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Showing posts from July, 2022

Were You Discharged from the Hospital Too Early?

You sent my father home from the hospital too soon.   Three days later, he was worse than ever and needed surgery! I’ve heard similar lamentations from patients and their families over decades.   Every doctor and hospital nurse has also.   And I acknowledge that sometimes families are correct; folks were sent home too soon.   However, in my long experience, most patients are not sent to the street too soon despite some folks feeling otherwise, usually after the fact.    First, let’s all agree that the medical profession – like your own occupation – is a human endeavor which means that perfection is aspirational.   An imperfect outcome or a catastrophic development does not mean that medical carelessness or negligence has occurred.   Medical malpractice is a real issue, but that is distinct from adverse medical outcomes, which is what I am focusing on in this post Medicine is not mathematics.   There is no formula or set of proofs that will reliably bring us the desired result

Why This Doctor Gave Up Telemedicine

During the pandemic, I engaged in telemedicine with my patients out of necessity.  This platform was already destined to become part of the medical landscape even prior to the pandemic.  COVID-19 accelerated the process.  The appeal is obvious.  Patients can have medical visits from their own homes without driving to the office, parking, checking in, finding their way to the office, biding time in the waiting room and then driving out afterwards.  And patients could consult physicians from far distances, even across state lines.  Most of the time invested in traditional office visits occurs before and after the actual visits.  So much time wasted! Indeed, telemedicine has answered the prayers of time management enthusiasts. At first, I was also intoxicated treating patients via cyberspace, or telemedically, if I may invent a term.   I could comfortably sink into my own couch in sweatpants as I guided patients through the heartbreak of hemorrhoids and the distress of diarrhea.   Clear

The Overuse of Heartburn Drugs

Stomach acid must be Public Enemy #1 for gastroenterologists and primary care physicians.  Why else would more than 10 million Americans swallow proton pump inhibitor (PPI) medicines each day? These medicines are potent stomach acid blockers.  Common examples of these medicines include Prilosec (omeprazole), Nexium (esomeprazole) and Protonix (pantoprazole).  PPI medicines have generated tens of billions of dollars for pharmaceutical companies.  And several of these medicines are available over-the-counter (OTC), which permits the public to self-prescribe for a variety of ailments. Are ordinary folks selecting these medicines appropriately when they purchase OTC?   I have my doubts particularly since medical professionals often prescribe these agents very liberally going beyond the boundaries of medical evidence.   I have also been culpable of the transgression of PPI mission creep.   Indeed, studies have shown that physicians prescribe these acid blockers for the wrong reason and al

Treating the Medically Uninsured

Imagine that you are a physician and the patient sitting before you has no medical insurance. This means, of course, that this individual will have to pay personally for the costs of blood tests, radiology studies, consults with medical specialists, prescriptions, diagnostic tests and even surgeries.   What do you think it might cost your patient if he is suffering from issues such as chest pain, weight loss, abdominal pain or dizziness?   Standard evaluations for these medical symptoms can cost many thousands of dollars.   Medical Care Ain't Cheap So, assuming you are the doctor, how would you modify your advice to be sensitive to your patient’s sober financial realities?   Which of the following modifications would you support for a patient who has no insurance? Instead of ordering a stress test for chest pain, prescribe heart medicine to see if this resolves the issue. Instead of sending the patient to the Emergency Room for a question of appendicitis, presc

Independence Day 2022

We are not, thank the Almighty, engaged in a civil war.  But it does seem that we are waging a war on civility.  Rage, anger, violence, division, hate and fear have crept into every corner.  Politics is increasingly regarded as a zero sum game.  Compromise and accommodation are considered by many to be signs of weakness.  If I can't get everything I want, then you will get nothing.  Should this be our modus operandi? And the country is in pain.  We are still suffering from the aftershocks of a horrendous pandemic.  Our kids lost a year of education.  Inflation is roaring ahead with no clear end in sight.  A recession with rising unemployment may be just around the corner.  Folks are scared.   A war in Europe reminds us that democracy is at risk. Political campaigns have taken on a coarse vulgarity that mirrors the erosion of etiquette and decorum at large.  The January 6th hearings, while necessary, are only further dividing a fractured nation.  And as all of this was boiling over,