From the monthly archives:

February 2009

health-careQ: I recently lost my health insurance benefits and now have to buy my own coverage. I can barely afford even the cheapest policy out there.

Any ideas?

A: Okay, first of all, this website is “Your ER Doc” not “Your Insurance Agent,” and certainly not “Your Congressman” but I’ll take a stab at it. You have to have insurance in case something catastrophic happens, so I favor a relatively inexpensive PPO plan with a very high deductible. This will deal with large bills that could result from hospitalizations, surgeries, etc. Under ordinary circumstances however, most healthy people will not get close to their deductible. This means that you now have to avoid getting sick or hurt as much as possible to save costs. It is absolutely imperative that you take full responsibility for your health. First read my top 10 list, “How to Stay out of the ER,” and also follow the following rules below.
Here’s how many cigarettes you can smoke per day: 0.
Here’s how many alcoholic beverages you can have per day: 1.
Here’s your new diet plan (which by the way I completely stole): Eat food, not too much, mostly plants.
Here’s your list of high impact sports you can participate in: Chess.
Here’s how much faster than the speed limit you may drive: 0.
Here’s how much exercise you need: 30 minutes aerobic every other day.

I’m sorry this is restrictive my friend, but at least it’s cheap.


Med spaNow that the economy has totally fallen apart, I finally have some career validation. I must say, I had been feeling somewhat regretful about my job choice, especially at 3am when there was an intoxicated teenager vomiting on my shoes. I would think, “Gosh, I could have a med spa someplace, and be a dermatologist or plastic surgeon catering to rich healthy people during regular hours.” Now that everyone is scrambling just to pay their mortgage, I’m pretty happy I didn’t throw down on a medspa.



We’ll see how long I remain happy about my career choice, after the state starts paying my bills with I.O.U.’s.


fertility-treatment Okay, I realize this may not be an emergency related thing, but I have to weigh in. Fertility treatments in a single woman who already has 6 kids? Unbelievable. With that kind of thing going on, it makes me wonder how long our species has before it goes extinct. Many people have lined up to thrash the mother for being so irresponsible, and the fertility doc deserves to have his license pulled in my opinion, but these individuals are hardly isolated examples of self-serving, irresponsible behavior. I am deeply concerned about one example after another of individuals behaving in ways that accelerate the non-sustainability of our society. babies From CEO’s that spend government bailout money on decorative toilets while their companies are crumbling, to commuters that drive gas-guzzling SUV’s that they bought on credit, it seems we are heading off a cliff. In his book Collapse, Jared Diamond describes the common features of societies that have collapsed throughout history. There are many, but one surprising feature among societies that fail is the tendency for its members to heap luxurious, non-essential resources upon themselves. They do this, not just until it becomes clear that continued resource over-utilization will result in their destruction, but well past that point. Diamond ponders at one point what the ancient Easter Islanders were thinking when they chopped down the final tree on their island, ensuring the doom of their society. Sadly, most of the trees were not being used for anything essential, but useless monumental statues to bring prestige and honor to its various tribal chiefs. Compare that to a single woman having 14 children in the midst of a severe economic recession. Perhaps some future author will write a sequel to Collapse, describing the foolishness of this woman, her fertility doctor, and the society that watched it happen.


faithsMost parents believe in modern medicine, and trust physicians.  They may not do everything that their doctor suggests, but generally speaking, they will abide by our recommendations.  However, parents are increasingly questioning their physicians and evidence-based medicine in general.  This is particularly true for some religious groups, whether they be small cult-like sects or more mainstream groups like Jehova’s Witnesses or Scientologists.  Lately it seems I am frequently negotiating with patients to do what is medically appropriate while not violating their faith.

I tend to be respectful of different faiths and opinions and try not to bully people into doing what I want.  However, when the patient is a child, and the parents want to avoid necessary medical treatment, we’ve got a problem.   So far, I have never had to get a judge to force parents to treat their child, but I think it’s coming.

There have been some sensational cases of neglected children dying of preventable causes such as diabetes, urinary tract infections, etc.  Even more common is the unvaccinated child, who becomes much more likely to get ill, or die as a result of preventable infections.

I certainly don’t think that modern (evidence-based) medicine has a monopoly on health, but I think many people forget its primary foundation.  Evidence based simply means that doctors offer treatments that have been tested using the scientific method, and have been found to be safe and effective.  Once you eliminate that simple requirement, you are dealing with treatments that may or may not have any merit, and potentially could be dangerous.


chopping-kindlingIf you need kindling, don’t hold onto a stick with one hand, while chopping down on it with an axe.  You would think this goes without saying.  By the way, a colleague of mine did this with disastrous results.  Knucklehead!