Lakeside Medical Musings

Heartbeats

While unpacking the last of the stored-away boxes from our move out to the lake, I came across my Dad’s very old, very beautiful electrocardiograph and, as if it were a time machine itself, I was instantly transported back in time…     As I’m sure you know, an electrocardiograph measures the electrical impulses from the heart and represents them as tracings on a strip of paper creating a diagnostic tool, known as an electrocardiogram, EKG or ECG.  When I…

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Drugs Just Cost Too Much

“Houston, we have a problem…” The problem is the skyrocketing cost of medical care in the United States.  For every dollar that goes into the healthcare pot, there is one less dollar that goes into your personal pocket to spend on other necessities such as food, clothing, housing, and even entertainment.  It is a serious drain on the quality of life in the US, and it is one of the primary reasons why real incomes are not increasing: your employer…

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Retirement: Two Years On

I haven’t written a blog in quite a while, but after Ruth received some wonderful feedback at a party she attended this week  — thank you, Russell, for giving me the nudge I needed! —  I have decided to plug in the old Smith Corona, shake out my fingers, and get back to work — which, coincidentally, is my blog topic for today. My good friend, Rob, is retiring this week, but before he did, we had the opportunity to…

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The Cancer of Fee for Service

The treatment of cancer is a  particularly sensitive topic in any fee-for-service medicine discussion.  Nobody wants to think that their cancer doctor’s treatment recommendations are in any way influenced by money, but while no one wants to actually talk about the influence of money on such a dire issue as cancer therapeutics, it is, in fact, a complexity that occurs not infrequently, and it is one that ought to be publicly addressed, no matter how sensitive the topic. As I…

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Here a Statin, There a Statin…

A reader asked me to dive into the current medical controversy over the use of statins — a wide-ranging topic that allows me to opine on a few related issues so, of course, I’m up for it! Briefly stated, statins are medications that are prescribed to lower cholesterol and are recommended by many physicians as a way to reduce cardiovascular disease.  There are many statins on the market  — Lipitor, Crestor, and Zocor, among others  —  and they have been…

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If You Like Your Doctor, CAN You Keep Your Doctor?

Today I am going to take a break from my series on preventive medicine to talk about a hot topic in Charlotte news coverage this past week that relates to Obamacare and the reality of medical economics.  President Obama famously stated, in relation to the ACA, “If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.”   These statements, while technically true, were actually misleading.  There were…

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Eat, Walk, Screen: One Doctor’s Search for Truth

Last week I fired some warning shots about unnecessary medical screening tests. This week I will share some of the screening recommendations from reputable medical research with which I agree.  My timing couldn’t be better — in this past week, several studies have been published that have upended many long held medical beliefs.  The first was that dietary cholesterol is probably not a significant determinant of the cholesterol level in your body and, as such, most likely does not need…

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$creening Te$t$

There are many reasons why the field of medical testing has grown exponentially over the past fifty years, and most of those reasons are not tied to quality patient care.  Plainly speaking, medical testing is where the big money is.  Physicians, hospitals, and healthcare systems all make huge dollars testing patients. While some of this testing is essential, a tremendous amount of it is of dubious value, and some of it can give such poor information that it’s actually of…

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My Science vs. Their Beliefs

In thirty-two long years of full-time medical practice, I have never had a malpractice lawsuit filed against me.  (Knock wood.) When younger physicians asked me how I was able to manage this against-all-odds feat, I would put my hand on my grizzled chin, cock my head to the side, and gaze upwards to the stars.  “Compassion, knowledge and empathy are the keys to avoiding getting sued,” I would reply, as if speaking from an oracle.  After a few portentous seconds,…

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Vitamin Luck Is Not For Sale…Anywhere

From the great Hebrew poet, Solomon Ibn Gabirol : “At the head of all understanding – is realizing what is and what cannot be, and the consoling of what is not in our power to change.” I am not a believer in the “Life sucks and then you die” philosophy. I’ve been lucky in both life and love, so I believe that life doesn’t suck, but I do know we all will die. Some of us sooner, some of us later,…

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Just a Shot in the Arm

And now for some lakeside musings on vaccines in general, and the flu vaccine, in particular… Over the past twenty years or so there has been a potent anti-vaccine movement (AVM – it even has a name!) that is spreading in the US and abroad. This AVM has a strong correlation with a more generalized anti-government movement.  When I was growing up in the 1950’s and 1960’s, vaccines were held in the highest esteem because of their newly discovered ability…

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Defibrillation Without Taxation!

