Where do I start with this: The $2.7 Trillion Medical Bill.
I’m going to let Ms. Rosenthal tell you about how many unnecessary colonoscopies we do. I’ll let her tell you how much more it costs here than anywhere else. I will address the anesthesia bit.
Let me tell you a little story. When I was a baby anesthesiologist my hospital sent anesthesiologists downstairs to do anesthesia for GI procedures …
Colonoscopies don’t need anesthesiologists
Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …
When a child can’t feel his poops
As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.
Although the article did document many procedures …
Who’s truly responsible for the $2.7 trillion medical bill?
Colorectal cancer.
Shudder. That’s the knee-jerk response that most of my patients give me when mention of their 50th birthday creeps into the conversation and I reveal that it is time for their screening colonoscopy.
Admittedly, a colonoscopy is not an experience that the overwhelming majority of the human race embraces with excitement and anticipation. Instead, it is a life event that is filled with …
What’s scarier than a colonoscopy?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is admitted to the hospital for a 2-day history of fever and abdominal pain. His medical history is notable for cirrhosis due to chronic hepatitis C, esophageal varices, ascites, and minimal hepatic encephalopathy. His medications are furosemide, spironolactone, nadolol, lactulose, zinc, vitamin A, and vitamin D.
On physical examination, temperature is 36.5 …
MKSAP: 45-year-old man with fever and abdominal pain
The real problem is not whether machines think, but whether men do.
– B. F. Skinner
When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a general surgeon and gynecologist in Georgia had performed gallbladder surgery with a laparoscope.
“Stupid stunt,” I snorted, or something equally derisive and all-knowing.
Some weeks or months later he returned to the topic, telling …
Will the da Vinci robot go the way of laparoscopic surgery?
In recent times, it seems as though every newspaper or magazine with a dedicated health section has a focus on the perils of gluten and the benefits that come along with adhering to a gluten-free diet. Or better yet, each week brings a new celebrity touting the dangers of gluten, and how it is an unhealthy ingredient that should be avoided religiously. Is this truly sound advice?
As a practicing academic …
The problem with leaping into a gluten-free diet
I have been struggling with a certain degree of cognitive dissonance following the announcement this winter of a study in the New England Journal of Medicine on the efficacy of fecal transplants as a therapy for clostridium difficile (C. diff) infections. While the study is the first to demonstrate the effectiveness of fecal transplants in treating recurrent C. diff infections (15 of the 16 patients in the group were cured …
The revulsion about feces: Get over it
One of the toughest parts of treating patients is managing their expectations. We wish that everyone could enjoy a perfect recovery with complete healing, but the medical profession is imperfect and life is unfair. Some folks cruise by decade after decade without a scratch, while others sag under the weight of chronic illnesses.
Accepting reasonable expectations can change the game for patients and their families. If the patient’s expectations exceed what …
Accepting reasonable expectations is a gamechanger for patients
Next in a continuing series.
Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …
That slippery bowel wants to be everywhere
The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense. Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.
When I …
Are the days of screening colonoscopies numbered?
A follow-up to Dear lawmakers: This is what it’s like to be a doctor today.
Thank you to everyone for the positive feedback. Over 60,000 Facebook “likes”, tweets, and newspaper requests was quite a surprise. I was especially moved by the multiple tweets from hospices, physician groups, and individuals recommending my article. This article really has hit a nerve and shed …
Dear Congress: Listen to doctors on the front lines of medicine
I am just back from my colonoscopy more or less. All went well, but I am still shrugging off the lingering tendrils of my sedation. So let’s chalk up any grammatical snafus to that, shall we?
I had, of late, had some GI symptoms. But those were mostly coincidental and likely due to extensive travel and the havoc changing time zones wreaks on circadian rhythms.
Mostly, it was just time to have …
This is what it’s like to have a colonoscopy
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My kids know that I enjoy a spirited argument. During the days when the dinner table was our public forum, I tried hard to offer a responsible voice of dissent on the issues before us. I admit now that the view I espoused was not always my own, but one that I felt merited inclusion in the discussion. I still do this with them and to others in my life …
Probiotics promise better health, but that’s hard to prove
During the last year I have been paying particular attention to lesser known and under appreciated miracles in medicine. It is a mystery why miracles of any sort would be under appreciated, but it is so very human to ignore things in plain sight which disrupt our deeply held belief systems or even are simply not what we are looking for.
For those readers who don’t believe that they could actually ignore something …
3 scientific breakthroughs plagued by uncoolness
I just took step three of the national board exams – the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring free-text answers, brought up subjects that we haven’t thought about since medical school (Sick children? Terrifying.) The test also shed some light into how doctors think under pressure and why reigning …
Do board exams teach doctors to overtest?
I am embarrassed. I am a specialist taking care of patients with inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis. I spend more than half of my time at work related to research regarding the benefits and risks of treatment options for these diseases. Specifically, I aim to translate the vast medical literature published on this topic into tools for patients (and their parents) to help them better …
Why is cost so obscure in healthcare?
I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared amongst many of my colleagues. Because of these concerns, I would like to …
Dear lawmakers: This is what it’s like to be a doctor today
Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times.
I’m doing essentially …
10 ways to make EMRs more doctor-friendly
When I first lay eyes on Marilyn, I don’t think she will survive another week. Eighty-nine years old with short, curly gray hair, she sits in a wheelchair in the examination room. According to the nursing sheet, she weighs one-hundred and nine pounds. She wears a bulky white sweater over a gray dress that seems too big for her tiny body. Her …
If these are your final days, how do you want to spend them?
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