Lakeside Medical Musings

Unsafe at Any Speed

A fast-growing medical issue that correlates with the aging Baby Boomer population is one that resonates deeply with me on both a professional and personal level — unsafe-at-any-speed elderly drivers.   As a primary care physician, I have spent years trying to stop elderly patients from driving when it would not be safe for themselves or others if they continued.  Sometimes I am successful in my efforts, and sometimes I am not. My own father was my biggest failure in this…

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The Political Football Called “The Medicaid Expansion”

In my role as a Navigator, I helped Mr. X obtain health insurance through www.healthcare.gov, and I’d like to tell you about that actual experience.  Mr. X is a 55-year-old single man living in North Carolina who works several low-paying part-time jobs and makes $12,000/year.  Because of his low income, he qualifies to receive a significant insurance subsidy from the government. He purchased a Silver Blue Cross plan through the marketplace with a monthly premium of about $13/month. Mr. X…

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Death with Dignity

This last story that I’ll tell about the importance of physicians having good communication skills happened very recently; I don’t think I would have been able to handle this situation early in my career.  This story proves the old adage that practice makes…well, better. I admitted a patient to the hospital with a very large, spontaneous, intracerebral hemorrhage (ICH) which is bleeding into the brain.  “Spontaneous” refers to the fact that the bleeding just happened; there was no trauma, tumor,…

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Death on a Highway

This is the second in a series of three stories I’d like to tell about the delicate art of physicians talking with patients.  As I wrote last week, open communication between physicians and their patients is one of the most important elements of good patient care.  I’ll admit, there are some medical specialties where the technical skill required is more important than the doctor’s communication skills. I would be fine hiring a cardiac surgeon who is technically superb and extremely…

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Can We Talk?

Today I am going to talk about… talking. Today’s blog is the first in a series about the complex tango of physician/patient communication. During my years in practice, I learned that basic diagnostic workups coupled with writing prescriptions and ordering tests to diagnose, treat, or prevent disease is the easy part of medicine. Most physicians are pretty bright people and, unless they are lazy, they learn to master these “basics” pretty quickly. Learning to communicate your thoughts to your patients…

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Affording the Affordable Care Act

An issue that hardly anyone mentions when discussing the pros and cons of Obamacare is the freedom (yes, that is the right word) that this program gives to many individuals.  I mentioned in an earlier post  how Obamacare allowed me to retire early because medical insurance was now available to me at a defined cost, without a penalty for my pre-existing medical conditions. Obamacare gives people the flexibility to retire, to work part-time if they — or their employers such…

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Patients Say the Darndest Things

After several months of writing this blog, I continue to frequently field the same question over and over.  “Why are you writing a blog?” Well, the answer is somewhat complicated, as answers regarding personal motivations frequently are.   Initially I started writing mostly as a record of my life’s experiences for my family, close friends, and myself. I wanted to share with my children some events that occurred in my medical life, outside of their view,  that influenced some the actions…

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The Vaaah Spa

I worked and learned in Veterans Administration Hospitals both in medical school in Augusta, Georgia, and during my Internal Medicine training in Dallas, Texas.  I am sure that I could write a book’s worth of stories about my experiences there, as the sheer insanity of both hospitals was just mindboggling.  The patients, the doctors, the administrators, the rules, the gaming of the system, the waste… all were utterly mindboggling.  It’s especially amusing to me as I listen to CNN’s endless…

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AIDS 1985–Under Every Rock

Several weeks ago, I discussed the beginnings of AIDS and how it intersected with the beginnings of my medical career in Atlanta in the mid-1980’s. Needless to say, it was a very difficult time for the gay community, but it was also a challenging time for the physicians who treated patients with AIDS.  The realities of AIDS changed the way we looked at all of our patients.  Whenever a previously healthy young person came down with an undiagnosed, severe illness,…

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I Flew Into the Cuckoo’s Nest

Psychiatry was a different kettle of fish in 1978 when I did my six-week rotation as a third-year medical student than it had been in 1948 when my father did his psychiatry rotation. (This is an appropriate time to note that neither I nor my father chose to specialize in psychiatry; we both wholeheartedly chose internal medicine — a decision I think will be clear as you read this blog post!) Psychiatry was a science of a very different sort,…

