Last July, I found myself needing to visit a doctor for an urgent medical issue. My period had started in April and never stopped. It was light, so it wasn’t too much of an annoyance, but after three months I figured I needed professional help.
I had started graduate school in Michigan the year before and was back home in California for the summer. I wasn’t sure if the new insurance …
Unexpected medical bills on a graduate student’s budget
Social connectivity to engage patients has real the potential to impact health through improvements in lifestyle, the main driver of wellness. This is in increasingly shorter supply as we collectively increase pounds, cholesterol, and blood pressure readings.
Many have written compellingly on why social matters for health. The best I’ve seen are a post by Jay Parkinson (of Hello Health and Fast Company fame) that borrows from Atul …
Social gaming to engage patients and improve wellness
You’ve had the sex talk, the smoking talk, and the drugs and drinking talk. But have you talked to your kids about tanning beds?
You should. Tanning bed use can cause skin cancer, including the deadliest form, melanoma. And, using tanning beds before age 30 increases a person’s risk of melanoma by 75%.
Equally worrisome: tanning beds can become addictive. A recent study showed that 80% of college-age tanning beds users couldn’t kick the habit.
This …
How to talk to teens about tanning beds
Up until last May, my experience of medical costs was limited to the $100 per month premium I contributed towards my employer-sponsored insurance and the nominal co-pays associated with well-child checkups and generic prescriptions. There was never any hesitation in seeing a doctor or filling a prescription. That all changed when went I back to school.
I blindly signed up for the school-recommended family insurance and naïvely assumed myself, my …
Care costs a lot and it’s not straightforward what the cost is
A recent study from Health Affairs took aim at physician salaries.
Well, not exactly their salaries, but fees. It’s a subtle difference, but that nuance is lost in the mainstream media narrative.
According to the study, “American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom.”
Thankfully …
Targeting physician salaries is a poor strategy for health care costs
All of us are role models, whether we see ourselves that way or not. Of course I love to imagine myself as a positive role model, but my eleven-year-old daughter has already informed me that things will be way different at her house when she’s a mama. However, we’re not going to focus on how uncool I am, instead, I’m going to share the stories of a couple of people …
All of us are role models, whether we see ourselves that way or not
The Annals of Internal Medicine occasionally reviews the articles and studies of note in a particular field of internal medicine for those of us who don’t read all of the specialty journals. Recently, there was an update in pulmonary and critical care medicine, the internal medicine specialty that is most intimately involved with caring for the very ill and those people who are at the ends of their lives. …
The problem of inadequate discussions of end of life wishes
Today was a rough day at work. My schedule of 10 patients for the afternoon rapidly ballooned into 17. People were sick and miserable. Those who were healthy were frustrated by the long wait. I heard myself apologizing over and over to each family.
The day was mostly a chaotic blur. Babies crying, phones ringing, parents reprimanding children on the brink of a meltdown. I don’t remember much of it, except …
Children who curse, and the power of words
When I saw my first patient die, I was in shock. You will never forget your first one, that always stays with you.
My first patient died during medical school, a young guy around 40. He died of complications from endocarditis. He was fine in the afternoon, talking about his family and what he does, but when I came back in the morning he was gone. I was shocked beyond …
Physicians need to be more proactive asking about code status
An excerpt from Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing (Rowman & Littlefield Publishing Group).
To be human is to experience an array of different emotions. We can feel upbeat and hopeful, cool and unconcerned or frustrated and fearful in a given day—even in a given moment. The heart of human experience beats with moments of joy and flashes of sorrow, and with …
Biology and biography: The Two-B Factor of depression
We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!
Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or …
Explaining human motivation towards unhealthy behavior
Most OTC products, excepting some medical equipment like crutches and diabetic supplies, now cannot be purchased with flexible spending account dollars without a physician prescription.
One of my partners asked last week how I am dealing with this issue. He has had several patients ask for a long list of prescriptions for OTC products so that they can use their FSP to pay for these things with pre-tax dollars. This puts …
Requiring a prescription for OTC products is a waste of physician time
There is a saying in psychiatry, “even bad therapy is good therapy.”
I always thought this was a terrible thing to say, but really, there’s some truth to it. The basic tenet of therapy is that a person is able to vent their feelings with an objective third party. Depending on how good the therapist is, he or she will be able to help that person process their feelings in …
Who benefits most from psychological therapy?
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Thump.
There is a strange sound emanating from the hallway. It’s more of a series of sounds, of thuds, punctuated by an odd, louder noise. The hallway is narrow, not much room for a five-year-old to create too much havoc. I close my eyes, and as I try to visualize the corresponding sequence of events the rhythm is interrupted by a much louder sound and the house shakes. A child has fallen …
Born premature, my sons have already endured a lifetime of hardship
Hospitals and physician practices are waiting with bated breath for the final changes to the HIPAA Privacy Rule, which the Department of Health and Human Services (HHS) is expected to release by the end of the year. One of the new rules could require healthcare providers to keep track of the instances in which patients’ health information is shared with third parties for reasons including treatment and managing payments. …
New HIPAA rules won’t enhance privacy, but they will burden physicians
The elderly population can be fun to take care of (they have more stories than you have time to hear), or they can be a handful in regards to all of their chronic complaints and numerous medications. But then, there are those senior citizens that come into clinic and tell us, “I don’t need to take medications, I haven’t taken medications my whole life, and look at where it’s …
How elderly patients can be stubborn to their own detriment
Sunday marks the tenth anniversary of the 9/11 attacks, and our keyboards, monitors and smartphones will likely play a big role as we commemorate the events. Numerous remembrance websites and videos already appear online, and people will undoubtedly take to Facebook and Twitter over the weekend to share their personal stories and express their thoughts on that tragic day.
Never before have we been so “plugged in,” and I had to …
9/11 grieving in the social media era
We live in an era of medicine in America in which patients want to be involved in their healthcare. This is very satisfying to physicians like me, who prefer to educate and engage patients rather than just telling them what to do. Granted, there are some instances when a patient does need to be told what to do (ex: “You have appendicitis. You need surgery.”)
However, when faced with a …
What to ask a doctor when faced with a difficult diagnosis
I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners. Mr. Luban brought up an interesting question, “What is health?”
Is health simply the absence of disease? If it is, there certainly aren’t very many healthy patients in my neck of the woods. Most of the patients I take care of have something that’s not quite right. I only know one perfect …
Dr. Abraham Verghese wrote in the New York Times recently about the threat of technology to proper patient care. This is an excellent piece and although I do not disagree with the overall message, I think Dr. Verghese conflates different issues currently plaguing our health care system.
Below, I provide some comments on a few of the major points Dr. Verghese writes about: “This computer record creates what I call an “iPatient” …
The threat of technology to proper patient care
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