I am not the first physician blogger to write about the difficulties of prior authorizations, denials, and appeals, but recent occurrences in my own practice have been so convoluted that I feel they must be shared. The nonsensical denials would almost cause one to laugh, if not for the reality that each denial represents potential delay in care for the patient and redundant work for the physician. That's work that expands ...

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It’s 8:45 p.m. in rural Chiapas, Mexico. A cool blanket wraps around the previously warm day in the small farming town of Honduras. With a syringe of medicine in his front pocket pasante, Dr. Ivan Martinez does a steady jog up a steep hill to see about a patient’s chronic pain. Nestled in the Sierra Madre Mountains, there are few flat places. At the door, he’s immediately and warmly greeted by multiple ...

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We tend to like threes. Hendriasis, in Greek — one through three, is a figure of speech used for emphasis in which three words are used to express one idea. For example: Veni vidi, vici. Location, location, location. Or one of the anthems of my youth — sex drugs and rock n' roll. Monty Hall had three doors on "Let’s Make a Deal." Even Uncle Junior, the patriarch in the “Sopranos,” ...

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With the attempts to repeal and replace the Affordable Care Act, it is a good time to educate our leaders on an opportunity to significantly reduce the incidence of the most expensive and common preventable, pre-existing condition: What your mother did or didn’t eat when she was pregnant with you. Yes, it is a pre-existing condition that determines how you die. Confused? Let me give you a little scientific context. Recently I was ...

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When Hurricane Harvey swept through Texas, devastating millions of people, I was lucky to be in an area of Houston where the flooding did nothing more than confine me to my apartment for a few days. It hurt to see so many people suffering after reading the news and social media posts about people losing their homes, many of their belongings, and in some cases, their lives. As the flooding ...

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She came to me with complaints of weight gain. I gave her a pill, and she shed 200 lbs. in 2 weeks. No, of course not. There is no such pill. Mrs. Lopez did not lose weight. At her follow up four months later, she had gained 11 pounds. I went back to my note, and it clearly said that I “counseled her ...

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I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause. To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information. A 
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications. On this visit and on two subsequent nurse visits, the patient's blood pressure measurements are less than 140/90 mm Hg. BMI is ...

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STAT_Logo I’m a physician, a husband and dad, a guy who tries to live by the golden rule. But sometimes I’m an escort into sadness and despair, plunging families into the darkest emotional depths with the news I must give.

One particular case from years prior stands out. Mary (whose name and identifying details have ...

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For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high ...

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