Clinical

“Improving the quality of care is the best way to decrease cost of care.” Dr. Raja Sabapathy at Ganga Hospital in India said this to me a few weeks ago. He is one of those unique individuals that truly practices what he preaches. His hospital has grown through leaps and bounds and is establishing itself as a Mecca throughout the…

Everybody has them.  If you think you’re an exception, ask your PA, scrub or circulator and get ready to be surprised.  I’m talking about bizarre little rituals in the operating room.  They’re usually innocuous, arbitrary habits, but if neglected, make the entire case feel “off”.  Maybe you always have to be the one to clip the tourniquet towel; maybe it’s…

When I was a resident, one of my attendings sat me down and tried to elucidate what he considered my “unreasonable” expectations for excellence and perfection. He asked me how many patients I planned to see each year and to write this number down (I proceeded to write “4,000”, a complete guess).  He then asked me whether I was going…

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’…

generic viagra www.industryrecycling.com 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…

One of my mentors, well into his 70s at the time of my fellowship, when presented with a dorsal ganglion, still presented the traditional option of hitting it with a book. I saw him do it just once, but he flashed a grin, said, “I have a special book for this,” went back to his office and returned with an…

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…

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…

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…

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…