Clinical

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…
Clinical

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…
Ethics

The Golden Rule for Correct Coding

At a recent Specialty Day talk on managing difficult worker's compensation patients, an ASSH member had a poignant and arresting slide that simply said "Don't Be a Rapist." By that, he meant that it was easy to overbill, overcode, and perform unnecessary procedures on worker's compensation patients, and that we have a moral and ethical obligation to treat these patients, and…
Education

Stop Lamenting the “80-hour Rule”

Although internal medicine programs instituted an 80-hour weekly work limit in 1989, the “80-hour” duty hour limit was formally implemented by the ACGME is 2003. The purpose of the limit was to ensure patient safety and reduce medical errors while protecting the safety of residents by preventing burnout and psychological distress.  While there is conflicting data with respect to whether…
Patient Communication

“What’s in your tool chest?”

I have never considered myself a “carpenter” and am not particularly handy around the house. My enthusiasm for orthopaedic surgery was not a love of hammers and nails, but a desire to be able to be both a primary care musculoskeletal provider and surgical subspecialist. I initially wanted to become a cardiac surgeon, and my interest in complicated problems and…
Patient Communication

Patient Communication 101

When I recently learned that a friend of mine, Miro Kazakoff, teaches Managerial Communication at the MIT Sloan School of Management, I thought, “Wow, what an interesting job” and “Why do they teach communication in business school but not medical school?” Miro was kind enough to take me through a crash course in communications, which I then tested out in…
Patient Communication

The Power of Humor

There is a lot of evidence and belief that humor can positively affect health outcomes. In the medical environment when patients are anxious and fearful, humor can reduce anxiety. In fact it is thought that the very purpose of humor is to counteract the negatives that are thrown our way in day-to-day life, preventing people from descending into doom and…
Clinical

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…