August 2008
12 posts
From the archives: Where do we go from here?
If you’re still with me, fifteen wordy posts later, you may feel buried beneath an avalanche of priorities and issues and complexities. Out of a whole heap of information, there is always the lingering question: where do we go from here? What conclusions can we make from all this quagmire of complication and controversy?
So here’s the post-game, the recap, the proverbial twelve steps...
From the archives: The Bridge to EPT
Where the dusty border town of Juarez butts up against the jutting mountains to the north, there is a bridge. On one side of this bridge lies Mexico, and on the other lies the city of El Paso, Texas. A place whose name itself invokes journey, transition, a throughway to greater things: The Passage.
Women on the south side of the river that divides the wealth of the north from the ...
From the archives: Paying the Piper
Today, you’re going to hear something new and different. Today you are going to hear this bleeding heart, tree-hugging, west-coast, San Francisco-born progressive make a neo-conservative argument. Free market, pay-your-own way, private enterprising, classical neo-liberalism. Hold on to your wallets, we’re going for a ride.
This argument concerns the question that underlies everyone’s...
From the archives: Down on the Pharm
A virile sixty-ish male chucks a football through a tire swing, raises a couple of fists in victory, and manhandles his comely wife; the final voiceover lists headache, flushing, dizziness, rash, cognitive dissonance, sudden loss of conscience, and pernicious priapism as possible unintended consequences of the little blue pill that made this moment possible. I might have just made up...
From the archives: Burden of debt
Becoming a doctor, it turns out, is all kinds of expensive. Four years of medical school, one year of graduate school to obtain a masters in public health. Fifty-something thousand a year, add on five years’ worth of accumulated interest (capitalized twice when I lost eligibility for deferral due to quirks of the federal loan program), and you have my total school debt: just over three hundred...
From the archives: End of the road
In a teaching hospital, it is often the intern’s job – when admitting a new patient – to ask after a topic that is gently and euphemistically referred to as “code status”…that is, if one were to stop breathing or generating a useful pulse during their admission, should the covering physicians make all attempts at resuscitation or let you go quietly into the night? More times than you might think...
From the archives: Overuse, underuse, barriers,...
There are a few folks out there who overuse the medical system. Every emergency department has its “frequent fliers,” and every clinic has its quota of disordered personalities on the rolls that require an individualized level of energy that could otherwise fulfill the needs of ten patients in the same time span. These patients are often the bane of primary care and emergent care ...
From the archives: The opt-out crisis
I was a sophomore in college, studying abroad, when my parents called me up to tell me my father was retiring. And so, at age nineteen, like middle-class post-adolescents all over the nation, I got booted off my parents’ cozy medical insurance plan and out into the nebulous world of the marginally insured. They did their best by me for a year or two; they qualified for COBRA, and since I was in...
From the archives: Unfunded mandates
The arrival of my intern class at the university hospital was occasioned by the opening of the brand spanking new emergency department. I never had the pleasure - or the horror - of seeing the old department, though its mythology remains. Occupied beds lining the hallways, bleeding patients begging as you passed anonymously on your way to find the one you were assigned to admit, and dingy, always...
From the archives: OHP, a bold experiment in...
Local newspapers are a funny thing - half pulpy fiber ready-made for the recycling bin, half voyeuristic insight into quirky local ways. When I first moved to Oregon several years back, I picked up the local rag one day, intending to peruse the low-end rentals section. The front page caught my eye; on it was a lengthy list of medical conditions, some five hundred or so altogether. Somewhere on the...
From the archives: Fifteen days of blogging for...
Doctors battle out the flaws and foibles of the American health care system every day. No matter what their opinion on the solution, few will disagree that we indeed have a problem in this country. Some will tell you we need more free marketeering, less government interference; others lean to the far opposite side, demanding reform toward single payer coverage or even a government-run ...
From the archives: Health care reimbursement - a...
Ever wondered how your doctor gets paid? It’s not something that most patients put much thought into, beyond a cursory glance at the vehicles parked in the physician parking lot and the realization that you’ll probably never drive a car quite like those. But it’s a rather germane topic when it comes to understand how your doctor treats you, and how satisfied you’re going to be with that care, and...
