Prior Authorization

Recently a managed care plan notified me that one of my patients should be taking daily aspirin for 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 fina

Medicine on a Grand Scale

Politics and healthcare are inseparable. This relationship is epitomized by Virchow’s oft-quoted declaration, “Medicine is a social science, and politics is nothing more than medicine on a grand scale.” Through most of the modern age—and certainly during our lifetimes—this has been a beneficial relationship, despite the vicissitudes of electoral politics. Apart from fringe movements, the progress of medical science has been endorsed, regardless of party affiliation. Unfortunately, there are alarming signs that the political consensus on the benefits of immunization is imperiled Medical students learn of German physician Rudolf Virchow (1821-1902) by way of his eponyms: Virchow’s node, the harbinger of gastric malignancy, and Virchow’s triad, the factors that provoke thromboembolism, a term he invented. Virchow’s other accomplishments include the development of cell theory and the coining of numerous medical terms—from agenesis to zoonosis. For these achievements, Virchow is conside

The Ten Rules of Beach Week

For Sloane, Rett, Henry, Cam, and Harvin The Ten Rules of Beach Week, you must understand, Ensure that your respite is perfectly planned. To make your adventure both peaceful and grand Let’s count down—together—each simple command. Food is the subject of rule number ten. It’s not complicated, so let us begin. The cook’s on vacation and we’re left to fend. If it’s not to your liking it’s best to pretend. Rule number nine is one you can’t skip. No one may speak of the end of this trip. It doesn’t exist ‘til the calendars flip. If the topic is mentioned, your lips you must zip. No crying at Beach Week, that’s rule number eight. Too bad if you learned this a little too late. Sad things may happen but you’ll have to wait. Please save all your tears for the unspoken date.  It’s said that this place is the border of heaven,  So you might be tempted to sleep ‘til eleven, But then you’d miss out on the mindfulness leaven. Savor each moment, that’s rule number seven. No one gets hurt if you fol

Healthcare is a Team Sport

There is a well-known painting that endures as an icon for compassionate medical care. Entitled The Doctor , it was the creation of Sir Luke Fildes, a renowned artist of the Victorian Age. The painting depicts a gravely ill child in a poor family’s cottage. Watching over the child is the eponymous doctor, illuminated by a solitary lamp. In the background, the desperate parents are revealed by the predawn glow on the windowsill, perhaps foretelling a new day and hope for recovery.  The Doctor , Luke Fildes, Public Domain via Wikimedia Commons Fildes was able to capture the drama of a life-threatening illness because he had firsthand experience. In 1877, his one-year-old son died of typhoid fever. This was before the age of antibiotics, immunizations, and public health. Doctors at that time had little scientific training and the nursing profession was still in its infancy. The prospect of

Thirty-Six Months

In December 1944, thirty-six months after the United States declared war on Nazi Germany, the 101st Airborne Division was surrounded by German forces in the Belgian town of Bastogne. Six months earlier, Allied forces had landed at Normandy and begun their resolute march toward the heartland of Germany. In December 1944, the Nazis launched a surprise counter-offensive in the Ardennes Forest of Belgium and Luxembourg. The Siege of Bastogne was part of this wider campaign that came to be known as the Battle of the Bulge. Hitler planned to drive a wedge between the Allied armies, crush the encircled forces, and deprive them of material support for continuing the war. If successful, he believed the British and American governments would sue for peace. By mid-December, Hitler’s plan seemed to be working. The weary Americans holding the town of Bastogne were running low on food and ammunition. Even the weather seemed to be taking sides. Dense fog precluded air support, and freezing rain, hea

Nothing To Do at DeBordieu

Days without duties or deadlines. At DeBordieu hassles are few. Don’t ask what we did on vacation There really was nothing to do. Nothing to do on the beaches. Nothing to do on the lawn. Nothing to do until sunrise. Nothing to do after dawn. At DeBordieu there are no hours. Check-in is when you arrive. Naps can be taken impromptu. Drinks may be served before five. At DeBordieu there are no minutes. No clock will the tardy upbraid. Just moments to tweak your umbrella, While taking advantage of shade. No keeping your nose to the grindstone. No striking the iron while it's hot. At DeBordieu nothing’s accomplished, And all of the bustles forgot. There’s nothing to fear but the gators. Disturbing their slumber is rude. This island has nothing to vex you, And nothing beyond can intrude. Nothing could be less exciting. Nothing could be more sublime. If something else you have been seeking May I suggest nothing next time. Nothing to do in the ocean. Nothing to do in the dune. Nothing to do

Anti-Abortion Legislation

On behalf of the South Carolina Chapter of the American Academy of Family Physicians (SCAFP), we are writing to express our grave concerns with state legislative actions in response to the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization. Our concerns include the impact of enforcing the “South Carolina Fetal Heartbeat and Protection from Abortion Act” and other contemplated laws that we believe violate the sanctity of the patient-physician relationship and criminalize the practice of medicine. The SCAFP is the largest primary care organization in South Carolina, representing nearly 2000 practicing physicians and medical students. Family physicians provide care to patients of all ages and see the majority of reproductive-age women who seek office-based care. Family physicians provide reproductive health services including family planning, preconception counseling, pregnancy, postpartum, and menopausal care. In rural and underserved areas, family physicians are ofte