Monthly Archives: March 2012

The Cost of the Doctor’s Pen, Part 2: “We have met the enemy and they is us”

Where doctors go for their fountain pen fix – Houston Chronicle

Pogo was right.  When we complain about the burden of insurance company paperwork and inadequate reimbursement by Medicare, we have to look at ourselves too.

Many factors drive the rising cost of health care. These include overuse of medical tests, repeat hospitalizations for chronic conditions like heart failure, excessive emergency room visits for conditions that could be treated by primary care doctors.  Just as we must think about the cost of each medication we order when we sign that prescription, we should consider our personal decisions and the perception it creates in the public eye.  If we want to claim the moral high ground, our personal habits must reflect the ethics we claim to practice.

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Busy days, busy nights at Jefferson Davis Hospital | Bayou City History | a Chron.com blog

Busy days, busy nights at Jefferson Davis Hospital | Bayou City History | a Chron.com blog.

These stark black and white photographs show riveting scenes of conditions at Houston’s segregation-era hospital for African-American residents.

The building was demolished 2 decades ago and a Federal Reserve Bank sits on the site along the shore of Buffalo Bayou south of downtown.

Read Jan de Hartog’s The Hospital to learn more about this facility and the genesis of our current county hospital system.  While conditions have improved, we now have over 1 million uninsured residents in our county.  I don’t think wait times have decreased much.

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Exercise Is Bad For You

“I told you exercise was bad for you,”  Mr. R called out as my wife wheeled me into the clinic.

Busted.  “I’ll never live this one down,” I thought.

Early that morning, I stepped off a curb while running and felt a sharp pain in my foot.   X-rays showed a 5th metatarsal fracture.  No weight-bearing for 6 to 8 weeks.  Boo.

I have been physically active as long as I can remember.  My parents enrolled my brother and me in every team sport our community had.  While my lack of hand-eye coordination made basketball and baseball challenging, I loved to swim and play soccer.  When I discovered running in high school, I found my true love.

After 28 years, 11 marathons, and 5 ultramarathons, I suffered my first running related fracture.  Overuse caused my previous injuries, but this one was random.  I ran that route every day.  I have stepped off that curb a thousand times.

So I put my foot in a walking boot and bought crutches.  Having never used them before, I had no idea how hard using your arms and one leg for locomotion was.  I lost 5 pounds and had to stop wearing my usual long-sleeved shirt and neck tie.  Forget the white doctor’s coat, that was like working in a sauna.

My patients got a real kick out of my predicament.  Everyone I have nagged for years now had the perfect counterpoint to my pleas to increase their activity.

“You’ll lose weight, your blood pressure will drop, and your blood sugar will plummet”

“Yeah, but look what happened to you.”  Touché.

The words of a colleague came back to me:  “But you LIKE to exercise.  Most of your patients don’t.”

So how do I motivate someone to do something she doesn’t like to do that might hurt her?  Scary statistics about heart attacks don’t motivate you to head out the door when it’s raining.  I have to find out what motivates you:  losing weight, looking better, or reducing stress.  I have to help you overcome your barriers:  the weather is too hot / too cold, the sidewalks are bad, my knees hurt, my neighborhood is not safe, my appearance embarrasses me.

So for Mr. R, I know we connected as doctor and patient because you are comfortable busting my chops.

And you know that I will keep trying to get you out that door and down the sidewalk.

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Supply drives demand: The Da Vinci surgical robot follows the same principle as the rest of the health care industry.

Abnormal Facies

I recently observed my first robot-assisted operation with the da Vinci surgical system (left).  It’s designed to allow for surgery that’s less invasive and more precise, resulting in shorter hospital stays.  As you can see on the manufacturer’s website, the da Vinci surgical system is the best thing ever invented, and is somehow related to senior citizens dancing on a beach.

Essentially, the system consists of a half-ton multi-armed robot on wheels (which doesn’t even wax or buff the floor as it glides around the room), a separate control counsel for the surgeon, and a crapload of wires that are presumably intended to trip the 12 assistants and device reps apparently necessary for the case to proceed.

The surgeon and several unfortunate residents or medical students will position the patient, make small incisions, and attach several ports through which tools can be inserted.  Then, an OR nurse who may…

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Showed video to entire clinic staff. Ins

Showed video to entire clinic staff. Inspired us to work harder #PCMH US Health Care: The Good News http://video.pbs.org/video/2198039605/

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The Oath of Maimonides

Moses Maimonides was a 13th century physician, philosopher, and rabbi.  Some attribute this oath to Marcus Herz, a German physician and pupil of Immanuel Kant.  Regardless of the real author or your religious persuasion, these words remind us why we do what we do.

The eternal providence has appointed me to watch over the life and health of Thy creatures.

May the love for my art actuate me at all time;

May neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind;

For the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

May I never see in the patient anything but a fellow creature in pain.

Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain;

For knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.

Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today.

Oh, God, Thou has appointed me to watch over the life and death of Thy creatures;

Here am I ready for my vocation and now I turn unto my calling.

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