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Blue Cross of Georgia does not always want to pay for people’s visits to the emergency room. The question, clearly is what they pay for and what they do not. To a certain extent, there are alternatives now that folks saw rarely if at all in the past.

Alternatives like urgent care.  In the trade we call it a “doc in a box.”  Long waits are not uncommon — it is generally one doctor present at a time, with many nurses and technicians who have enough time to at least have an authentic — if brief — interpersonal relationship with the patient. Sometimes people get wheeled into such places. By definition, patients are usually ambulatory in a “walk-in clinic.” I have worked in such places that specialized in psychiatry, where you could see pretty much anything, although prescription refills were clearly dominant. Read more on Avoiding Emergencies In Georgia…

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The psychological ability to adjust to chronic medical illness is an area where there has been very little study.  Lately, I find myself working mostly with this population of people.  I’m noticing that some adjust very well and some do it very poorly.  It depends on a lot of factors.

The situation is clearest when the illness we’re talking about is back or neck pain.  Back pain, more than neck pain, has been clearly correlated to the presence of major depression.  If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.

Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make.  Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary.  Quite honestly, most back pain patients are in no way prepared to do this.  Mostly, this is because anything that is sedentary is going to require a higher level of education.  Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…

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I don’t think I know anyone who can say they’ve never had a headache.  And some have them often enough that they’re given about as much attention as a hiccup or a sneeze.  But sometimes, a headache can be more than a headache.

I was in Minneapolis doing a rotation in neurology through a university headache clinic. A lot of people were referred through primary care physicians and some even from other neurologists.  They were strange headaches to them, but headaches that were frequently seen by these university neurologists in Minneapolis.

I remember seeing a professional football player who had cluster headaches with such intense pain that it brought him to tears.  There were many middle aged and older people, but there’s one girl I remember in particular. She was 23 years old and was given to me to see with no pre-screening. Read more on Headache or Tumor…

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