There are two significant costs to the US government for the Affordable Care Act (ACA.)  The first is the cost for premium support to lower-income families and individuals. As an example, let’s use Frank, a 30  year-old man earning $15,000 per year; we would all agree that Frank would have difficulty in paying $250 per month, an estimated cost for health insurance in 2015, which would constitute approximately 20% of Frank’s pretax income. In the past, Frank would just make…

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And What Difference Does That Make?

I think my despair probably peaked in the winter of 1981.  I had survived my internship year, and now I felt I could confidently handle most of the medical problems I encountered in the hospital. I was proud of the skills I had developed through that grueling year, but  I had also begun to see the 80-110 hour-work weeks as more of a badge of honor than as something to actively resent.  But being an Internal Medicine resident at Parkland…

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Where Have You Gone, Marcus Welby?

Once upon a time, people went to their physicians seeking medical advice for medical problems, and they actually tried to follow the advice they received for their $35.00 appointment. Times have certainly changed, and now people are just as likely to Google a medical question for their answers as go to their doctor for their $100.00 appointment. Medical consumers are eager now to find a person with a passion, a computer, and an agenda, and consumers are ready to follow…

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Sleepless in Dallas

I graduated from the Medical College of Georgia, Georgia’s public medical school, in 1979 with what was, by all accounts, a top-notch education.  I had found my niche, excelling in both my classes and my clinical rotations, and I finished in the top 10% of my class.  I routinely received high praise for those top scores, as well as for my clinical acumen and the relationships I forged with patients and coworkers.  I was rewarded for my efforts with election…

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“All Bleeding Stops”

When I started medical school in 1975, a memorable speech by one of my professors centered around this attention-grabbing statement:  at least 50% of what we would learn during the next four years would eventually turn out to be either irrelevant or just plain wrong.  He said this would happen for three major reasons: new diagnostic tests would make the ones we were now learning obsolete; medications and treatments would continue to improve and completely change the way medicine was…

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Unthinkable Now, Commonplace Then.

The tragic Ebola epidemic in Africa — and its resultant echoes on American shores — has filled the news for weeks now. Several US-based patients have been flown back from Africa, where the mortality rate for Ebola approaches 70%, to be treated in the United States where the mortality rate is quite low when early treatment is aggressively initiated. There was an article in the Wall Street Journal in August, see here,  about physicians contracting Ebola because of a simple…

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Obamacare is Not THE Answer

Ruth and I have been married for 30 years.  For the first 28 years, she was an addict.  Together, we handled her “problem” well during those years, but we both agree that it did interfere, to some extent, with our daily lives.  More often than I like to admit, we went to some mighty seedy places for her to get her “stuff.”  I often sat in the car outside a 7-11 or other type of convenience store while she went…

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Who, Me?

“This is the first admission for this 60 y/o male who has been non-compliant and is admitted with…..” If I was admitted to the hospital, that could be the first sentence in the HPI, History of Present Illness, of my hospital admission.  The HPI is where physicians write about the history of the current problem as told to us by the patient and from the information that we find in the patient’s medical record.  It is the meat of the…

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The List

One thing that has been a constant in all my years of medical school, training and the practice of medicine is the patient list, the daily printout of the patients I am taking care of in the hospital.  The list is always sorted by room number so physicians can use it as a road map, of sorts, for their day’s journey.  It includes the patients’ name, birth date, age, sex and attending physician.  The shortened version of it looks something…

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