Why is American health care so expensive?

Fecal transplant, thanks to the recent article in the New England Journal of Medicine out of the Netherlands, has made it to the front page, the big time. In my inbox today was a link to a how-to article from medscape from a doctor from Eastern Virginia Medical School who apparently does the occasional fecal transplant for recurrent Clostridium difficile  colitis. In this article, the author says that one must do $500 worth of testing on the donor, then make up a particle free stool slurry of stool and non-bacteriostatic saline under a hood (due to the biohazard aspects of making poop soup) filter it and instill the mixture via a colonoscope to the patient who has taken 3 gallons of polyethylene glycol solution and preferably had only clear liquids for 2 days. He says that the procedure should only be done for patients who have had Clostridium difficile  for 3 months which has not responded to antibiotic therapy. There is no evidence to suggest that giving donor feces b...

During the last year I have been paying particular attention to lesser known and under appreciated miracles in medicine. It is a mystery why miracles of any sort would be under appreciated, but it is so very human to ignore things in plain sight which disrupt our deeply held belief systems or even are simply not what we are looking for. For those readers who don't believe that they could actually ignore something that is both true and in plain sight, I refer to this  YouTube video, a classic experiment in selective attention. If that is not enough, there is a study in the journal Psychological Science (just reported in the popular press yesterday) which shows that radiologists looking for cancer failed to see a very obvious and ridiculous image on a chest x-ray. I would propose, also, that we are even more likely to ignore information if that information is uncool. Things that are cool make us feel indestructible and things that are uncool make us feel weak or embarrassed or ou...

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce...

I just got back from a 7 day Zen meditation retreat in Northern California. I have done 3 of these in the last 10 years, about as frequently as I get my teeth cleaned, and similar in some ways. They are time consuming, not particularly cheap or comfortable and I feel much better afterwards. Zen, however, unlike preventive dentistry, is really interesting. I started meditating about 15 years ago when the stresses of being a mother of small, often irritating children as well as a small town physician had made me into a person I didn't particularly enjoy being around. My sister had started meditating and recommended that I just count my breaths up to 10 and then start over again while sitting on the floor for 20 minutes. It sounded simple, and I figured I would do an experiment, counting breaths every morning for a month and I would see if I was a better person. It was difficult. I kept falling asleep and could rarely actually count my breaths up to 10 without becoming distracted....

Locum tenens (literally "place holder") is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride. When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that having the skills of a physician would be able to allow me to travel and interact with places and people in a meaningful way, have adventures, roll up my sleeves, get my feet wet, that sort of thing. It turns out that this is true. Doctors with certain skills, especially internal medicine and hospital medicine, are wanted all over the country, especially in small towns and rural hospitals, and locums are hired often to avoid catastrophe while a hiring a permanent physician. I have worked in California, Washington, Oregon, Idaho and Alaska in the last year and it has been really interes...