Bitter Pill: Why Medical Bills Are Killing Us


Steven Brill wrote “Bitter Pill: Why Medical Bills Are Killing Us” in Time Magazine, Feb 20, 2013. This 36-page behemoth is actually a quick read, and I think worth the time spent. I never learned this stuff in medical school.

As doctors, we order tests for the “benefit of the patient” regardless of cost. We take this as a badge of honor, that we’re willing to forgo expense to give our patient the best care possible. But it doesn’t stop there. The patient does get a bill for this stuff. They are uneducated consumers. We are uneducated providers. Students and residents, this will become your problem. It will probably become my problem. I think it’s worth taking some time thinking about how this will affect how you practice medicine.

Of course, there are other sides to this story. Hospitals report that they need to charge higher prices to recoup losses from patients who couldn’t pay. Device manufacturers will want to recoup their R&D costs. And we cannot deny the profit motive in inspiring innovation.

Regardless, we should start talking about this now so we can address.

NPR had an interview with the author. If you don’t want to read the 36 page article, take a listen to this: Planet Money – Medical Bills

Also check out the post on Medicare and the Affordable Care Act. As always, feel free to put your comments below.

There’s not nothing more we can do

Ashley Shreeves (from SmartEM) is an EM doctor in NY who took a year to do a palliative care fellowship. Now she practices both. It would, at first, seem to be paradoxical. In EM, we are trained to do something. For us, the end-of-life is a challenge to overcome – not to be met gracefully. This lecture will change the way I approach these situations, I hope you watch. Let me know what you think.
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An introduction to Medicare and the Affordable Care Act

Many students have asked me for an explanation of how the health care system works. When we are done with that, we’ll review Consciousness and the Meaning of Life. That’s a big question. So, let’s take it in pieces.

First let’s look at Medicare. This is a government sponsored program that provides health care funding to older people and those on dialysis or disabled.

Next let’s look at the Patient Protection and Affordable Care Act (PPACA or sometimes known as ACA or “Obamacare”). I can’t beat this professionally created video by the Kaiser Foundation.

[slickquiz id=5]

Enhancing pain scale effectiveness

I’ve never really understood the utility of the pain scale. I understand that certain certifying bodies mandate its use and therefore we’re required to use it, but for me, when people consistently rate their pain at 11 or 13 – I never understood how I was to use this.

Seems patients have difficulty with it as well. This gentleman, however, has nailed it.

Sometimes you just need a laugh. Enjoy.

Splint Like a Pro

splint_like_a_proPaul Casey and I were making videos to teach splinting. The lighting was poor, the audio terrible and Paul’s splint application technique was pathetic. So we instead decided to see if someone else has already done this. Luckily someone has. Rob Orman (from the ERcast podcast). It’s called Splint-Like-A-Pro because Rob goes to the ortho techs, who do this all the time – the pros, to see how they do it.
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Ubiquitous learning (uLearning) and iPads

imgresThe use of mobile devices (like smart phones and old school PDA’s) allow for students to learn within the context of what they are studying. For example, a student learning about plants can be out in the forest with their device. A student learning about social sciences can be in a museum. The devices can be equipped with RFID readers so when a student gets close to an item, it triggers information to be presented about that item. For example, when a student nears a particular plant, the smart phone would show information about that plant. Of course modern equipment can use GPS data to trigger content instead of RFID chips. Continue reading “Ubiquitous learning (uLearning) and iPads”