Janice Boughton, MD

Janice Boughton is a physician who blogs at Why is American health care so expensive?

What’s wrong with socialized medicine, and what we can learn from the NHS

Policy

September 26, 2016

The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children’s Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still …

We can’t agree on the value of the yearly physical

Janice Boughton, MD

Physician

August 18, 2016

“I’m going to the doctor next week for my yearly physical.” So normal. Of course you are. Everyone should do that.

But the concept of a yearly examination of one’s whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question.

I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at …

Who are the patients that stay in the hospital for a very long time?

Janice Boughton, MD

Physician

April 11, 2016

I just finished reading a very delightful A Piece of My Mind essay in JAMA. JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …

Customer service in health care: Does AIDET really work?

Janice Boughton, MD

Physician

February 1, 2016

Mnemonics can be incredibly cool. When I was in medical school, there was just too much stuff to remember and memory aids were so very helpful. Most specifically I refer to the vile and inappropriate one that helped me remember the cranial nerves which I remember to this day and will not share in print.

In ancient times orators used memory palaces to memorize long speeches or poems, associating words with …

Why are medical bills full of mistakes?

Janice Boughton, MD

Physician

October 18, 2015

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Within the last two days, I received a bill for my glasses and read a post by a friend ranting about medical billing mistakes. This is a huge problem that is so common that it could be considered the norm. It is ridiculously expensive and could probably be fixed.

My exposure to medical bills has been through patients who show them to me, …

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Why are medical bills full of mistakes?

Drugs and devices are getting more expensive and less useful. Why?

Janice Boughton, MD

Meds

August 27, 2015

A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles evaluated.

This is nothing new, but it looks to me like there are increasingly more of these articles which celebrate products and fewer interesting articles about the science of medicine. The other thing …

Please forgive us for prescribing controlled drugs to just about everybody

Janice Boughton, MD

Meds

May 25, 2015

Lately I’ve had the opportunity to work in an outpatient clinic where the regular doctor is out sick for a prolonged period of time. It is a breathtakingly beautiful little community, with green hills and a crystal clear river. It is also troubled by methamphetamine and prescription drug abuse.

The little clinic in town is unwittingly a partner in this crime. Like …

Resistant hypertension? Or failure to take blood pressure correctly?

Janice Boughton, MD

Conditions

April 30, 2015

I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have …

My experience with an emergency airway management CME

Janice Boughton, MD

Physician

April 4, 2015

Physicians need to complete about 50 hours of some kind of continuing medical education (CME) every year. The ideal kind of class is one that we actually attend in person, with teachers who are expert in the field being taught and are somewhere near the cutting edge. CME classes are especially nice when they include something hands-on rather than just a lecture format because much of medicine is hands on …

Real-life examples of ultrasound in the developing world

Janice Boughton, MD

Physician

March 8, 2015

In the last year and a half, I’ve been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I’m not actually vacationing.

Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how …

The measles outbreak and vaccines: We need civil discourse

Janice Boughton, MD

Meds

March 1, 2015

There has been an outbreak of measles, a vaccine preventable disease, along with an outbreak of people yelling at each other. There have been angry exchanges between people who would like all children vaccinated according to the recommended guidelines and people who support the rights of parents to choose which vaccines to give their children, if any, and when to give them. There has been much focus on the assertion, …

Does Tamiflu work and what are the side effects?

Janice Boughton, MD

Meds

February 20, 2015

The flu season has really gotten into gear now with 46 of our 50 states reporting widespread influenza activity as of January 3, 2015. Influenza is a virus that infects the respiratory tract, causing sore throat, runny nose, fever, and cough. Rarely people with the flu will have nausea, vomiting and diarrhea, but this is not “stomach flu” which is a term some of us use to describe any one …

Why does treating heart attacks cost so much money?

Janice Boughton, MD

Physician

December 7, 2014

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An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …

Should hospitals manage hospitalist programs?

Janice Boughton, MD

Physician

November 29, 2014

I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together.

When I first worked here, 2 years ago, they …

Why do drugs cost so much?

Janice Boughton, MD

Meds

November 12, 2014

Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …

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Why do drugs cost so much?

Ebola! But don’t forget about the flu.

Janice Boughton, MD

Physician

October 31, 2014

Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers.

Ebola is a nasty virus, surely, with a case fatality rate of 80 percent. Overall health and nutrition as well as living …

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Ebola! But don’t forget about the flu.

Emergency room doctors can safely use bedside ultrasound

Janice Boughton, MD

Physician

September 27, 2014

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 …

This is what population health looks like

Janice Boughton, MD

Policy

September 18, 2014

It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so …

ALS and the ice bucket challenge: A matter of priorities

Janice Boughton, MD

Conditions

September 9, 2014

The ALS Association, and the British version, the Motor Neurone Disease Association, have made boatloads of money off of the ice bucket challenge. Originally the idea was that a person would challenge another person to donate money for ALS research and if they hadn’t done so in 24 hours, they would dump a bucket of ice water over their head. It turns out that people like dumping ice buckets over …

Why are doctors still prescribing Zetia?

Janice Boughton, MD

Meds

July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

Janice Boughton, MD

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