Here is the lesson I learned on that flight today as I cared for that lady and yet again gave up more of my time and my life for someone else who I will never even see again. I know that I could have cared less who she was, how much money she may have had, whether she was an illegal immigrant or the Queen of England. I know that she was someone who needed help and I was privileged to be able to help in some way. I also knew this: Those fools in Washington will never get this

The story of how I was schooled on call at 3am.

Continuing the development of our theme “how prevention often fails to prevent”, we bring to your attention a patient care interaction from today. A background primer on our thesis here: no matter how much or how loudly someone screams and yells and pays and incentivises doctors to extol the virtues of prevention, people may have a very different vision for their lives. That vision may not include in any way, your good advice to eat better, or stop smoking, or take better care to watch your blood sugar or whatever …

The last few months have been dizzying for us doctors. On a daily basis we see everyone talking about us, our work, our motivations, our ethics and our abilities and all the while no one, it seems, is actually talking to us about anything. Even more disconcerting is our realization that the persons doing all of this talking are themselves the least appropriate to be speaking. It is only by dint of their positions in life and the bully pulpit they command that their voices are even heard. We feel …

I was having a conversation with a friend of mine the other day regarding health care. We discussed the reform efforts and she felt one of the major solutions was” reimbursing doctors and hospitals for wellness as opposed to disease.” I agreed promoting wellness was a great idea but patients don’t always go along with the plan. I related a story of patient I took care of about six months ago. He was a middle aged, intelligent man who had been treating his own cancer. This …

Our mission here at TBM is to bring the voices of physicians to the health care reform debate; in fact to any aspect of health care. It is these voices that have been so absent for far too long. To that end, we bring you this excellent piece by Maria Martins, an ER physician from New York who shares our passion for enfranchising the voice of physicians. Her post was orginally published at mises.org. Enjoy and thank you , Maria.

As I was musing about the sad condition of California and its budget woes, I came across a website that lets any average Joe (or average plumber for that matter) try to ‘balance the budget’. You can choose what things to cut, what things to save– all with the goal of somehow eliminating 20 billion dollars or so from the current expense column.
It got me thinking, maybe a similar website is in order for HCR. If so many people think that dealing with the fine grain issues of doctoring …

A growing problem in health care: doctors closing their doors.

If you want to know a fatal flaw to our health care system, look no further than a busy obstetric floor. The other night, I was called to place a labor epidural in a nice young woman whose only previous exposure to anesthesia was during surgery for a cosmetic breast augmentation($4000-$8000 cash). After my medical evaluation was completed, I began to clear some space for the equipment I would need to perform a labor epidural-an elective procedure to manage labor pain. In order to clear some space, …

We have to say that we were taken a bit off guard by the recent emanations from Congress about doctor-patient discussions about the end-of-life. Specifically under HR 3200 it would now be reimbursable for a doctor to counsel medicare patients about end-of-life-choices. Even as these words are clicked out on my Macbook Air I find them difficult to fathom. There are just some things that go together and are by their very nature, inseparable. Starsky and Hutch, Batman and Robin, Summer and Hot Dogs… and, BEING A DOCTOR AND TALKING …

As we previously reported in the post entitled President Obama Impugns Physician Integrity, Obama tells a nationally televised audience: a doctor would remove a child’ tonsils simply for the money as opposed to trying cheaper, conservative methods. This wasn’t the only statement he made that night which showed an incredible degree of tone deafness to how much impact his statements have as the President. To characterize physicians as individuals who would do harm in order to reap monetary rewards shows contempt for the profession; a fact which will …

There has been much chatter about primary care and the need to bolster the ranks to improve the health care system and decrease costs. While the role of the primary car physician is invaluable, specialty medicine has become the pariah destroying American health care in some circles. Its’ as if specialty medicine provides little value especially given its supposed added costs. To this, I post this article for our readership. In a nutshell, it touts the improved outcomes-lower mortality- that specialty training provides. …

President Obama unfairly impugns the integrity of the medical profession and undermines the parent-patient-physician bond. Perhaps that is not a mistake.

We can get all the evidence, write our guidelines, have our Root Cause and Peer Review meetings, and go full-bore, nose to the grindstone with our efforts to do better, and it is entirely possible and even likely that are patients have no interest in allowing us to do that job.

I have come to the conclusion that politics are too serious a matter to be left to the politicians.
Charles De Gaulle
French general & politician (1890 – 1970)
This quote sums up our general thoughts about our faith in government at this critical time in our country’s existence. It is especially true regarding the healthcare debate. The outcome of HCR will have a generational impact on the lives of all Americans. What we are striving for here at TBM is to provide cogent, fact laiden views on medicine. …

If you want to know what plagues the US healthcare industry look no further than my case from last night. A woman in her early 40s came in for an emergency operation-a sexual mishap that usually happens mostly in gay men. She was a self-described cognac and brandy abuser-as she described it, “the expensive stuff”. She had undergone elective plastic surgery for enhancements. But here was the kicker, she was a Medicare patient-Medicare is usually reserved for individuals over 65 or those with significant disability. …