You may have heard this week about a new study, led by my friend and colleague Pete Cram, which revealed astonishing variation in prices for hip replacement surgery. Staggering, actually—ranging from a bit over $10,000 to over $125,000. I have blogged a bit about hospital prices, and doctor fees, even a recent post on orthopedic…
Andrews was easily the most anxious patient I took care of that month, a gray Michigan February (is there any other kind?) which I spent in the hospital caring for patients admitted to the general medical ward at the Ann Arbor Veterans Affairs Medical Center. (Andrews is a pseudonym, as are all the patients I blog about, unless…
I got an email recently from someone who read Critical Decisions, and who said it resonated with her in part because of work she does with a breast cancer hot line. “I’ve been volunteering as a Helpline worker for Living Beyond Breast Cancer. We get a lot of calls from women who seem to have…
The first test tube baby was born July 25th, 1978 in the north of England. Louise Brown was called the “baby of the century” by some and a “moral abomination” by others. It wasn’t Brown who critics accused of being immoral, of course. She was just a blameless infant. Instead, it was her doctors who…
As if being diagnosed with breast cancer wasn’t bad enough, many women with this diagnosis face complicated decisions about what kind of medicine or chemotherapy to take, if any, to reduce their chance of cancer recurrence. As I discussed in a recent post, the mathematics of such decisions can be hard to comprehend for many patients. …
Let’s warm up with a quick arithmetic problem, which I want you to do in your head. What is one thousand plus forty? Now add another thousand And thirty more Plus twenty Plus another thousand And finally, add an additional ten. What’s the answer? According to Dean Buonomano, in his excellent book Brain Bugs, the majority…
Imagine picking up a telephone and hearing your doctor tell you there is a “999 out of 1,000 chance that you’ll be dead within a decade.” That’s what Leonard Mlodinow experienced in 1989, when his routine HIV test didn’t turn out the way he expected. Mlodinow tells this story in his 2008 book, The Drunkard’s Walk,…
Medicine, today, is supposed to be “patient-centered.” But sometimes the patients feel a little off balance. What can they do when everyone seems to be trying to push aggressive, expensive treatments on them? One solution — or a partial solution — is known as shared decision making, in which patients are given specific tools, such…
It is not an easy time to be a physician in the United States. Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision. Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for…
A cranky customer snaps at his barista, lodging an unjustifiable complaint about the service, the temperature of the drink…about anything and everything. He came into the store angry (and in pain from a chronic illness) and he needed something–or someone!–to take it out on. He is met by a well-trained smile, the barista doling out…