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Real Meaning At Christmas

slumsEvery day I go to work and spend time with suffering people. They come to me for help and for comfort. They open up to me with problems that they would not tell anyone else. They put trust in me — even if I am not able to fix their problems. I serve as a source of healing, but I also am a source of hope.

Christmas is a moving season for many of the same reasons. No, I am not talking about the giving of gifts or the time spent with family. I am not talking about traditions, church services, or singing carols. I am not even talking about what many see as thereal meaning of Christmas: Mary, Joseph, shepherds, wise men, and baby Jesus. The Christmas story most of us see in pictures or read about in story books is a far cry from the Biblical account. The story we see and hear is sanctified, clean, and safe.

Before I go on, I want to assure my readers that I am in no way trying to persuade them to become Christians. I am a Christian, but whether or not you believe the actual truth of the story, there is much to be learned from it. I find it terribly hard to see the real Christmas story here in a country where the season is filled with so much else — much of it very good. It is far easier to just be happy with family, friends, giving gifts, singing songs, and maybe even going to church, than it is to contemplate the Christmas story. I think the Christians in our culture have gotten way off base on this — much to our shame.

Christmas is not about prosperity and comfort. It is about help to the hopeless. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

When A Doctor Is “Spent”

“I need you to do me a favor,” my nurse asked me at the end of our day on Friday.

“Sure,” I answered. “What do you want?”

“Please have a better week next week,” she said with a pained expression. “I don’t think I can handle another one like this week.”

It was a bad week. There was cancer, there was anxiety, there were family fights, there were very sick children. It’s not that it’s unusual to see tough things (I am a doctor), but the grouping of them had all of us trudging home drained of energy. Spent.

I think this is one of the toughest thing about being a doctor (and nurse, by my nurse’s question): The spending of emotional reserves. I’m not physically active at work, yet I come home tired. I don’t have to be busy to feel drained. It’s not the patients’ fault that I feel tired. They are coming to me to get the service I offer to them, and I think I do that job well. The real problem is in me. The real problem is that I care. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

May We All Die So Well

Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.

She lived for him. She was always telling me of his pain, frustrated with the fact that he didn’t tell me enough. She was anxious about each complaint of his, wondering if this was the one that would take him away from her. Many of her problems were driven by this anxiety and fears, and she spent many hours in my office giving witness to them through her tears.

As his health failed, I wondered about her future. He was the center of her life, the source of her energy, joy, purpose. How could she manage life without him? How could she, who had so much lived off of the care of this wonderful man, find meaning and purpose in a life without his calming presence?

Then he died. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

The Virtue Of Unnecessary Care

I case you didn’t hear the news, the American healthcare system is in financial crisis. One of the biggest culprits indicted in this crises is “unnecessary care,” with estimates ranging from $500 to $650 billion (total spending estimate is $2.6 trillion) going toward things labeled “unnecessary.” Personally I think this is an underestimate, as it doesn’t take into account the some big-ticket items:

  • Brand name drugs given when generics would do.
  • Antibiotics given for viral infections (and the additional cost due to reactions and resistance).
  • Unproven costly care considered “standard of care” (PSA testing, robotic surgery, coronary stents).
  • The unnecessarily high price of drugs.

One of the main reasons I am an advocate of EMR is to measure and analyze care, eliminating that which is wasteful, futile, or even harmful. The biggest burden on our system is not the fact that we have a hyper-complex payment system that hides the true cost of care. The biggest burden is the wasteful care that this system agrees to pay for. In fact, I suspect that the main reason our system has become hyper-complex and covert in its spending is to hide this waste from prying eyes.

It sounds easy: Just eliminate costly unnecessary care and save the system. While you are at it, why not bring world peace, eliminate poverty, and make a detergent that cleans, softens, and deodorizes all at once? Read more »

*This blog post was originally published at Musings of a Distractible Mind*

The Seduction Of Primary Care

Hey there, big, smart, good-looking doctor…

Are you tired of being snubbed at all the parties? Are you tired of those mean old specialists having all of the fun?

I have something for you, something that will make you smile. Just come to me and see what I have for you. Embrace me and I will take away all of the bad things in your life. I am what you dream about. I am what you want.  I am yours if you want me…

Seduce: verb [trans.] attract (someone) to a belief or into a course of action that is inadvisable or foolhardy : they should not be seduced into thinking that their success ruled out the possibility of a relapse. See note at “tempt.”

(From the dictionary on my Mac, which I don’t know how to cite.)

If you ever go to a professional meeting for doctors, make sure you spend time on the exhibition floor. What you see there will tell you a lot about our system and why it is in the shape it is. Besides physician recruiters, EMR vendors, and drug company booths, the biggest contingent of booths is that of the ancillary service vendors.

“You can code this as CPT-XYZ and get $200 per procedure!”

“This is billable to Medicare under ICD-ABC.DE and it reimburses $300. That’s a 90 percent margin for you!”

This is an especially strong temptation for primary care doctors, as our main source of income comes from the patient visit — something that is poorly reimbursed. Just draw a few lab tests, do a few scans, do this, do that, and your income goes up dramatically. The salespeople (usually attractive women, ironically) will give a passing nod to the medical rationale for these procedures, but the pitch is made on one thing: Revenue. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

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