Why is American health care so expensive?

On June 24, 2022, the Supreme Court overturned Roe v. Wade, the 1973 case that provided women with a legal basis for a right to get an abortion. (Full text of opinion and dissent here --pay attention to page 148 to the end, the dissent.) This will make it difficult and dangerous for women in states whose legislatures oppose abortion to terminate a pregnancy. Many women, regardless of what state they live in, now believe that it is illegal for them to get an abortion. The amount of misinformation going around regarding this subject has been large, and now it is frustratingly larger. In the face of all this confusion, I would like to praise the JAMA (Journal of the AMA) for publishing a very nice, straightforward article about how to provide medical abortion in the first 10-11 weeks of pregnancy. By medical, I mean pills. There is a pretty simple combination of a couple of common medications, one to reverse the effects of progesterone and the other to permit the cervix to open to allow p

I have been a practicing physician since finishing medical school in 1986. The year after that, I started my internship at the Johns Hopkins Hospital on the Osler medical service. I remember how excited I was about my salary of $17,000 that year. I called my mother. She was so proud. It was plenty to cover my food, apartment, gas for my VW Rabbit and essentially nothing else since I worked all the time. By the time I finished my medical residency I was 28 years old and lived in Seattle where I was able to buy a house with my boyfriend (now husband) who was a scientist in a company that paid him a decent salary. My first job out of residency was with a healthcare cooperative, doing primary care and consulting internal medicine. After 4 years of that, I moved to rural Idaho where I have been ever since. For 17 years I was a "traditional internist" meaning I took care of my own patients in the office, took care of them when they were admitted to the hospital and provided some ot

It was a beautiful early spring day. I was working in a little patch of native plants, clearing away some pine needles and pulling dandelions. It was pretty much perfect weed picking soil, moist with spring rains but not muddy. In order to avoid stepping on the plants, I grabbed a vertical handrail support and swung myself up to the sidewalk and directly into the end of the rail. I felt and heard my rib cage crunch. Ow. When I could breathe I found that, although it was painful, I could still do some things around the yard. I was pretty sure that it would get worse, so I worked a bit and then rested inside. It did get worse. Daily it became more painful so that on day 3 almost anything I did was excruciating. Twisting, leaning over, taking a deep breath, yawning, sneezing, coughing and taking a shower. Lying down in bed was a trick. As the song goes, the rib bone's connected to the everything else bone. There was no really pain free way to lie down, though there were positions that

Happy 2022--let it be filled with good things. And on that note, I wrote a poem. (After reading Manifesto of Encouragement by Danielle LaPorte) Even now   All is not lost-- even now your frozen pipes are melting. Cells in your body are repairing what is broken and injured. T cells and B cells are working together to keep the bacteria and viruses in balance with the cells that make up what you think of as you. Macrophages are cleaning up the mess. Thanks for your service. That cancer cell? Nope. Sorry buster, not today. Natural killer cells. You don’t even pay them. Certain very bad jokes aren’t being told. The last person to tell them has just died. He didn’t use the internet so the ripples of their passage only exist in the vibrations of rocks. That thing you did that still makes you cringe? Even now the last person, other than you, who knew about it has just forgotten. Just yesterday you learned a new thing and at this very moment you remembered what it was. P

I've noticed that when I'm at work, I generally love my patients. I may have complaints about them, wish they would behave differently, get frustrated with their choices, but I do feel a warm connection with them. (OK, there are people/patients who I find I am violently allergic to, but they are rare.) I work in an area which votes differently than I do, and I don't necessarily agree with my patients, but I have their backs and want what's best for them.  I don't necessarily feel that way about my fellow Americans. As a group many of them seem to act in ignorant, short sighted and often hateful ways. But when I meet them in a stuffy little office, I like them and on the important stuff, we usually see eye to eye. Why is that? I think I'm being hacked. My brain, that is. I think that there may be a concerted effort going on to make me feel like I'm not a powerful and loving part of a valued whole. It seems like what I read and what I'm exposed to in news

  I've been writing a few things about the climate at the other place, https://doctorjanicesblog.org/. Just thought I'd mirror those here. Since I last mentioned the climate in this blog, there have been catastrophic floods in the Northwest and record high temperatures in the east coast. The area of South Sudan where I have spent time teaching ultrasound and helping out a bit in a hospital serving internally displaced people remains flooded. For most of a year now there have been no safe places to sleep in the land near Old Fangak, other than those protected by mud dikes and sandbags. So not safe, actually, at all. Gardens are flooded. Roads are rivers. I see photos and I don't recognize the place. I can only barely imagine what it must be like to be trying to live there. Flooding is normal in the rainy season, but never persisting through the dry season like this. The climate continues to change and the results are unpredictable and often tragic. I have been writing a bit