I got an unusual request last week.  I written a prescription of a generic medication (which has been generic for a couple of years) and the prescription was denied by the insurance carrier.  The reason for denial: I had to try a brand-name medication first. Stop.  Read that again.  They wouldn’t allow me to give a prescription for the (cheaper) generic drug because I had to try the brand-name medication first.  This ...

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“The specialist rescheduled me again,” the patient told me, looking embarrassed.  ”I think he doesn’t want to see me any more.” “I’m sure that it isn’t that he doesn’t want to see you,” I replied.  ”This has to be a miscommunication with the front desk.  It happens all the time; it drives doctors crazy.” “I don’t know,” he continued.  ”I just got on Medicare, and I wonder if maybe he doesn’t want ...

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I am an EMR geek who isn’t so thrilled with the direction of EMR.  So what, I have been asked, would make EMR something that is really meaningful?  What would be the things that would truly help, and not just make more hoops for me to jump through?  A lot of this is not in the hands of the gods of meaningful use, but in the realm of the demons ...

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Us and Them And after all we’re only ordinary men The wanna-be congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face.  ”The first thing I am going to do when I get to congress is to work to repeal Obamacare,” he said, expression growing subtly angry.  ”I will do everything I can to give you back the care you need from those who think big ...

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This past July marked the 16th anniversary of the installation of our electronic medical record. Yup.  I am that weird. Over the first 10-14 years of my run as doctor uber-nerd, I believed that widespread adoption of EHR would be one of main things to drive efficiency in health care.  I told anyone I could corner about our drive to improve the quality of our care, while keeping our cash-flow out of ...

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Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: "Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks. Take your electrocardiogram on your smartphone and send ...

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“I want you to get me a new doctor,” she told me, a bit of disgust coming out in the sharp tone in her voice. “What happened?” I asked. “He asked me if I was nauseated, and I told him no, I was just vomiting.  Then he asked if I was feeling pain in my stomach, and again I told him no, it was just vomiting.  He then told his nurse to ...

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My in-laws are in town for my daughter’s graduation.  When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law.  ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor.  The one you found for us is wonderful.” My wife smiled at me warmly.  I just earned myself big points.  Yay! Her parents and mine are ...

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It was during my residency that the first indication of heart toxicity of antibiotics affected me personally.  The threat was related to the use of the first of the non-drowsy antihistamines – Seldane – in combination with macrolide antibiotics, such as Erythromycin causing a potentially fatal heart arrhythmia.  I remember the expressions fear from other residents, as we had used this combination of medications often.  Were we killing people when we treated their ...

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Hello, Pandora.  What do you have in that box? Yes, I am going to talk about ... autism.  The last time I did so I was inundated with people trying to convince me of the dangers of immunizations and their causal link to autism.  I really, really, really don’t want to go anywhere near that one. No, I am not going to talk about the cause of autism; I am going to ...

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"I need you to do me a favor," my nurse asked me at the end of our day on Friday. "Sure," I answered, "what do you want?" "Please have a better week next week," she said with a pained expression. "I don’t think I can handle another one like this week." It was a bad week.  There was cancer, there was anxiety, there were family fights, there were very sick children.  It’s not that ...

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Everyone liked him.  Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes.  The subtle humor was still there, coming out of a man who was weak, in pain, dying. She lived for him.  She was always telling me of his pain, ...

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I always find it very ironic to see doctors bashing EMR on the Internet. They are bashing a tool designed to gather and organize information, improve communication, and give immediate access to important information, while using a tool that gathers and organizes information, improves communication, and gives immediate access to important information. It is fine to bash the current state of EMR (I saw one site complain that EMRs have a ...

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