Why is American health care so expensive?

About 15 years ago a non-healing wound on a  person with diabetes or vascular disease was treated by surgeons and primary care physicians, sometimes by podiatrists, and would take months or years to heal and often lead to amputation. Wounds like this were depressing for both patients and physicians because they combined pain and hopelessness and resulted in death, disability and use of lots of resources. Starting about 10 years ago, I started to see, from my primary care practice, fancier wound dressings and doctors and nurses who specialized in taking care of wounds and ulcers. This was a great relief to those of us on the front line, struggling and failing to heal these things. The success rate for healing seemed to improve, but ever so slowly. The problems with healing a wound involve the fact that wounds happen for a reason, unhealthy tissue or lack of sensation leading to injury or fluid buildup from internal problems or pressure due to immobility. Many of these issues wil...

Valentine's day is a silly holiday, sort of. Really unpalatable sugar hearts in colors not seen in nature with provocative non-sequiturs printed on them and children making 30 nearly identical tiny greeting cards for their class members and little stuffed puppy dogs with oversized plastic eyes holding satin heart pillows for sale in grocery stores and and and...yet... It is actually pretty wonderful that America celebrates a holiday in the middle of February, a very dreary month, that is dedicated to love and the human heart. Even if that holiday is  hyped to a ridiculous level of excess by retail enterprises, it is still overall a good thing. I am presently a fan of the human heart. After going to a short ultrasound course put on by the Department of Emergency Medicine at Harvard Medical School in November, I have been intrigued by the possibility of making ultrasound imaging a routine part of a physical exam, since it is harmless and uses no resources. When I got back from Harv...

Many physicians are thoughtful, intelligent, compassionate and creative, but the process of training for this job doesn't necessarily foster those qualities. And let me be clear, I have nothing against sheep, other than to have noticed that people who keep them don't seem to be particularly impressed with their problem solving abilities. I think that when we as physicians get particularly tired and overworked, we stop thinking for ourselves. When I went to medical school at Johns Hopkins, there was a subset of clinical teachers who I thought of as the "grand old men and women of medicine." They were the people who understood their subject area with keen insight and who loved to teach. I felt privileged to be near them as they visited patients and explained their thought processes. Their ideas were fresh and they were passionate about them and they were definitely not sheep. My recent locum tenens hospitalist job was really busy and there was a tendency to test and...

I just started my first out of town doctoring job. I flew out for an orientation on Thursday and then drove back here for the week of work on Sunday. After Thursday's hospital visit my reaction was "what was I thinking when I said I would do this?" People go through a lot of trouble to end up in jobs where they are comfortable, well known and respected. This job, at least from the vantage point of last Thursday, was a very different thing. I would be responsible for somewhere between 12 and 20 patients who I knew nothing about in a hospital which has over 200 patient beds, 5 floors, 3 adjoining buildings, using two entirely new computer systems. So what happened? I did sleep well the night before I started, which was great. They gave me 12 patients to start, and my beeper was mercifully quiet for the first 4 hours of my 12 hour shift. The patients were just people, like they are anywhere, which was reassuring, and they were grateful to have someone talk to them and list...