The ER demonstrates the inverted priorities of American society We fling open the doors of America’s emergency departments to help those who can’t afford health care.  We have legislated this protection: No person can be turned away for financial reasons.  This is very compassionate, and represents the higher angels of our culture.  Alas, it also is emblematic of the stupider demons of government.  You see, the ER demonstrates the inverted priorities ...

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The Journal Psychological Science just published a complicated, long, and fascinating study about happiness. The full text is tucked behind a paywall, but it’s great reading if you can get your hands on it. The authors arranged four separate experiments, looking at the effects of getting things versus experiencing things, and how the anticipation of waiting might affect happiness. Some of the studies involved just imagining a future purchase or vacation; ...

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It used to be that the greatest cost at a doctor’s visit was paying for the visit itself. Nowadays, the office visit is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help with the un-Affordable Care Act. In the last few ...

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Many of our patients are besieged with unsolicited Internet advertisements offering them unbelievable solutions and cures to most of mankind’s medical maladies.  Patients come to and ask for advice about these promises to magically restore their health. Since I receive so many requests from patients to evaluate these offerings, I have put together five questions that patients should ask themselves before proceeding to buy from websites offering outlandish claims, including restoring ...

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About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then. Consider that we are now a year in to the implementation of the ...

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He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  "They offered me peritoneal dialysis," he said, "but I decided against it and figured I'd just let nature take its course.  The hospice people are so wonderful -- I've got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, ...

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A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. Because of the concern for aspiration, an ambulance was called and the child was taken to ...

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There is much to deplore in our medical system.  Atrocities abound in the dark recesses of hospital wards, the overpacked waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials.  Yet time and again, the most vile of of insults are hurled at one setting in particular.  I'm talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, ...

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She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches ...

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