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Showing posts from October, 2018

Behind the Scenes in a Medical Office

Here is a potpourri of medical vignettes.   All are real life scenarios that I have experienced in my practice.  The absurdities of life also permeate the medical profession.  An insider’s view of medicine, as in any profession or industry, may be less sanitized than its public face.  Here are some Scenes from Scopesville, Ohio. Act I, Scene I Patients are routinely told that they should not eat or drink on the day of their colonoscopy.   Recently, a patient decided that these instructions did not prevent him from eating a full breakfast.  This is where the phrase, ‘you prepped for nothing’, applies. A patient comes to see me on the advice of his primary care physician.  He has no idea why he has been sent.  Let the sleuthing begin! A patient asks for a work excuse for the entire week following his colonoscopy. I am asked to fill out disability papers for a patient I saw once a year ago. A patient complains to me and my staff about a $20 copay.  We have nothing to do wit

How to Save Health Care Dollars

Health care costs in America are incinerating nearly 20% of the Gross National Product.    Can you say, non-sustainable?    Folks have been bloviating for decades about reforming the health care system with respect to quality, cost and access to care.   This is quite the quagmire.   If it were easily solved, then it would have been done during the Truman administration. He couldn't get it done.   Here are a few reasons why it has been so tough to crack this case. Cutting costs can threaten medical quality. I know of no player in the Medical Industrial Complex who is willing to sacrifice his own revenue to serve the greater good. Pharmaceutical companies receive federal research dollars but are not subject to reasonable governmental control on their opaque pricing schemes. The public expects every conceivable medical benefit, preferably for free. The fee-for-service model drives unnecessary medical care. Pharmacy Benefit Managers – huge middlemen – suck out

It Takes a Village - A Look Back...

I prefer to do business with small, privately owned establishments rather than patronize the big box centers that have pushed smaller stores to the margins or off the grid.  Of course, I do spend money at the large centers for the same reasons that all of us do.  But, I miss the personal attention and interest that a single proprietor and the staff can provide.  South Orange, the small town, or actually village, where I was raised was full of these stores where we bought hardware items, sandwiches, clothing, medicine, shoes and ice cream cones.  I would periodically stop into the bank, with my passbook, to deposit my accumulated cash from my paltry weekly allowance. (As a third grader, I received 10 cents per week.)  When I would pop into to one of these places, the owners knew me and my family, not quite the experience in some retail stores today where one guard has to admit me into the store and another must scan my receipt before I can exit.  Village Hall in South Orange, NJ

When Diagnosing Colon Cancer Might be a Mistake

So much of life depends upon timing.    Sure, we plan, but we know how much of our life’s events are unplanned and unexpected.   So often, our jobs and our mates – two of our most defining accomplishments – are the result of a chance encounter or a random act.   Life does not reliably proceed in an orderly manner. This is often true in the medical profession.    Here, physicians in our quest to seek out and squelch disease, often discover what would should have been left alone.   For example, is discovering prostate cancer in an older man a true benefit if the tumor would have remained silent throughout the man’s life?   Whenever possible, it is best to ask the question, ‘what will I do with the information?’, before recommending a diagnostic test to a patient.   There is a risk to disturbing the natural order of things. Are we really just shooting dice? Sometimes, medical events occur on their own without any prompting from a physician.   I was contacted by a physician