A Grave Prognosis for the Affordable Care Act
Shambolic “repeal and replace” attempts are no longer needed to render a grave prognosis for the Affordable Care Act, the law that provides medical coverage for 45 million Americans. The most virulent threats are proliferating in the judicial system. More
Another Hospital Billing Trap
We needed a X-ray to rule-out a fracture so opted for an urgent-care center, which did it quickly and efficiently. As the three employees closed up shop for the day, I reflected on how urgent-care centers filled a perfect niche between the ER and the impossibility of snagging an immediate orthopedic appointment. But this is health care in America, and nothing ever closes up tidily. Two weeks later a bill arrived…. More
Covid Vaccine Heebie-Jeebies
Few patients seem to have specific reasons for declining the Covid vaccine. There’s just a vague hedge, or an abashed, “I don’t know, I just don’t.†It’s as though they have a communal case of the heebie-jeebies. More
It Shouldn’t Be This Easy to Lose Health Insurance
Why do Americans even have to “remember†to get health insurance every year? We don’t ask citizens to remember to enroll with the fire department every year, or to remember to sign up for electricity service or water. More
Medical Errors during the Covid Crisis
There’s no doubt that what went right during the Covid pandemic was far greater than what went wrong. But things did go wrong, and part of the professional commitment that has been so justly lauded entails an honest reckoning of our shortcomings. More
Coronavirus: Why Doctors and Nurses Are Anxious and Angry
The story of the coronavirus is still being written. The stories of polio, Ebola, H.I.V. and measles — all, alas, still in progress — remind us that public health is an ongoing, never-let-’em-up-from-the-mat effort. Narrow vision, data ignorance, image-conscious decision-making and truncated memory are the very elements of contagion. No amount of Purell can sanitize that. More
The Impressive Profits of Nonprofit Hospitals
Seven of the ten most profitable hospitals in America are nonprofit hospitals. Is this an oxymoron? The real question surrounding nonprofit hospitals is whether the benefits to the community equal what taxpayers donate to these hospitals in the form of tax-exempt status. More
The Daily Exploitation of Medical Staff
Corporate medicine has milked just about all the “efficiency†it can out of the system. With mergers and streamlining, it has pushed the productivity numbers about as far as they can go. But one resource that seems endless — and free — is the professional ethic of medical staff members. More
The Insulin Wars
Insurance companies and drug manufacturers have come upon an ingenious business plan: They could farm out their dirty work to the doctors and the patients. When there’s an E. coli outbreak that causes illness and death, we rightly expect our regulatory bodies to step in. The outbreak of insulin greed is no different. More
Prescribing Democracy
“There cannot be any doubt,†Dr. Rudolf Virchow wrote in 1848, that the recent typhus epidemic was a result of “poverty and underdevelopment.†His prescription was “free and unlimited democracy.†Hmm–a prescription for democracy. Not something you get at your average doctor’s visit. But maybe that’s what we need. More
A Doctor’s Responsibility
“Excuse me, sir,†I imagine the scenario playing out, “do you mind if I barge in on your life to see if I can save your life?†At what point does concern morph into presumption? The line between kindly interventions and condescending ones can be perilously thin. More
Time for the Medical Profession to Stand Up
Advocating for patients is as much a part of medical care as the medical care itself. Should that advocacy, however, extend beyond the doctor’s office, when politics has palpable effects on patients’ health? Most doctors see an intrinsic distinction between calling an insurance company and calling a senator. But in terms of our patients’ health, there is a moral argument that they are equivalent More
The Conversation Placebo
Pain remedies developed by the pharmaceutical industry are only modestly effective, and they have side effects that range from nausea and constipation to addiction and death. What’s often overlooked is that the simple conversation between doctor and patient can be as potent an analgesic as many treatments we prescribe. More
The Pain Med Conundrum
Under-treating pain violates the basic ethical principles of medicine. On the other hand, we are lambasted for over-prescribing pain medications. What are doctors to do? More
Board Recertification: A Waste of Time?
It used to be that you tackled the medical board exams just once after residency. Then you went into practice and never looked at a No. 2 pencil again. More
