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Move Fast and Break Things

My father was a brickmason. As a teenager, I spent many summer days working as his assistant. I despised almost every moment—the heat, the drudgery, and my father’s company. My attitude was much like Mark Twain's, who wrote, “When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much he had learned in seven years.” Looking back, I am ashamed of my adolescent disrespect for his hard work, skill, and meticulous attention to detail. One incident stands out vividly. He and his crew had just completed the hearth and chimney for an imposing multi-story home. A critical error in the blueprints caused the hearth to be misaligned by several inches, a minor flaw that compromised the living room’s aesthetic balance. The homeowners were adamant that this mistake be corrected. Unfortunately, moving the entire house would have been far easier than relocating the chimney. The only solutio...
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A Candle in the Dark

The struggle between reason and superstition has raged for centuries. Since the Age of Enlightenment, the proponents of science have mainly carried the day. The byproduct of these victories is a world replete with material abundance, technological wonders, and healthy children. Unfortunately, the rise of political regimes promoting misinformation and quackery presents a unique threat to the public good. As experts in healthcare and guardians of patient well-being, physicians have a crucial role in combating this dangerous trend. Nearly three decades ago, astronomer Carl Sagan published The Demon-Haunted World , a book dedicated to educating the public about the scientific method and the importance of critical thinking. In general, Sagan was hopeful that science would prevail by serving as a “candle in the dark.” Despite his optimism, a sense of dread permeated his writing. He took note of the explosive growth of the Internet in the 1990s and observed that pre-millennial America was rip...

Backstage People

Remarks on being named South Carolina Family Physician of the Year. I am humbled and incredibly grateful for this honor. Let me start by thanking the Board of Directors of the South Carolina Academy of Family Physicians and our Executive Vice President, Paquita Turner, for allowing me to serve in this organization for the past three decades. I also want to recognize my wife, Betty, for her support, encouragement, and patience for nearly 42 years. This honor means the world to me — but, honestly, I can’t get over a nagging feeling. If you have impostor syndrome, you know what I’m talking about. It’s the feeling that maybe you don’t deserve it. Imposter syndrome is very common in our profession. A recent study said forty percent of physicians have this affliction. Betty, however, has a different name for this phenomenon. She calls us Backstage People. For many years, Betty and I volunteered with our local professional ballet company (no, we didn’t dance!). For a while, she was president...

Prior Authorization

Recently, a managed care plan notified me that one of my patients should be taking daily aspirin for the secondary prevention of heart disease. A quick review of the chart showed that we had discussed this before, and the patient was likely already taking aspirin. Sadly, his medication list did not accurately reflect this fact. “I’ll fix that,” I thought, and entered an order for aspirin 81 mg daily. I’m sure you can imagine the next thing that rolled out of our fax machine: A prior authorization request for a 126-year-old generic drug that costs less than $1 for 100 tablets. How did we get to this point? In the halcyon days of yore, doctors wrote their orders, and somebody paid for it—no questions asked. Well, that is not exactly true. In the 1960s and earlier, most people paid for medical care out-of-pocket (or simply did without if they could not afford the treatment). It was the advent of Medicare, Medicaid, and the expansion of employer-sponsored health insurance that shifted the...