How to save hundreds of dollars on your medical bills Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice. A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to ...

Read more...

Attempting to alter the health care marketplace so provider decisions are based on patient value has shaped my career for the last 20 years.   Often use of the health care delivery system creates a learning opportunity for me as well as the poor, unsuspecting provider of care.  A recent experience was instructive. A close encounter with a jungle rock while mountain biking sent my husband back to our cruise ship with ...

Read more...

Several years ago I took care of an elderly woman in the ER.  She came in with a chief complaint of chest pain.  She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better.  She didn’t know she was about to die, usually people who are about to die look much worse. She looked good, all things considered.  ...

Read more...

Ms. Smith (name changed) is 82-years-old, but currently looks about a hundred. I met her, intubated, in the ICU two weeks ago. She lived alone, hadn't told family she wasn't feeling well, but had called 911. In the emergency department, she was struggling to breath, and was intubated, having gone into respiratory failure. She was found to have a severe pneumonia affecting the majority of both her lungs. She also went ...

Read more...

There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine.  Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that "helps" people yet gets abuse dished upon them on nearly a daily basis. A 2006 survey of emergency nurses showed that 25% ...

Read more...

I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.

Why have so many patients lost trust in their doctors?

You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question.  I haven’t found any ...

Read more...

Inappropriate use of emergency departments (EDs) → congested EDs → over-worked staff members → frustrated staff members → speculation of more non-emergent ED usage → expectation to provide high customer satisfaction scores → decreased actual customer satisfaction → decreased reimbursement → higher costs of ED → budget cuts → decreased staffing → return to beginning. Whose idea was any of this?  None of it makes sense to me.  The idea of providing reimbursement to healthcare agencies based on customer satisfaction scores is ...

Read more...

A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn't think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission. And there she sits ...

Read more...

In medicine today diagnostic testing and advanced imaging is readily available and widely utilized in most every clinical setting.  Many physicians have given up the stethoscope and physical exam in favor of an echocardiogram and a CT scan.  Fear of missing something pervades every emergency department and has resulted in hundreds of thousands of unnecessary testing costing billions of dollars in healthcare expenditures. Of course, the driving causes of increased testing ...

Read more...

Cardiologists are causing patients to get cancer. It’s true. Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever. As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual. And cardiologists routinely subject patients with normal coronary arteries ...

Read more...