She drew the life-saving medication into the syringe, just 10 cc of colorless fluid for the everyday low price of, gulp, several hundred dollars. Was that a new chemotherapy, specially designed for her tumor? Was it a “specialty drug,” to treat her multiple sclerosis? Nope. It was insulin, a drug that has been around for decades. The price of many drugs has been on the rise of late, not just new ...

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Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer. The patient (I’ll call her Jennifer Decker) had stage 4 breast ...

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Aggressive control of blood pressure has saved millions of lives and has prevented millions of people from experiencing heart attacks, strokes, and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but when primary care doctors like me help people get their blood pressure under control, we do just as much good as any of our colleagues who practice as cardiovascular surgeons. ...

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Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor ...

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Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the ...

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Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year. What’s a poor patient to do? For starters: They can talk to their doctors about these costs. According to a study my colleagues and ...

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The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways. So what it is ...

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She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable ...

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Cancer drugs have become increasingly expensive in recent years. No one blinks anymore when a new lung cancer or colon cancer treatment comes to market priced at more than $100,000 per patient. In part, we don’t blink because we have simply gotten used to such prices -- the shock has worn off. Moreover, many of these new treatments are targeted therapies that only work for patients whose cancers express specific mutations, ...

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If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000! That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit ...

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