You have just gotten a job offer that includes health insurance.  You’re lucky enough that your spouse has great family insurance already, but hey that health insurance is going to cover the cracks in the deductible and co-insurance, so you feel great about that double coverage as you sign your contract. Well, you just got scammed.  That is, double coverage is a scam, and you would have been far better off ...

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Dear President-elect Trump, I am writing to reach out to you, something I have never been inspired to do for a president-elect in the past.   First, congratulations on your hard fought victory, and to your family.  It was a surprise for many of us. While it was probably a happy morning in your campaign and family, it was a pretty dark morning in my household.   Our family was very supportive ...

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When I talk to my patients, one of the greatest concerns I hear is regarding the fear that they might get a cancer at some point in their life. It is a very reasonable fear, as cancers of the female reproductive tract and breasts are not as rare as we might like. Perhaps educated by Angelina Jolie’s announcement of her BRCA mutation in 2013, many women now ask me about ...

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Last year I wrote about a few strategies for decreasing costs in the operating room.  Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical. In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives.  If you want to understand human behavior, all you have to do is identify the incentives that drive ...

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As I look back over my 10 year career in obstetrics and gynecology, I am sometimes struck at how many things have been discovered in this time period. When I started the origin of pre-eclampsia was unknown, and now we know that it likely originates in an overabundance of a molecule called Soluble FMS-Like Tyrosine Kinase, a competitive inhibitor to natural angiogenesis in the placenta.  Ten years ago the origins of ...

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I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy.  What a blast!  There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience. Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so ...

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Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval. This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature.  When a denial occurs, the physician or patient has several opportunities to appeal this decision.  The first appeal is ...

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One thing that many residents do not know is that there are more benefits to becoming a board certified physician than just that plaque on the wall.   One of these benefits is that ability to pick up a few extra hours of work here and there doing consulting for the multitude of companies that would like the opinion or expertise of a physician. In some cases this consulting can be about ...

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When one is a medical student, pretty much everything one does is directly supervised.  Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients.  They practice these decisions, but there is always someone more senior ratifying them. Once a student becomes  a resident, things start to change.  As residents are physicians, they have the power to write ...

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One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way. A popular term bandied about is “Unnecesarean”, a catchy ...

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