if the children that we “fixed” as a child have actually been made better or whether they would have adapted and done just fine on their own. These decisions are made by parents and surgeons since the babies certainly don’t have an opportunity to participate in the decision making. Often it seems we…

Education and Mentorship in the Digital Age

In today’s world, we are almost never out of touch.  The advent of the cell phone gave us the potential to be constantly available.  Email allows us to send and receive messages at all hours without disturbing the other party. The popularity of text messaging has added a new, perhaps even less intrusive, form of communication.  Although these advances have…
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