My patient had onychomycosis – toenail fungus.  Not a devastating disease.  The treatment for this fungus is a 12-week course of terbinafine.  About $50 for a month’s supply ... $150 for 3 months.  Terbinafine’s potential side effects include liver toxicity. During my primary care clerkship at the Bronx VA Hospital, I treated several patients who had onychomycosis and had undergone the antifungal treatment.  One patient declined treatment with terbinafine because ...

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The VA isn't perfect, but definitely is better than other health care systems I have worked in so far.  It embraces the idea of patient-centered medical home, where a primary care physician coordinates and takes responsibility for a patient’s care ... the old-school definition of good medical care that has recently become popular again, ...

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I recently finished another 5-week clinical rotation.  This one was primary care (outpatient internal medicine +/- family medicine). First a few words about primary care as a field:  I found it to be both awesome and boring. It was awesome because I was the "doctor."  I had essentially full responsibility for my each patient.  From calling him in from the ...

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I recently finished my 10 weeks in Internal Medicine and have moved on to 1 week each of Ophthalmology, Neurosurgery, Anesthesiology, and Otolaryngology.  This week: brain surgery.  (Tomorrow, the world.) In 3rd grade, I wrote “I want to be a brain surgen [sic].”  Ever since, it’s been a goal of mine to be a neurosurgeon.  Well, until college ... when other interests and the anticipated reality of a 7+ year residency ...

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President Bush once said something along the lines of, "We do have universal health care in this country — just go to the emergency room." EMTALA.  The law requiring emergency rooms to treat everyone’s emergent conditions, a well meaning act that has had disastrous consequences for hospitals’ bottom lines.  A disgustingly flawed law on many levels. How do you prove it is not an emergency condition?  You work it up.  ...

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Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care. It hit me one day, during my medicine rotation.  We were working up a patient, and I was ordering tests with my resident.  The patient had liver disease and perhaps some ascites. He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have ...

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