The fact that there was not more loss of life in the Boston Marathon bombings is attributable in large part to the medical community's prior efforts to build and sustain emergency-preparedness programs and to practice its response in exercises and drills.

The Boston Marathon bombing and the medical response offer several important lessons, including that the remarkably low mortality rate (1%) was attributable in part to several factors favoring the rescuers and that disaster preparedness still requires planning.

In recent years, Brigham and Women's Hospital has activated its emergency response team for many drills that taught staff familiarity, comfort, trust, and routines during a disaster. After the Boston Marathon bombing, when the hospital treated 39 survivors, routines saved lives.

Recent years have seen highly publicized examples of doctors' rejecting patients on the basis of such characteristics as sexual orientation and weight. Differential treatment based on negative moral judgments of patients is unethical, and legal standards largely agree.

More effective models of care delivery are needed, but their successful implementation depends on effective care teams and good management of local operations (clinical microsystems). Clinicians influence both, and local clinician leaders will have several key tasks.

The importance of registered nurses is expected to increase under health care reform. Thanks to a surge in RN graduates, predicted workforce shortages have not materialized. But some uncertainties still threaten the sufficiency of the workforce in the future.

The U.S. palliative care model adds another layer of specialized care to a complex, expensive health care environment, and there are too few palliative care specialists to meet demand. Distinguishing primary from specialist palliative care would improve quality of care.

Decisions are influenced by whatever decision makers stand to gain or lose, economically, psychologically, and socially. Leaders of health care organizations must therefore shape incentives so as to promote the institution's goals but avoid unintended harm.

The U.S. Preventive Services Task Force proposes to assign a grade A recommendation to HIV screening in the general population 15 to 65 years of age — with implications for the financing of HIV testing, resources required for HIV treatment, and who will bear the costs.

Although service is fundamental to a physician's role, it is being harmfully undermined within the medical profession and in graduate medical education, according to surveys of residents conducted by the Accreditation Council for Graduate Medical Education.

Although Cuba has limited economic resources, its health care system has solved some problems that the U.S. system has not yet managed to address. Everyone has a family physician, everything is free, the system is tightly organized, and the first priority is prevention.

Awaiting surgery for a malignant pleural effusion, the man is in pain and looks much older than his 50 years. The medical oncologist thinks he's dying. But the surgeon believes the procedure will help, and medical hierarchy discourages questioning of such decisions.

In 2011, a strain of Klebsiella pneumoniae resistant to multiple antibiotics, including carbapenems, was identified in the intensive care unit (ICU) of the Clinical Center of the National Institutes of Health (NIH).¹ This organism has since colonized at ...