Why is American health care so expensive?

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Racism, structural Racism and a wonderful speaker, Dr. Kimberly Manning

I just heard a talk by Kimberly Manning MD, Associate Professor of Medicine as well as the Associate Vice Chair of Diversity, Equity, and Inclusion at Emory University School of Medicine, department of Medicine at the American College of Physician's virtual yearly meeting. She gave one of the plenary addresses and hers was called "Broadening your life lens, the case for diversity." I almost didn't watch it because I attend this meeting for the concentrated information on how to take care of patients with certain conditions that I get from talks with names like "Pearls for the management of insomnia not to miss." I thought that this was a talk for other people, and since I had studied this subject, maybe not for me. But I watched it anyway. It was great. Dr. Manning is a full professor at her institution, which makes her very special. She told us that 0.7% full professors of medicine are black women. 25% of full professors are women and Black women make u

Covid, re-evaluated one year later.

In early March 2020 I began to write posts about Covid 19. There were few places that people could get good information that addressed the big picture and made it possible to understand what was happening. It seemed like I should write some things that made sense of it all. I wanted to write about what I knew, or thought I knew was true, since there was so much misinformation circulating. So, during the second half of March, I wrote nine blog posts. What did I say and was it true? In my very first post I talked about how everything would change . How we would burn less carbon, we would learn how not to travel for work, how we would learn not to transmit other viruses, like influenza. That was all true . The demand for gasoline was so low that oil prices dropped to a fraction of the cost of production. Planes didn't fly much. We haven't had a flu season to speak about due to infection control measures. I said we should have massively expanded testing because it would allow p

Post Covid-19 Syndrome: dying of Covid is terrible, but some people get sick and just don't get well

In my present job in a low cost health clinic I don't see much acute Covid. Patients in the infectious stage of the coronavirus are dangerous to everyone they breathe on and potentially infectious virus particles can survive on surfaces in clinic, putting staff and other patients at risk. We see most patients who are still infectious in their cars or we arrange video or telephone based visits. If they are very sick, they need to go to the hospital. Sometimes I feel guilty that I am not taking care of these very sick patients, but that's not my role right now. The people I do end up seeing are patients who have had Covid, should have recovered, but are still sick. There are many of these people. These are young people, in their 20's maybe, who got sick, tested positive, took 2 weeks off of work, but then can't function normally when they try to go back. They are older people, often with other chronic diseases, who were doing fine but now can't take care of their hou

What to do about a system that promotes police violence? Shift where the money goes.

I've been thinking about police violence, crime, the criminal justice system and its horrors, racial barriers to success, fear and racism in general. It's been a busy few days as I've tried to educate myself on problems that have been impacting black and brown people for a long time. The video clips that are now circulating are bringing the reality of police violence and disrespect to even people like me, who are protected from that reality by accidents of birth and the privilege of living in a peaceful place. I've been able to generalize those visuals a bit. I have also listened to the stories of my formerly incarcerated patients. The experience of people in poverty, especially when non-white or vulnerable due to homelessness or mental illness, is that police are to be feared. We are now seeing people die because of interacting with police, but that isn't even the biggest problem. There are far more people who are injured physically, mentally or through inappropri

People still aren't getting it: Death counts from Covid 19 underestimate actual numbers!

I have recently become aware that some people are mistakenly getting suspicious that Covid 19 death counts are an overestimate. That is probably because the numbers are awful and very hard to visualize. Nearly 110,000 deaths have been documented so far in the US, which is undoubtedly significantly below the actual number who have died from the disease (see my previous blog on the subject, from very early on in the pandemic.) Our freshman US representative in Idaho, who serves a dark red district of a very conservative state, recently wrote a letter to the CDC concerned that the guidance they have given regarding filling in death certificates will lead to a falsely elevated number of people who have died of the disease. I just wrote Mr. Fulcher a letter explaining why this is wrong. "I saw your letter in your recent email encouraging the CDC to count Covid deaths accurately. I think you may not know some of the nitty gritty of documenting cause of death from a doctor's standpoi

In solidarity with people protesting the killing of George Floyd

I am not especially qualified to write on the subject of racism or the militarization of policing or how the criminal justice system perpetuates poverty and loss of opportunity based on race. I am white, grew up in predominantly white neighborhoods and have always had certain expectations based on those privileges. Like most people I have my own story flavored by my own challenges. None of these challenges are based on race. I have watched from my safe community where police generally act like good people. (Obviously this is from my standpoint which may not represent everyone's experience.) As a doctor I have cared for police refugees from big cities, retired officers whose experiences of police culture drove them away and marked their personalities. I have enough connection with people on the receiving end of the criminal justice system in other communities that I am not entirely ignorant, but my experience is definitely limited. So in this time of Covid 19 and now widespread demo