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What Some Patients Will Do For Drugs: A Strange Phone Call Late At Night

9:00 pm:

Hello. It’s Mrs. Mumbledimumbler; I need the doctor to call me right away. My hip is driving me crazy. Please call me.

I listen to the message three times so I can sort of make out the name. The problem is that even though I think I can understand it, I don’t recognize it at all. But I call her because she said she needed me to call her right away.

Hello. I need you to call me in some tramadol right away.

“What was your name again?”

She repeats it clearly enough for me to confirm that I really don’t recognize it.

“Have I ever seen you in the office?”


Let me get this straight: it’s 9:00 at night and your hip is hurting, so you call a doctor who’s a complete stranger and insist that they call you in a powerful painkiller without ever having seen you, taken your medical history, or examined you? I don’t think so.

“Um, I’m sorry ma’am, but I really can’t do that unless you’re an established patient in my office.”

Oh, okay; never mind.

I suppose I should count my lucky stars that she didn’t want vicodin.

*This blog post was originally published at Musings of a Dinosaur*

How To Micro-Tweak Diagnosis And Treatment

A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.

Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.

Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »

You Could Pay A Fee For Calling 911 If You Abuse The Service

It turns out calling 911 isn’t free.  Imagine that.    911 communications may actually cost you money.  People who pay taxes aren’t the only ones who are fitting the bill anymore.  In some places ambulances are charging fat surcharges for the extra equipment necessary for the ambulance ride?  How much does an ambulance ride cost if you are morbidly obese?  How does an extra $500 in addition to the base rate.
911-CommunicationsBut even people who don’t require extra equipment will have to start paying extra for the right to make the call to 911 communications.  How much extra?  How much will calling 911 cost in Tracy, California?  Well, if you want to pay a $48 per year fee, you can call 911 communications centers  as many times as you want.  But if you don’t want to pay the fee, how does $300 per call sound.  If you’re having a stroke, calling 911 communications may just cost you your arm and your leg.

That’s right.  $300 to call 911 communications for an emergency.  Or perhaps the problem is too many people are calling for nonemergency reasons.  If you can’t get the frequent abusers who show up at the hospital by ambulance for nonemergent problems to stop calling 911, maybe you can collect their $300 by garnishing their welfare and disability checks.
At some point, our country is going to have to stop excusing the actions of  the economic tax abusers and start implementing personal responsibility with real consequences that hold folks accountable for their actions.   I  think charging  a fee is an excellent deterant to unnecssary abuse of a system that is overwhelmed with nonurgent convenience care.

*This blog post was originally published at Happy Hospitalist*

Writing Skills And When Having A Physician Friend Can Save Your Life

I’ve always wanted to be a doctor.

Never a writer.

With a new year and a new decade, I am determined to become a better writer not because of some childhood dream or expectation from others, but because of a near mishap that occurred at the beginning of 2000. A simple phone call changed the destiny of my brother from having a good outcome to having a great outcome. A simple phone call may have been the difference between “you are cancer free” to “I’m sorry to tell you it’s come back.” Read more »

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

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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