Prior authorizations (PAs) have become increasingly burdensome for providers — they contribute to 92 percent of care delays and an estimated 77 million are submitted manually each year. In fact, the process has become so burdensome that many physicians get fed up with the process end up writing for less-effective prescriptions because they know the preferred drug will require a prior ...

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Despite meticulous time management and delegation as a doctor, there were times when I found cobwebs on the laundry left on the clothesline too long, or a moldy school lunch or squashed banana forgotten at the bottom of a school bag at home. I would ensure all the important school dates were in my diary, but I was often tripped up by the curriculum day when school was suddenly off ...

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As I sat in a frozen yogurt store a couple of years back, I watched as two young men pulled up in an expensive vehicle. They were wearing athletic attire from a private faith-affiliated university in the neighborhood. Both grabbed sample cups and cup-by-cup consumed about ten dollars-worth of yogurt each before jestfully yelling “Gracias” to the Latin store employee and walking out the door without paying for anything. Then ...

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I stuck myself with a hypodermic needle the other day. Intentionally. The first time in over 25 years of doctoring. More surprising, a six-year-old patient told me to do it, so I had to. The boy, who I’ll call Tyler, came to the office with his father and had a large ganglion cyst on the back of his wrist -- bigger than a jellybean. I told Tyler and his father all ...

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Does the flu shot cause the flu? Let me tell you, without a doubt, that the flu shot does not give you the flu. This is perhaps one of the most common misconceptions I hear as a physician. People absolutely swear by it. I’ve even had people tell me that family members got the flu shot and then died suddenly. I’m sympathetic, but how misguided! Before we talk more about the flu ...

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When you or a loved one is sick or injured, health care decisions are fundamentally a matter of trust.  You trust your physician will have the answers you need, because you know that, as a highly-trained medical professional, they’re qualified to make the best recommendation for each and every patient under their care. Physicians receive some of the most rigorous education and training of any profession. They spend the better part ...

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The beverage industry derailed the movement for soda taxes in California by convincing state elected officials to pre-empt local taxing authority in exchange for cancelling a ballot initiative that would have made all new taxes difficult to pass. But taxes are not the only way to reduce sugary beverage consumption in California or the U.S. as a whole. The beverage industry has come up with several ideas on how to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks' duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for 3 years and oral cyclophosphamide for 1 year. ...

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The children of survivors are important to the Holocaust story.  The children are the future of the past.  For a time, it seemed that no one would be left to create a future.  That history has been so carefully, lovingly chronicled.  It must be preserved.  If it is preserved and told, the possibility exists that there will be no more war.  That is always the hope of the survivors. This is ...

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September 28, 2018 marks 90 years since Sir Alexander Fleming discovered penicillin as an effective antimicrobial which would soon save millions of lives. He warned soon afterwards that unless we used penicillin judiciously, we would see antibiotic resistance, and he was right. With decades of inappropriate antibiotic prescribing, we have dug ourselves a deep hole of antimicrobial resistance, and inaccurate penicillin allergies is but one shovel used to put us ...

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In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings. To simplify things a bit, every health care system on earth has three main stakeholders:

  1. Patients
  2. Physicians and clinicians
  3. Administrators
Yes ...

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“Do your parents realize that he could die?” I had been summoned to the workspace of the ED physician who was trying to save my brother’s life. I remember noticing that he was short with thick brown hair and a crisp white coat which were both too tidy and incongruent with the message he was delivering. He struck me as someone who was earnestly playing the role of a physician instead ...

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Just over a month has elapsed since my retirement from patient care. I’ve been to one grand rounds at my prior medical center, encountering a smattering of old friends, some preceding me to retirement, others in active discussions with their financial advisers and others a mixed multitude of residents and students assigned to the secondary campus that month looking upon us geezers in the small video access conference room with ...

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A thought, a word, a story. Simple concepts in a complex world, but they can have a profound effect on how we live our lives. Today's world may seem, at times, a blur. We are inundated every day with headlines of natural disasters, man's inhumanity to man, and simply, just life slapping us in the face. How can we maintain a sense of sanity and security when the world around ...

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Last Friday, as I sat finishing up notes on the last of my almost 30 physicals (this number is never any surprise for us pediatricians this time of the year, it’s back to school week, so every Thomason, Dickinson, and Harrison is lining up for sports physicals and regular physicals and all sorts of clearance and medication forms that need to be filled out and turned in “yesterday.”) I took ...

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I was walking in the store the other day and ran into a recently deceased elderly patient’s relative. As he walked by, I thought to myself, I better stop to say I am sorry. So I shouted to him, “Hey how are you?” He paused, and I continued to walk over and proceeded to offer my condolences. I stated “I am sorry about the death of your loved one. I ...

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I am a retired family physician (FP) and do extensive traveling in my RV. Since I have multiple medical problems, I attempt to carry with a copy of my medical records with me. I am often surprised by the information that is included in the office dictation or the hospital record and wonder how that information was obtained since it was not elicited by asking me for the info. Case in ...

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There are now more than 700 million obese people worldwide, 108 million of them children, reported the New York Times in 2017. In Brazil, food giant Nestle sends vendors door-to-door hawking its high-calorie junk food and giving customers a full month to pay for their purchases. Nestle calls the junk food hawkers, who are themselves obese, “micro-entrepreneurs.” Big Food is increasingly targeting poor countries as “emerging markets” ...

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Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time. Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? ...

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When I first announced my boyfriend and I were engaged, I was met with follow up questions. “When is the wedding?” “How did he do it?” And, inevitably, “Will you be taking his last name?” My reply to the latter was often met with a furled brow. I heard, “I am surprised you of all people would take someone’s last name. That’s great though!” Similar responses repeatedly caught me off guard. During ...

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