Many of us now have high-deductible health insurance plans, which makes us “cash-pay” patients until we meet our deductibles. According to a Health Affairs health policy brief, high deductible plans are now much more prevalent in both individual and group markets. The higher the deductible, the lower the monthly premium. If you have a high deductible plan and don’t consume much medical care, you are most likely a cash pay ...

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One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as ...

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I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose -- a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure ...

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Vox's Sarah Kliff wrote a story of how patients are the health care system's free labor.  It's a good article, go read it. I did a quick take on Facebook Live, imploring doctors and patients that they need to be on the same side.  We want to same thing: Better care for patients.  Neither can change health care by themselves.  If we truly want to make a difference, doctors and ...

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Like many physicians, I’m a people pleaser.  On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering -- and I really meant it.  What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically. Medical school and residency didn’t adequately prepare me for the emotional strain of ...

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Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it.   Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain. The 92-year-old patient is bleeding into her head, but has blood ...

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As a registered nurse and health care writer and editor for more than 25 years, I routinely wrote or assigned stories to other writers about the health of LGBT individuals.  I valued these stories not only because I was a nurse, but also because I thought the subject was worthy of coverage. I believed our nurse readers should be aware of the specific health needs of their LGBT patients. I followed ...

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A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer.  The doctor was in a hurry and advised her to ask the staff, but the staff was busy with other patients and told her to call them later. The patient did not call. The gynecologist ordered ...

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Many of us who suffer from chronic pain and illness are on medications that carry side effects that, in some cases, can be as difficult to cope with as our initial health problems. I’ve recently started a medication that I’m scheduled to be on for five years. I’m taking it because it significantly reduces the risk of a recurrence of my recent bout with breast cancer. And so, yes, I’m taking ...

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Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments.  Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing ...

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