Luis Collar, MD
Luis Collar is a physician.
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Latest articles
Physician voices
An excerpt from A Quiet Death. Even as I lay perfectly still in the near-complete silence of my car, I could hear Dr. Tierney’s adenoidal voice in my mind. He always seized every opportunity to assure us that his diagnostic…
An excerpt from A Quiet Death.
Even as I lay perfectly still in the near-complete silence of my car, I could hear Dr. Tierney’s adenoidal voice in my mind. He always seized every opportunity to assure us that his diagnostic or therapeutic approach to patients was firmly supported by the literature. That, at least in the sense he intended it, was pure bullshit.
The medical literature had grown exponentially …
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Using algorithms to beat down our physician colleagues
Drugs and prescribing
Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly…
Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly effective in the treatment of chronic hepatitis C (HCV) infection. In fact, with an overall SVR (sustained virologic response) of 90 percent for the genotypes studied, Sovaldi may represent a cure for many of the 3.2 million Americans afflicted …
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Sovaldi: The drug pricing paradigm has shifted
Health policy
1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth.…
1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth. But the truth is that the vast majority of physicians are average in virtually every way. Despite all claims to the contrary, …
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Hard truths: Dispelling 10 health care myths
Health policy
“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy,…
“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy, infant mortality, and countless other indicators of health. Until we fix our broken, prohibitively expensive delivery system, things will only get worse.”
I’m not sure if anyone has used those …
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Stop trying to copy health care systems from other countries
Physician voices
“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?” “Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth.…
“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?”
“Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth. “But you know I never get the flu shot.”
“I know,” I said, still hopeful I could change her mind, “but influenza can be very dangerous, particularly in patients over the age …
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Medicine and its tension with faith
Physician voices
I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change.…
I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still …
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The relevance of physicians is dwindling rapidly
Health policy
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this…
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act.
My question, however, is simple. Where is the evidence that …
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Why more health insurance isn’t necessarily better
Health policy
Legislative bodies are moving with unprecedented swiftness to ensure we lead healthier lives. From bans on soda to bans on fast food, from mandates on health insurance coverage to mandates on EMR use, from bans on trans fats to mandates…
Legislative bodies are moving with unprecedented swiftness to ensure we lead healthier lives. From bans on soda to bans on fast food, from mandates on health insurance coverage to mandates on EMR use, from bans on trans fats to mandates on care delivery models, our governments (federal, state, and local) are supposedly helping us live well. But our current approach to health care is about as scientific as our approach to fashion — skinny jeans, …
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We must restrain our penchant for bans and mandates in health care
Drugs and prescribing
Despite representing only 4% of the world’s population, the United States accounted for almost 35% ($326 billion) of the global market for pharmaceutical drugs in 2012. Not surprisingly, the pharmaceutical industry’s business practices, considerable marketing budgets, and substantial profits are…
Despite representing only 4% of the world’s population, the United States accounted for almost 35% ($326 billion) of the global market for pharmaceutical drugs in 2012. Not surprisingly, the pharmaceutical industry’s business practices, considerable marketing budgets, and substantial profits are hotly debated as part of virtually every health policy discussion. But before addressing the possibility of transcendent evil in that industry, we should pose a more mundane yet critical question: …
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Is Big Pharma evil? Doctors should share the blame
Health policy
Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard…
Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard to public opinion. After all, reconciling medication lists, reviewing lab results, and discussing health behaviors simply aren’t as exciting. In fairness, though, surgeons have always had one other advantage: anesthesia. …
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Fix primary care with technology and anesthesia
Health policy
As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality…
As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers.
But in an age where science, technology, and health policy …
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Let’s learn from No Child Left Behind: Measuring quality in healthcare
Physician voices
“Doctors are crooks.” “They’re getting worse than lawyers.” “I don’t go anymore. They’re just out for a buck, and they don’t really do anything for you anyway.” “I stopped getting checkups when my old one retired. He was good, took…
“Doctors are crooks.”
“They’re getting worse than lawyers.”
“I don’t go anymore. They’re just out for a buck, and they don’t really do anything for you anyway.”
“I stopped getting checkups when my old one retired. He was good, took his time. I haven’t found anyone like him since.”
“They always think they know everything … a bit too much self-importance there, without ever walking in my shoes.”
“They all say the same thing; it’s …
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A culture of contempt has led to medicine’s downfall
Physician voices
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness”…
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …
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How many patients can a doctor safely see a day?
Health policy
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And we never seem to question this premise…
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And we never seem to question this premise enough before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. But where is the evidence insurance plays any role in …
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The Affordable Care Act perpetuates a myth of health insurance
Health policy
The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for…
The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …
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Is health care a right or a business? It’s time to make a choice
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