A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act. The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: ...

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Just a little over a week into 2014, my new year started off with a bang -- literally -- as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising. Just a little over a week from ...

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One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community centers. What ...

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2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits. The study in question showed that when health insurance was extended to Oregon residents ...

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From MedPage Today:

  1. Will Docs Write Rx for Apps? Doctors can now write scripts for the first prescription-only app -- but the question remains whether they'll pick up a prescription pad to write for mobile technology.
  2. What an Emergency Department Report Card Tells Us. The press release promised that a new report would answer the question: "Are your state's emergency rooms making the grade?"

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Donald is large. Very large. At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks. "My stomach hurts," he says, his voice surprisingly high and childlike. It is 10:00pm in the emergency room, and I am already swamped with patients I'm trying to move through the ER before my shift is over. Asked if he's ever felt this kind of pain before, ...

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The interpretation of results of a policy study lies in the political inclination of the beholder. If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance. This ...

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Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain.  His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab.  In the interim, his chest pain worsened.  Sure enough, he developed an anterior MI.  The tombstones ...

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His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway.   My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain.  Fortunately, his testicle was still intact and only needed to be put in the proper place. I am an attending physician in the emergency department and trauma center at San Francisco General Hospital.  I ...

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My cancer shows how our world is ruled by love I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is. Love is when I go to the ER at UCLA, where I work, for a cough and feeling that “something isn’t right,” and even though my complaints are mild, I’m brought right in and ...

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