A recent New York Times piece had the catchy title, “Don’t visit your doctor in the afternoon.” It was prompted by a study published in JAMA Network Open that had the much less catchy title “Association of Primary Care Clinic Appointment Time with Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening.” The study found that the frequency of appropriate ordering of ...

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As my patients aged along with me, I noticed both the expected increased numbers of people with some form of dementia and even more patients who were worried about this topic. Unless you have been away on a ten-year safari, you are very aware that dementia is a growing problem. Some 5.8 million Americans are living with Alzheimer's disease, and similar numbers occur in most western countries. The incidence goes ...

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One of the arguments made against adopting single-payer health care in this country is that it would “lead to rationing.” This assumes that we lucky people in the U.S. have unlimited access to whatever health care we need and are at risk of losing it. This argument came to mind when I saw a few recent news items. One was that a federal judge, U.S. District Judge Robert Scola, recused himself ...

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A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.” As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves. Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a ...

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This is the scenario. You (or your mother) were admitted to the hospital with pneumonia. On the third day a cheery continuing care nurse comes in and says, “You don’t have a fever, and the doctors feel you can be discharged to finish your course of antibiotics, but your nurse tells me you are still too weak to go home, so we are going to send you to rehab. Here ...

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Kaiser Health News told the story of a 69-year-old woman who went to a new doctor for her annual check-up, assuming it was covered by Medicare and was happy with the visit until she got a $400 bill. Most Americans believe in “annual check-ups,” at which your doctor reviews your medical history, gives you a thorough physical and orders lab tests. The actual value of such visits has been questioned, but ...

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During my time in practice, I had at least eight patients who came to me sure they had systemic lupus erythematosus, also commonly called SLE or lupus. This is an autoimmune disease, characterized by joint pain, that can affect almost any organ, including skin, kidneys, brain, and heart, and can even be fatal. In every case, they had been given this diagnosis because of a blood test called an ANA, ...

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To treat any condition, the doctor needs to know what it is. You would not expect to have your sore ankle treated with penicillin or to have an appendectomy recommended for your sore throat. While this may be self-evident, I know of at least one patient who had a normal appendix removed because the surgeon did not notice the few telltale blisters that were warning the careful observer that the ...

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An excerpt from Prescription for Bankruptcy: A doctor's perspective on America's failing health care system and how we can fix it. Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue ...

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