I pause outside the exam room door. Inside, a patient waits. The chief complaint on the schedule is vague, but I never complain about the ambiguity. A wise doctor once told me there are three reasons for a patient's visit: the one they tell the staff, the one they tell you, and the real reason that will be revealed in good time. Before I open the door, the weight of the unknown presses down on me. Then I turn the doorknob and walk in. What happens inside those four walls is a ritual of normalcy. The door closes, shutting out the noise and chaos beyond. The patient speaks, and I listen. We discuss their concerns, and I offer guidance based on my training, experience, and the collective wisdom of the scientific method. The patient shares their vulnerability, and together we make a decision. It's a normal transaction between two human beings collaborating in good faith. The privacy is absolute; the honesty, assumed. In the exam room, the rules of reality remain firm. Science w...
The American transportation system is much like the American healthcare system: inefficient, expensive, and dangerous. Everyone wants to fix it, but conventional wisdom often leads to solutions that make things worse. Building more roads destroys neighborhoods and paradoxically creates more traffic congestion. Similarly, unleashing market forces in healthcare leads to higher costs, consolidation, and neglect of our poor and rural communities. If you live in one of South Carolina’s major metropolitan areas, you know how bad traffic can be. My son commutes between his offices in Greenville and Spartanburg, which are about 40 miles apart. Although most of the route is on Interstate 85, a one-way trip can take up to 90 minutes, with an average speed of just 27 mph. Automobile transportation is both time-consuming and expensive. According to the American Automobile Association, the average annual cost of owning and operating an automobile is over $11,000. Traveling by car is also...