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Latest Posts

Is Healthcare A Right Or A Privilege?

Is healthcare a right or a privilege? Depending on how you view this determines how you feel about the recent healthcare reform which was signed by President Obama. As a doctor, I firmly believe that having healthcare is a right.

As a nation, we agree that individuals should be accountable for their actions. People often argue that those who are reckless with their bodies by ingesting chemicals via cigarettes or drug use and who subsequently develop cancers shouldn’t be subsidized by others’ insurance premiums as the latter group works hard at staying healthy by exercising, maintaining a healthy weight, and eating generous portions of fruits and vegetables. Some how it isn’t fair. Unfortunately, life and good health aren’t quite that easy or predictable. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

“Am I Having A Heart Attack?” A New Self-Test Kit

Home-Heart-Attack-Self-Test-Kit“Am I having a heart attack?” From the files of the strange and unusual comes this self-test kit for myocardial infarction, otherwise known as a heart attack.

For the lay people out there, a heart attack occurs when bloodflow to the heart muscle stops, usually because of a blockage in the arteries around the heart (coronary arteries).  (It’s what happened to Bill Clinton, although his heart muscle didn’t die, as it likely had collateral bloodflow from other arteries.) When bloodflow stops, the heart muscle dies. When the heart muscle cells die, they release compounds into the bloodstream which can then be detected on blood draws.

That is the basis for detecting a heart attack by drawing blood. There are some compounds that are specific to the heart, such as troponins that will only go up when the heart muscle is dying. Other enzymes, such as the CK go up with any muscle damage, including the heart.

That is the basis of this new self-test kit for heart attack testing from China Sky One Medical that tries to answer the “Am I having a heart attack?” question at home. It was approved in China in 2007 and recently received European Union clearance as well. Read more »

*This blog post was originally published at The Happy Hospitalist*

Practice Medicine Or “Advise” For $3,000 A Day?

It’s very generous of Sanolfi-Aventis’s marketing department to make this offer for me to serve as an “advisor” for dronedarone (Multaq), but seriously–I was a bit skeptical that they wanted my “feedback on the reasons for and against utlilization of Multaq® in the appropriate patient as well as to understand communication and educational needs with regard to Multaq® and the atrial fibrillation state in general.”

Where were they when the drug launched? Might it be because this drug hasn’t quite been the blockbuster they’d hoped for?

But, of course, I’d never be swayed to use more of this drug by such important consulting work. No, really.

P.S. Sanolfi-Aventis marketers: Please update your prescriber database with my correct workplace.

Musings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Insurance Or Not, The Patients Nobody Wants To See

In the practice of medicine, as in any human endeavor, we encounter a wide variety of human beings. While thinking about this recently, in light of the passage of the healthcare reform act, I realized something startling that supporters of the bill may not realize: There are some patients that nobody wants to see.

This uncomfortable truth exists irrespective of the presence or absence of insurance. Sometimes physicians are accused of dismissing or avoiding certain patients on the basis of their finances alone. While that problem exists (and I have seen it), a great many of the patients who can’t find (or keep) a doctor simply aren’t much fun to be around, much less to treat. Read more »

*This blog post was originally published at*

Independent Primary Care: The “Loss Leader” Of Medicine

Medicare’s sustainable growth rate, or SGR, has been the bane of doctors for years now. To encapsulate, this is the reason for Medicare’s annual threat to cut doctors’ fees by 20% or more, only to be staved off at the last minute.

Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:

Primary care has many fixed expenses in addition to those we bear: they pay rent, nurses and techs and secretaries, healthcare costs for their employees, equipment, scheduling software, etc etc. The fixed costs portion of a typical office practice can be much higher, consuming 60-80% of gross revenue. Worse, many of these “fixed costs” for primary care are not truly fixed, but increase annually consistent with inflation.

I wrote several years ago that primary care is the “cheap DVD” of the medical profession — a loss leader to bring people in the door for more lucrative services. Shadowfax agrees, arguing that it’s unlikely there will be any independent primary care practices in the near future:

I predict that, if nothing else changes in the overall model of physician reimbursement, within a decade there will be almost no independent primary care left in existence — they will all have been subsumed into hospital-owned or group practices to serve as “loss leaders,” existing solely to drive referrals to profit centers like surgical services and imaging facilities.


*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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