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Showing posts from April, 2019

End of Life and the Medical Profession

Physicians and nurses deal with the deepest issues of the human condition – life and death.   Our profession brings new life into the world and does our best to bring comfort and peace at the journey’s end.   It is a profound and emotional experience for medical professionals to be with a patient and family when life ends. There are other professions who routinely confront loss of life.   Law enforcement personnel, paramedics, firefighters and soldiers all are exposed to events that most of us would never wish to experience. The medical profession and society is struggling to preserve our humanity in a 'cut & paste' world where one's worth is determined by the quantity of twitter followers.   Hugging a child.  There's no 'app' for this. On my very first day of medical internship in Pittsburgh, I was called by a nurse to pronounce a patient dead.    I had never seen the patient before.   The only deceased individual that I had any close co

Musings on Religion

There is a confluence this weekend of holy days from two venerable monotheistic religions.   Today is Easter, which represents the anniversary of the resurrection of Jesus Christ, a foundational theological principle of Christianity.     Christians await the Second Coming, when they believe that Jesus will return to establish a world of peace and justice. Passover, which began on Friday evening, celebrates the iconic and gripping tale, chronicled in the Book of Exodus, of the emancipation and liberation of the Jews who were enslaved under a cruel Egyptian regime.   The yearning for freedom and resistance against tyranny carefully documented in the Torah, is truly a universal template that is relevant to this very day.   Jews Crossing the Red Sea Leaving Bondage Behind The religions are so deeply intertwined.   While I am neither a Christian nor a scholar, I have taken some effort to study the New Testament so that I might gain some understanding of this ‘offshoot’ of my

Step Therapy - Pharmacy Benefit Managers are at it again!

Among the many tools that insurance companies wield to save money is a technique called ‘step therapy’.  This is a technique that exasperates patients and physicians.  Here’s how it works.  A patients comes to his doctor with a medical issue.  The doctor, who presumably has a decent measure of medical training, experience and judgment, decides to prescribe a medication, in an effort to ameliorate the patient’s distress.  Let us call this magic elixir Pill A.  The doctor zaps this prescription to the pharmacy at the speed of light using the ever trustworthy electronic medical record.  The satisfied patient leaves with the mistaken impression that his cure is just around the corner. Here’s where the fun begins.  Of course, the patient may receive the typical denial as Pill A is not on the formulary.  Keep in mind that an insurance company’s denial doesn’t mean the patient can’t fill the prescription.  Insurance companies would never interfere with a physician’s medical judgment.

Why I Fired Two Patients From My Practice

You're fired!  We've all heard this directive that was popularized by our current chief executive. It is much more common for a patient to fire a physician than it is for a doctor to cut a patient loose.   Yet, I sent 2 of my patients termination letters in the month prior to my penning this post, which represents a firing surge on my part.   This has been a very rare event in my practice.   Since physicians are patient advocates by training and practice, we tend to extend leniencies to our patients, giving out 2 nd and 3 rd chances routinely.   But, the doctor-patient relationship is not unbreakable and both sides have responsibilities to maintain it.   The Doctor-Patient Relationship Should be a Partnership - not a Duel. Here are some reasons that patients have offered justifying seeking a new physician.   Keep in mind that these given reasons represent patients’ perceptions, which may not necessarily represent absolute truth. Poor or absent communication