"Nobody went into medicine to sit in a team room at a bank of computers, endlessly clicking through templated notes, interrupted to triage pages. We chose medicine so we could build relationships with people while sorting out their stories, using our observations to make sense of their ailments, and formulate plans to help patients feel better."

—Timothy Niessen, assistant professor of medicine, part of a Johns Hopkins team that created a curriculum for the Osler Medical Housestaff Training Program called Advancing Bedside Cardiopulmonary Examination Skills (ACE). Complementing ACE is a midweek session in which an experienced clinician joins residents to model physical exam techniques and bedside interactions. The impetus for both: growing concern that physical exam skills have begun to erode as residents spend more time updating the electronic medical record and looking at scans, and less time at the bedside with patients.

—Surgeon Martin Makary, lead author of a study reported in JAMA Surgery. The study noted that arthroscopic partial meniscectomy accounted for an estimated two-thirds of all orthopaedic knee arthroscopy procedures in older patients in 2016. But multiple clinical trials, Makary says, have shown that compared with regular exercise and physical therapy, the procedure provides no additional benefit in older patients with meniscal tears linked to aging and everyday wear and tear.

Sparing patients the unnecessary operation has tremendous implications for reducing the burden of health care use, for rehabilitation, and for complications related to surgery, including opioid-related complications, since most patients are prescribed opioids after the procedure, Makary notes.