School Sneezing
A patient of mine just sent me a request for a COVID test on her 2 year old that got…
Musings
The Herd Moves On
The following article from highly respected SLO pediatrician Dr. Bravo resonates: “Most SLO County teens are unvaccinated against COVID. Local…
Rewind
As California tiptoes up to “reopening” later this month I’m reminded about something I wrote a few years back: Removal…
Psyche in the City
A couple weeks back I was up to my usual routine on a nearby street chatting with parents, while watching…
Vaccine Truck
My second COVID-19 booster and the general vaccine rollout have made me think about a moment in Haiti a decade…
Pandemania
Photo by Anastasiia Chepinska on Unsplash As belt tightening lockdown gets going again here in CA, I keep wondering where…
Politics as Public Health Emergency
Photo by Ajay Parthasarathy on Unsplash It’s been a while since I’ve posted anything. To some extent I’m exhausted by…
Welcome to the Hospital California
I found myself humming this a few shifts ago, when trying to transfer a patient with lingering effects from COVID.…
“What do you think about all the testing?”
This question finds me pretty often now. I’m not a public health guru and I only have a small sliver…
#SoonToBeInfectedAndDeadLivesMatterToo
I thought I’d assemble another Slishman sleeper. All the social media, news, presidential Tweets, riots, bumper stickers… there’s just so…
The Best Laid Plans of Mice and Friggin Idiots
A number of people have asked my take on “Plandemic” and a viral interview of a couple docs in Bakersfield…
Rethinking ID (infectious disease)
Being a small fish in a hamster wheel I’m not expecting to accomplish much from another Covid post. CPAP hoods,…
Rabbit Holes
COVID posts keep coming and I’m topped off. Nevertheless, here’s another to scroll on past. Some folks type to change…
Coronaville
I haven’t been typing as much lately because, well, life. But I’ve been asked by a few folks for an…
When Pandemics Collide
So a few days ago after the kids had fully destroyed our house, we decided to venture out for a…
Independence Day Tip (inspired by a patient with dementia)
Photo by Tricia Galvin on Unsplash UTIs are part of the human condition, and unfortunately, more so for elderly women with dementia. My…
Abortion Evolution
Three things have led me to this hornet’s nest:1. An article by a med student who plans to offer abortions…
CTopia
Photo by Ken Treloar on Unsplash On my last shift I ordered roughly 10 CT scans, which unearthed zero pathology. That day I…
“Selective Vaccination”
Photo by Max Felner on Unsplash As Zak heads to the pediatrician for another round of vaccines, I thought I’d type another atypical…
Pinworm Panic
Worms part 2… and yet another med school lecture I must have missed. A few nights ago at 2am a…
Cash or Hosing?
My posts tapered to near zero about six months ago in part due to an $1850 emergency medicine board recert…
Technodysplasia
My father tells a story about one visit to his doctor. He sat in the waiting room watching the appointment…
Price Opacity
A Pre-R patient just sent me a e-rant about her ER bill that came to $6000 for her kid’s ear…
Trick of the trade
A friend’s dad was struggling with plugged ears. The VA wanted him to drive to LA to have them evaluated.…
Anthem Emergency
EMTALA swings the ER gates open on entry. “Give me your tired, your poor, your huddled masses… but preferably your…
Follow Up
To my ER friends past and present who also spent countless hours reading textbooks by Tintinalli and Rosen among others,…
Flu… A Martian’s View
From the article Doctors in SLO County seeing an influx of patients with flu: “If you start to feel those flu-like…
Malls and Hospitals
A recent “1A” podcast about malls, plus the article Why Major Hospitals Are Losing Money By The Millions, sent me…
AMA should be DBU … (Don’t Blame Us)
Photo by Bernard Hermant on Unsplash Nothing makes me appreciate my general luck so far more than walking into work each day. A…
If the Affordable Care Act was a car…
If the Affordable Care Act was a car, I’d call it a rusty Pinto… maybe drives; possibly street legal; not…
Standing, Kneeling, and Snowballs
I try to steer from politics, but with all the noise on Facebook about the NFL and anthems, I thought…
Price Transparency & Paper Prescriptions
In two of the three hospitals where I work patients are asked for their “preferred pharmacy” at the time of…
Rolling Dice
Photo by Josh Appel on Unsplash When you see your doctor, hopefully you have a nice relationship already. Hopefully you can freely ask…
Blurred Lines
I had an unusual call a couple weeks ago from a patient in Illinois referred to us by a relative…
Pre-R’s Niche
Photo by Louis Maniquet on Unsplash “Don’t get me wrong. The model you have made for Pre-R is awesome. I love it. My…
Take the Full Course or Else! Or Else What?
Ever since med school I’ve been struck by how much medicine is more art than science. Dosing and treatment durations…
The Golden Rule as Legal Loophole?
A few nights ago I got a late call from a patient with a clear cut UTI. Pharmacies close early…
Universal Healthcare? Please Define
For starters, are we talking government as the single payer too? It’s an important distinction. Personally, I’m not yet sold.…
Healthcare Reform Reform…
The future of Trumpcare really had us wondering last week. For some reason the Marx Brothers came to mind: Groucho:…
Referral Madness
A number of people have contacted me recently hunting for a new doc, because apparently another primary care physician (PCP)…
What’s fair?
Like most of us, this past election cycle and the pending demolition of the ACA have sent my mind spinning…
Second anniversary!
Well, the experiment continues and there’s really no reason for us to pull the plug at this point. For any docs…
Should we blame patients?
Why do patients choose the paths they choose? Just about every shift, I and my coworkers shake our heads, and…
Flu Insanity
Well I just worked one very long, hard 24 hour shift. I saw 40-50 patients, and the large majority were…
Narcan in the Water
Moving on to a bigger problem than CHS, narcotic overdose deaths now exceed traffic and homicide deaths. Toward the end…
The Silver Rule
Having grown up with a German/Protestant mother and a Bostonian/Jewish dad, on topics of religion, I call myself “flexible.” Actually,…
We vaccinate… selfishly
A couple docs forwarded to me this article Vaccines 101: Too Much Too Soon?, so I’ll keep it going. Plenty of great…
Pre-R amplifies decency – ER amplifies absurdity
A few shifts ago I was fairly burnt at 6:00 am when an ambulance delivered a 30 year old with…
Oaths and Snake Oil
True confession… I never took the Hippocratic Oath. I was out on a boat. For whatever reason, at the end…
Coumadin – Choose Your Poison
Sleep-running after a 24 hour shift a couple days ago, I face planted in the dirt. A few scrapes, but…
1.5 Year Report
The evolution of our medical startup continues, but it’s hard to know when the term “startup” no longer applies. Technically,…
Healthcare Snowball
A snowflake rolling down a hill will have less and less sense of rotation and movement over time the bigger…
Where will telemedicine land?
While our main focus is the old school house call, Pre-R also offers some tele-medical consultation, because we believe the…
Limits
Like many of us, I’ve been reading the news and posts here about Orlando. Typing seems to be our therapy,…
Brain Drains
I was born in ’71 and the last manned moon landing was in December ’72. This sticks in my craw.…
Systems or starfish?
During a recent ER shift a patient arrived late at night who was released from prison just 9 days prior.…
Doctor Shortage or Admin Glut?
I keep reading dire articles about the lack of primary care doctors. A “perfect storm” is nearing because medical…
ER vs. Pre-R
With every ER shift, and every Pre-R call, I’m coming to realize these are pretty different universes. A couple med…
“Have you ever been sued?”
…inspired by a friend named in two law suits for patients he never met. Every credentialing hospital and malpractice…
DIY Medicine
Walking out of Home Depot today my mind wandered to a hardware store where my folks used to go when…
Strokes, Heart Attacks, and Bombs
These seem unrelated, but give me a chance. I was eating outside at a restaurant with my 5 month old,…
Worried Well
A surgeon friend sent me a book called “The Social Transformation of American Medicine.” Good stuff, but I wish there…
Survivor Bias
Or what I prefer calling sky diver bias. As we ready ourselves to bring our baby Max for his second…
Pre-R Hydration Services
Most healthcare activities fit within the buckets of prevention, diagnosis and treatment. Family practice docs and pediatricians cover all three…
Patient Ping Pong
Last shift a woman returned because the day prior she was seen for abdominal pain and her doc said to…
Our First Anniversary
Pre-R has weathered the first year, and we plan to carry on. New businesses typically face “dips” in their first…
Free Will Bubbles
This post is more philosophical and out there than usual, so my apologies ahead of time. Recent conversations about high…
Whose Time is More Valuable?
The article Why an Uber for health care is doomed to fail briefly made me consider tossing the Pre-R towel. But not…
Competing for Suffering
Med school in St. Louis exposed me to a variety of “competing” hospitals. Same thing in Albuquerque during residency, with…
Why we don’t take Medicare
Since the early days of Pre-R (January) many people have asked whether we accept Medicare. Actually, some doctors make Medicare…
Probable vs. Possible
This is for my premed and med student friends in reaction to the following article After a verdict: Doctors need to…
So sorry, I can’t be your PCP
I recommend for all of my patients to have their own primary care physicians and some ask whether I ever…
What’s a true Emergency?
A week ago a patient sent me the following article, OU Medical Center ER To Charge Fee For Non-Emergency Visits, which is…
10 Month Report
Our Pre-R experiment continues, and folks in town are gradually getting to know we exist. Word of mouth, followed by…
Chips
A little after midnight last night I got a blast from my ENDORPHIN POWER COMPANY past. A woman who had…
Disillusionment or Illumination
I walked into medical school with a vague sense I might want to be a small town family practice doc.…
Medical Climate Change
During my residency from ’97-’00 I remember considering patients to be insured or uninsured. It was very binary. We rarely…
Removal of meds can come with far more stress for doctors and patients
Photo by pina messina on Unsplash You may not be aware that it’s far easier to start patients on new medications than to…
MIND-BODY-WALLET
In my four years of med school and three years of residency, not once did I ever see a patient…
Diagnostic Dilemmas
Pre-R makes sense for low hanging fruit. Lacerations, UTIs, ear infections, rashes… Why should coders, billers, collectors, insurers, governments step…
6 Month Report
The experiment continues and we’re still enjoying. We’re getting about a call a day now, and happily, from people who…
Upcoding
Organized crime and US healthcare have much in common. Those on top make enormous profits. Those in the middle generally…
CrowdCentsing – A click towards price transparency
Some of you may know about my quest for real time price transparency in healthcare. Vanessa has just built her…
“Incidentalomas”
“Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.” Illustration…
Antibiotic Police
Photo by Jack Finnigan on Unsplash This article in Modern Healthcare, Telemed docs more likely to prescribe broad-spectrum antibiotics,begs the question about how practice…
Finer Dining
Imagine staggering into a restaurant and waiting 2 hours for a table. Imagine this restaurant is the only one in…
Why No Narcotics?
It’s not because we’re mean. Emergency medicine has seen a massive swing in its use of narcotics over the past…
ACA and Single Payer
I was asked about the following link “Doctors descend on Vermont to restore patient control over health care” as well…
It’s a Wonderful Vaccine
You’ve heard too much about this already, but I just gotta add the Slishman slant. Anti-vaccinators are getting pummeled by…
“I can’t diagnose you by phone, but…”
Phones ring continuously in most ERs. I’ve learned to block the racket, but every so often I overhear nurses or…
You have a right to be seen in the ER, but beware of the side effects
Every law like every drug has its intended effects and its side effects. “EMTALA” is a law you perhaps couldn’t…
Medical records are like your grandfather’s attic…
…Some nuggets, but mostly crap. Adding “electronic” means sortable, searchable, bigger attic, more crap. Unfortunately, no one has the guts to…
Friends and Family Plan
Photo by Duy Pham on Unsplash After having seen a few patients in their homes now, I’m starting to really understand another major…
Your Most Expensive Drink
Photo by Michael Discenza on Unsplash Who here has awakened in an ER after a binge? I ask this of most Cal Poly…
Why Not Concierge Medicine?
For basic acute medical care and Pre-R, it’s just the wrong force vector diagram. Every pay structure comes with hidden…
HIPAA: So you like your privacy eh?
As a patient, me too. But I wish I could dial it in a bit better, maybe with some refined…
“Ebola is So Last October”
No matter how devastating the disease, that line captures the come and go of today’s plagues in the news. It’s…
Life Preservation vs Improvement
Dr. Earnest Ceriani makes a home visit to patients near Kremmling, Colorado, in 1948. (W. Eugene Smith/Life Magazine) Emergency departments…
Medical Business Experiment
Premeds are like bright-eyed stem cells. They walk into med school wanting to help people generically. Who and how to…
Who’s to blame?
Patients are asked to take their non emergent problems to their primary care physicians, but with long waits, ERs are…