I value those behind-the-scenes programs on TV, especially when they warn you of dangers that you may never know. Here is a little behind-the-scenes story that you will really want to read because it might involve you! One of my chief interests in making sure patients are not only treated properly but that all the safeguards and protections are observed.

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One of the themes that keeps coming up in those little “newslets” for 15 minutes of Continuing Medical Education each is that systematic screening for several serious diseases, like cancers, is simply not as efficient as one wishes it were. At the very least, in terms of cost, it rarely pays. Sometimes people try to identify a subset of people who should be screened; but all too often, even that is a daunting task.

Some stalwart and doubtless realistic physicians sometimes suggest–screen patients who ask for it. This seems strikingly similar to the young doctor in Amiens who told me, that if he wanted to build a practice and feed his family, he had to give everyone antibiotics. It is that ancient trend of anti-intellectualism, patients who second-guess the doctor, people who are worried about their health– And yet, these people could argue that (they have paid their health insurance and earned what they think is good care), and they are individuals and not statistics. Read more on When To Screen For Things Medical That Could Kill…

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She was 32 years old and a child of the streets.  I wondered if she were a Down syndrome — what we medical types call the mosaic (partial) trisomy 21 — the chromosomal abnormality some still call Mongolism.  This was purely an intellectual exercise, as the county health service would surely not pay for the expensive study, so I would probably never know.

Homeless person sleeping on a park bench.Previous doctors had prescribed anti-psychotic medication, but she did not tolerate any of the various brands available through the county clinic. I had her try a little Abilify (arapiperazole) and it did seem to help when she remembered to take it.  Or when she slept somewhere it would not be stolen.

Read more on Public Medicine — Cheap Is More Important Than Quality…

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