The Status of Rural Hospitals in 2019

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2019 has been a difficult year for rural Maine hospitals. Calais Regional Hospital recently filed for bankruptcy and just a few months ago Penobscot Valley Hospital did the same. And more hospitals in our state and across the country are imperiled. Over 100 rural hospitals in the US have closed since 2010 and it is… Read more »

You Get What You Pay For

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Last month, I wrote about a study which linked the availability of primary care with life expectancy and which also showed that the availability of primary care providers has a much more powerful impact on life expectancy than the availability of specialists.  Primary care settings are the most cost effective place to offer preventive care,… Read more »

An Apple a Day?

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Everyone knows this old saw and the implication is that keeping away from a doctor implies that you are healthy. I like the message that healthy eating and living translates to better health, and in fact one of my favorite cartoons depicts a man sitting on his doorstep happily eating an apple with three men… