Archive for the 'General' Category

One of the hardest things we will all likely face is the challenge of dealing with the medical system at the end of life. It has become complicated in every way. The care is complex, the decisions are overwhelming and agonizing. There are usually multiple providers and physicians (not to mention family and friends) each with opinions and counsel. The reimbursement system for health care has been a mess America for a long time. Who understands it? We see patients and families struggle with these issues every day. I’m rereading “Horse and Buggy Doctor” written in 1938 by Arthur E. Hertzler a small town Kansas doctor. It’s about his medical practice in the first part of the 20th century. It makes me appreciate the good things we have and how fortunate we are to live in America at a time when so many things can be done to treat disease and injury. Nonetheless, finding the best care possible today is not an easy task. The “best care” is not always the most care! Books I often recommend are: Ira Byock’s “Dying Well” and Joanne Lynn, Joan Harrrold, and Janis Lynch Schuster’s ” Handbook for Mortals” All of these books are available on tablet. (even Hertzler’s!) They are not exactly beach vacation reads but I hope they serve as useful references when needed.

RLM  (4/30/2014)

The treatment of pain with medication is one of the most challenging tasks our physicians must perform. It requires knowledge of pharmacology, experience, patience and courage! Courage, because medicines routinely cause side effects, have toxicities, and may fail at their intended purpose. There are risks of interfering with medication plans or philosophies of referring physicians. In addition, prescribing pain medication is apt to be judged and second guessed by family, colleagues, insurers, regulators and attorneys. Strong opinions abound! At times medications are inappropriate and the refusal to prescribe under patient pressure can also require courage. Medicines must be chosen for their merits, prescribed with a proper plan, at the proper dose, for the proper amount of time with an eye on consequences. Physicians and patients must also deal with the frustrations of cost, insurance plan coverage restrictions, preauthorizations and other obstacles to the use of many medications. Good medication management requires education, monitoring and modification. Patients and family must be made aware of all these important considerations. With good and careful trials, timely follow up and patience we are often able to establish excellent medication plans to help our patients.

RLM. (3/26/14)