"I just got sick and tired of being an "assembly line" doctor"! I knew immediately what she meant by that statement, she was on the medical treadmill and going nowhere. Her previous places of employment as a doctor were like production lines, impersonal and cold and neither the patients nor the doctors were happy. But the concept of an assembly line can actually be a good thing in health care, it's not the assembly line that's the problem as much as the people responsible for running it. An assembly line is just a system, a system that allows for maximum efficiency. Take the world's most famous assembly line, the one designed by Henry Ford. In the autumn of 1908, Henry Ford's first Model T rolled out. It cost $825. While much less expensive than the other cars of that time, for Ford it was still too expensive. Ford was convinced that ordinary hard-working people needed cars and his cars were still not affordable for the masses. In 1913, he visited a meat packing plant in Chicago and saw how the large slabs of meat were on an overhead trolley system and butchers would slice off their piece of meat as [...]

Recently a man came into our clinic and had a bloody t shirt wrapped around his thigh. He said, "I cut my leg pretty bad this morning when I was using my hand saw, do you think I need stitches? Within that question are several other questions and I think I have the answers for all of them: The answer for him was "yes, you will benefit from stitches", once I saw the wound. Stitches are recommended for many reasons which include: to stop minor bleeding, to close the wound after a thorough cleaning of it, to prevent an unsightly scar, to encourage faster healing and help prevent infection. But does everybody need stitches? Not at all: Just about any wound will heal under normal circumstances (no infection, good blood supply, adequate nutrition) but it takes much longer and requires constant care. There are times when we don't recommend sewing up a cut especially if the wound is uncommonly dirty and/or already infected. In that case, sewing up the cut just traps the already present bacteria in the wound and in a matter of 2-3 the patient would be back and the sutures would have to be removed so the infection can drain. [...]

He was a big guy but he was hurting when he walked in the door. "I have a very sore lump on my back, it's draining some stuff that smells terrible" was what he told me and I agreed. He had a skin cyst that needed surgical intervention and he had come to the right place. Skin cysts are sometimes no problem and sometimes they are problems that need a minor surgical procedure. They are just sacs located just under the skin surface that have an outer wall and an inner "filling" with liquid or semi-solid material. Most skin cysts are called Epidermoid cysts (commonly called Sebaceous cysts) and are filled with a thick, foul-smelling protein called keratin. They are prone to infection with Staph skin bacteria that normally inhabits the skin. They are not cancer, they are not life-threatening but they can be bothersome especially if they become infected and an abscess forms around the cyst. So here's what I did... Like any pus that's trapped in a closed space, it needed to be surgically drained. I numbed the skin around the cyst with local anesthesia and made an incision right over the cyst/abscess and drained the infection [...]

Earlier in the week I wrote about Winston Churchill and his speeches to the people of the British Empire. I had seen the movie "Darkest Hour" and was blown away by the courage of Winston and King George VI (who was the king in the movie The King's Speech). Churchill was a rock and dearly loved his homeland and it's people. I made reference to Churchill's third speech (not shown in the movie) which was called "the finest hour" speech and was delivered only 2 weeks after the speech to the House of Commons and the people of England that ended the movie. From darkest hour to finest hour, a feat probably only accomplished by Winston Churchill. Whenever I hear those words "finest hour", I think of my old boss in residency, Dr Henry Laws. He was a man not unlike Churchill... confident but humble, a remarkable leader of men. He had a hundred "sayings" we residents called "Laws-isms" and whenever the subject of an abscess came up, he said, "draining the abscess, that's a surgeon's finest hour." That meant that the abscess was not going to get any better by throwing antibiotics at it until it was drained and that, [...]

Ever heard of a "one-liner?" No, it's not what you would use as a pick-up line, it has to do with business. It's basically what you say to someone if they ask you (in an elevator, on an airplane) "what do you do?" Instead of launching off into the wild blue yonder with your answer such as  "well, that is a good question because it's kinda complicated"... you have your one-liner ready so that you can tell them in 10 seconds what you do. According to Donald Miller in his book "Building A Story Brand," it's always best to not confuse people with "noise." If a person sitting next to you on a plane asks you what you do, they really don't want to hear about how your great grandfather started the company. They want to hear how what you do can benefit them and that involves getting right to the point with clarity. Here is what I say: "The only thing more painful than being in need of urgent medical attention is having to sit in a crowded waiting room a long time to get it. I run a clinic where you are treated like the doctor and [...]