Fran Barker called today. She was in a panic because the cost of her monthly prescription of 150 mg amitriptyline tablets had gone up to $130 from $13 the month before.
Amitriptyline has been available in this country since 1961, and the 100 mg strength was on Walmart’s list of $4/month drugs the last time I looked at it a few months …
What is going on with generic drug prices?
The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews.
With a physician who is an expert in airway anatomy at her side, and all the technologic …
Joan Rivers’ death: What went wrong?
Part 2 of a series. Read part 1.
I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper before anyone had had the decency to contact me. What kind of people act like that? Civilized behavior, respectfulness — in short, all the ways in which you’d think nice …
Why must medical malpractice cases be devoid of decency?
One hundred forty-nine messages.
This is what I return to on my first day back from vacation.
Many of them were marked with a little red arrow, indicating a high-priority phone message.
Recharging with a little time off is a darn good thing, something we all need, and something which has been shown to help all of us be better at what we do. All of us, no matter what our jobs are. …
Caring for patients after coming back from vacation
The recent arrest of Minnesota Vikings star running back Adrian Peterson on child abuse charges has sparked a national conversation on the manner in which parents should discipline their children. Allegedly, Adrian Peterson injured his 4-year-old son by spanking him with a thin tree branch (“a switch”) and leaving cuts and bruises all over his body.
After learning of Adrian Peterson’s indictment, Peterson’s mother, Bonita Jackson, was interviewed by the …
The problem with physically disciplining children
When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I …
Where is compassionate end-of-life care for the elderly patient?
Around the country, doctors are leaving independent practice and joining large groups owned by health care systems. It’s a trend: the recruiting firm Merritt Hawkins predicts that if current growth continues, over 75% of newly hired physicians will be hospital employees within two years.
There seem to be a number of reasons for this consolidation of physicians and hospitals into islands of care. One is the desire for larger groups to …
Will integrated physician groups appeal to millennials?
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers: government or private. It turns out this medical marketplace game is not all that new. It’s just become wilier, as I have shared in a couple of posts over the summer.
An obituary last week for Dr. Rashi Fein, an influential economist with a …
Question why your relative needs to be at a rehab facility
It’s not often that I find myself speechless. I have heard all sorts of stories in my office — as a sexuality counselor, I am often humbled by the trust that people place in me and how much they disclose about their private lives. But one conversation I had with a patient literally made my jaw drop.
The patient is a …
Estrogen therapy and breast cancer: The pharmacist said no
There’s been a lot of controversy recently about workplace wellness programs: Do they save money for employers on health care costs? Can they produce measurable benefits for employee health? Do they unfairly punish people who are unable to participate? Are these programs just a ploy to shift medical costs to unhealthy employees?
Recently Austin Frakt and Aaron Carroll revisited these questions in a piece for the New York Times’ Upshot column, “Read more…
Workplace wellness programs: Are they really failures?
Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …
When your child doesn’t poop: Solving the constipation death spiral
I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.
An article came out in the …
Emergency room doctors can safely use bedside ultrasound
She was sick. Not sick like a high fever, body aches and a runny nose. Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed. There was oxygen, and dialysis, and a colostomy. She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by …
What personal responsibility means to a physician
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If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math.
Remember that a complication is a blameless event, in contrast to a negligent act when the physician is …
Complications are a reality of medical life
“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds.
Mr. Jones just had a transhiatal esophagectomy (THE). The esophagus is the muscular tube that connects the back of one’s throat to their stomach. It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed.
A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up …
To reduce health costs, everyone needs to be on the same page
Medical students are repeatedly taught the importance of the physician-patient relationship. We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get …
Vulnerability is a virtue in medicine
Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.
Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.
Within a minute, an administrative secretary came out and …
How hospitals discourage doctors: A step by step guide
The simple truth is that radiology reports can be hard to read, especially for those without a medical background. The combination of advanced medical technology and the wonderful subtle intricacies of the human body often result in a final document that more closely resembles a William Faulkner novel (translation: difficult to understand!) than Dr. Seuss. The goal is to try to …
An insider guide to reading your radiology report
The Affordable Care Act (ACA), commonly known as Obamacare, increased the availability of FDA-approved contraception to women through cost-free coverage under the contraceptive mandate. With the exception of some religiously affiliated insurance plans and employers who are legally exempt, this mandate supports women’s access to comprehensive reproductive health care, including the most effective forms of contraception. However, an integral part of family planning was left out of the legislation: contraceptive …
Why are men left out the contraceptive mandate?
1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion. The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary care, it …
Physician assistants: 5 predictions in the era of health reform
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