It seems to be trendy these days to say we’re all overmedicated. People say we swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.
However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …
How to know whether antidepressants will help
Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …
Boxer at Rest: A physician’s interpretation
Asthma is a common problem in children — nearly 10% now have it — and the number is increasing. Researchers are not sure of the reasons for this steady increase, but decreased air quality, lower activity levels among children, and an increase childhood obesity have all been implicated. Whatever the cause, it means that millions of American children take medicine for asthma. A significant number of these children end up in …
Asthma in children: A complete primer
In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.
I distinctly recall the time in my medical education when I realized I was becoming more medical …
Doctors need to remember that they need to be human first
In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.
In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …
The outrageous ER markup for a tetanus shot
To what end?
Those three words have become something of a mantra, a mission, a philosophy of care.
3 words that define a philosophy of care
Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances — layoffs, foreclosures, accidents, violence — can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of …
Understanding the intersection of health care and social services
At the end of a long day at my medical practice, I am sitting at my computer catching up with friends via Facebook. Suddenly, a notification pops up: one of the patients I saw today has sent me a friend request. I know that the ACP, AMA and every other physician organization recommends strongly that doctors not connect with patients via social media, so I quickly click to decline the …
The repercussions of declining Facebook friend requests from patients
As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.
While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document …
How a letter of intent can help with physician recruitment
Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.
Having too many claims for level five CPT codes …
How to respond to a Medicare audit: 17 tips from a lawyer
It is in our nature to lie. Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication. What happens …
What happens to us when we lie about dying?
Why aren’t people in hospitals more attentive to the needs of patients?
In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha …
How can we reduce friction in the hospital?
I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”
This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …
Who’s in control? Why both doctors and patients are frustrated
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If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?
It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …
Solving the weekend effect for patients in the hospital
Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …
JAMA removes cover art, and why that matters
While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …
Should smokers pay higher health insurance premiums?
Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …
What does it mean to be a medical intern?
I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with …
A physician expert witness speaks out
Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.
Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …
Why insurance is the wrong model for health care
Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air.
The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents …
The remarkable resiliency of the human body
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