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Move Fast and Break Things

My father was a brickmason. As a teenager, I spent many summer days working as his assistant. I despised almost every moment—the heat, the drudgery, and my father’s company. My attitude was much like Mark Twain's, who wrote, “When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much he had learned in seven years.” Looking back, I am ashamed of my adolescent disrespect for his hard work, skill, and meticulous attention to detail. One incident stands out vividly. He and his crew had just completed the hearth and chimney for an imposing multi-story home. A critical error in the blueprints caused the hearth to be misaligned by several inches, a minor flaw that compromised the living room’s aesthetic balance. The homeowners were adamant that this mistake be corrected. Unfortunately, moving the entire house would have been far easier than relocating the chimney. The only sol...
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A Candle in the Dark

The struggle between reason and superstition has raged for centuries. Since the Age of Enlightenment, the proponents of science have mainly carried the day. The byproduct of these victories is a world replete with material abundance, technological wonders, and healthy children. Unfortunately, the rise of political regimes promoting misinformation and quackery presents a unique threat to the public good. As experts in healthcare and guardians of patient well-being, physicians have a crucial role in combating this dangerous trend. I am a board-certified family physician at MGC Carolina Family Physicians, an NCQA Recognized Patient-Centered Medical Home. I am also past-president of the South Carolina Academy of Family Physicians, and a Fellow of the American Academy of Family Physicians. I am a board-certified family physician at MGC Carolina Family Physicians, an NCQA Recognized Patient-Centered Medical Home. I am also past-president of the South Carolina Academy of Family Physicians, ...

Backstage People

Remarks on being named South Carolina Family Physician of the Year, June 2024. I am humbled and incredibly grateful for this honor. Let me start by thanking the Board of Directors of the South Carolina Academy of Family Physicians and our Executive Vice President, Paquita Turner, for allowing me to serve in this organization for the past three decades. I also want to recognize my wife, Betty, for her support, encouragement, and patience for nearly 42 years. This honor means the world to me — but, honestly, I can’t get over a nagging feeling. If you have imposter syndrome, you know what I’m talking about. It’s the feeling that maybe you don’t deserve it. Imposter syndrome is very common in our profession. I saw a recent study that said forty percent of physicians have this affliction. Betty, however, has a different name for this phenomenon. She calls us Backstage People. For many years, Betty and I volunteered with our local professional ballet company (no we didn’t dance!). For ...

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...

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 ...

The Absurdity of Medical Freedom

Archie Cochrane (1909-1988) was one of the fathers of evidence-based medicine and the namesake of the Cochrane Collaboration. His professional life was profoundly influenced by his experience as a World War II prisoner of war. While serving as a physician in the British Army, he was captured during the Battle of Crete in May 1941. He spent the rest of the war as a medical officer in POW camps. Eventually, he was placed in charge of caring for Allied prisoners suffering from tuberculosis. The resurgence of tuberculosis during the war was a public health catastrophe. At that time there were no effective antibiotics for tuberculosis. The options available to Cochrane consisted of either bed rest or an intervention such as pneumothorax or thoracoplasty. Bed rest does have a physiologic basis (lying flat reduces the oxygen tension in the lung apices). As for the other treatments, no one knew if they really worked. These therapies were based on opinion—and ...