“Can we pleeease feed that little girl in room two,” the nurse pleaded. “Her mother is driving me craaazy asking if she can go down to the vending machines and get something. I think she needs to smoke and needs an excuse to leave the baby with the dad. All she has is a bladder infection.”

“Hey sweetheart,” I said, interrupting my wife’s thoughts as she concentrated on writing her blog. “How would you rate me? You know, as a husband.”

It had been a long day when I sat down by the roaring fire to enjoy a glass of red wine. My father-in-law, who lives with us now, sat down nearby and began to describe his worsening, but stable angina. While attempting to pay close attention to his story I began to notice something strange that I initially mistook for the effects of the wine.

“That’s it! I’ve had it!” I shouted to the air, throwing the envelope on the floor.
“What is it now?” my less-than-sympathetic wife said, dramatically emphasizing now.
“They’re already hiking our taxes, that’s what,” I said, rising from the breakfast table and starting to pace.

One of the greatest benefits of being the executive editor of Emergency Physicians Monthly is that I get to read Greg Henry’s column before any of you do. I get to laugh at his unending wit, look up all the Latin phrases I’ve never heard before, and occasionally censor some of his more bawdy phrases. But I never cease to be challenged. This month, Greg’s column on “maturing the physician career” is so important that I want to use this editorial space to give a resounding “Amen!”

Last month, I wrote about the innovative treatment that cured my mother-in-law of her C. diff. infection (you can read about our “elegantly icky solution”). We were singularly thrilled when she recovered, happily overlooking the fact that her problem was caused by my own overdiagnosis of infection and overtreatment with a broad spectrum antibiotic.

I’d love to shield the identity of the patient in this story. But I can’t, and you’ll understand why in a minute. It’s not that I’m worried about a HIPAA violation or a law suit. After all, the patient was my mother-in-law. She and my father-in-law – Pop Pop – have moved in with us . . . so they aren’t going to sue anybody. And while I hesitate to embarrass my soft-spoken “Mom Mom” with the details of this tale, I have to tell this story straight. Here goes.

You’ve heard it said that, “Talk is cheap.” Well that turns out to be particularly true in the realm of health care spending. Studies show that if you communicate clearly with patients and their families, there’s a fair chance that they’re not going to want to spend all the money that you feel compelled to spend.

Last month’s somewhat surprising Supreme Court ruling to essentially uphold the Affordable Care Act has left us wondering what to expect next. While the emphasis of the ruling rested on whether the ‘individual mandate‘ could be ruled a legal tax – something both sides of Congress disagreed with for different reasons – the overlooked aspect of the ruling is its impact on healthcare for the poor.

Steve Lopez, a columnist for the L.A. Times, recently reported a classic tale of medical care sticker shock. A man brought his daughter to an emergency department, wanting to check to see if she had appendicitis. She didn’t. The bill for answering that question was almost $5,000.