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Obamacare–A Primer

One of the first things I did after I retired was participate in the official 30-hour training to become a Navigator for the Affordable Care Act. A Navigator is a person who helps applicants through the process of signing up for health insurance through www.healthcare.gov.  I wanted to do this for two reasons – one, so that I could learn as much as possible about the actual non-politically-skewed facts of ObamaCare and two, so I could be helpful in furthering…

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“The Patient is the One with the Disease”

As my blog has been mostly political and economic narratives, I need a break from facts and figures, so I’d like to tell you a personal story about an event that had a large impact on me in my earliest years as a medical professional.  Keep in mind when reading this that, as a physician, I see both life and death from a different perspective than people from outside the narrow world of the hospital.   Over many years of witnessing…

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AIDS–A Different Generation

Having now completed a number of these posts, I am sensing a pattern starting to take shape. I realize that I am writing a lot about experiences that happened early in my medical career.  I think this is because those were the formative years of my medical life, as well as my adult life, and, while experiences that I had later in my life certainly diverged from and exceeded many of my early experiences, in retrospect those later experiences have…

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Obamacare–The Why Nots

My next few blogs are going to discuss the Affordable Care Act, also known as ObamaCare. I have become a much greater fan of it as I have gotten to know it better.  I recently completed a thirty-hour course that qualified me as a Navigator, and I will be using that information to assist people in signing up for health insurance for 2015. I feel like I finally have serious and significant facts – not just left- or right-wing blather…

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Obamacare and Me

It was almost exactly five years ago that I decided to embark on a serious emotional and financial path towards retirement. Over 25 years, I had diligently saved, invested, and traded in the stock market to accumulate enough money to allow me to walk out of the hospital and enjoy those post-employment/pre-you-know-what years.  One of the biggest unknowns was how much money I would need in order to retire.  I worked on a budget and used all sorts of retirement…

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News Flash–Charlotte Comes in Sixth

Why is Healthcare so Expensive in Charlotte? Today’s Charlotte Observer has a front page article stating that Forbes magazine lists Charlotte as the sixth most expensive city in the United States for healthcare costs.  See article here. While doctors and hospitals produce high charges everywhere, unless you are uninsured, these charges don’t mean much to you, personally.  What matters, though, is how much your private insurance company actually pays to the providers for the charges submitted.  Whether a patient is…

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Vienna—Georgia

In February of 1978, I was a third-year medical student at the Medical College of Georgia in Augusta.  As third-years, we were called Junior Medical Students (JMS) and fourth-years were called Senior Medical Students (SMS.)  We worked ridiculously long hours during in-hospital rotations and we were on call, as well, every third or fourth night, but we did have one thing that was very special and made the long hours worth it.  When seeing patients, we introduced ourselves as we…

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I Know EVERYTHING, Mr. No!

There were times in my life when I thought I knew more than anyone else. These are stages that everyone goes through, right?  Late in my teenage years, I clearly knew more than my teachers, my parents and really everyone over the age of thirty. The Vietnam War was wrong. Marijuana was no worse than the alcohol that all the “old” people swigged all the time. And I should have the legal right to vote and to drink. I was…

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Fee for Service–Or Not?

Hmmmm… A place where medicine isn’t practiced on a Fee for Service basis…. Do you suppose there IS such a place, Toto? There must be. But it’s not a place you can get to by a car or a train. It’s far, far away… New Zealand!  We’re not in Kansas anymore, Toto. Well, not that far actually. In fact, medicine is practiced like that almost everywhere but here in the US. But one place that I have personal experience with…

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News Alert: Fee for Service the IPC Way

As many of you know, I was a hospitalist — a hospital-based clinician seeing only hospitalized patients requiring internal medicine care — until I “retired” last December.  The radical concept of a hospitalist, as a new type of internal medicine subspecialty, was conceived in a New England Journal of Medicine Article in 1996 by Robert Wachner, MD.  I began my medical career as a traditional office-based internist, just like my father before me, and the majority of my day was…

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