Education

Absolute vs Relative Risk Reduction: Number Needed to Treat in Hand Surgery

I recently read Overdosed America: The Broken Promise of American Medicine by John Abramson.  The story of the COX-2 inhibitor, Vioxx, is one of the prime examples used in the book to show how pharmaceutical marketing and publication bias can result in disastrous outcomes for the public.  However, the part of the book that I found most interesting was when…
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Community

You Get What You Celebrate

It is a well-known business principle that “you get what you measure.” Any of us involved in pay-for-performance and complying with the various hospital metrics can relate to that. But recently I heard an interesting variation on this theme. On his podcast “The Tim Ferriss Show”, Tim Ferriss interviewed Frank Blake, former CEO of Home Depot. Blake’s version was “You…
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Education

Life Long Learning

In a field of medicine such as hand surgery, although some fundamental entities stay the same (pathology, anatomy, etc), there are inevitable changes and advancements as time passes.  Even if the underlying anatomy remains unchanged, a surgical approach may be refined over time to hopefully improve outcomes and minimize time and risk. New technology and implants are constantly being proposed,…
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Community

Do you have an action plan?

My last JHS Focus post introduced the Waterline model as a guide to providing clarity regarding the root causes of team conflict and/or underperformance. I suggested that, more often than not, a system or process issue may be the basis for the problem even though we, as emotionally driven team members, may attribute underperformance to an individual or to an…
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Work/Life Balance

“New Year’s” Resolutions

Unlike residency and fellowship, which are typically divided into discrete rotations or blocks; the passage of time in practice seems to flow in a relatively unobstructed fashion. Certainly the long winter drags on and business inevitably picks up as summer arrives,  indicating the change of season.  But, without distinct check points throughout the year, it is easy to forget to…
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Clinical

The Science Behind Crazy O.R. Rituals

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…
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Career Path

What is the purpose of retirement?

Many doctors are increasingly frustrated about the bureaucratic and regulatory environment of physician practice. For those who are nearing retirement age, it is tempting to “hang it up” early to escape the stress of a job that has lost its fun. Since younger physicians are frequently much more adept at the use of EHR’s and other forms of technology, they…
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