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.
She was rail thin and her deeply wrinkled face reflected the years she
had spent sucking on her “cancer sticks”, as she called her cigarettes. I
had seen Dorothy many times before in the ED. She had trained so many
residents on the nuisances of end stage COPD. The 60/60 rule for
intubation, PO2 below 60 or PCO2 above 60 just didn’t apply to her any
One of the primary expectations from the passage of the Affordable Care
Act was that fewer people would go to the nation’s emergency departments
rather than their primary physicians, thereby reducing the overall cost
of health care.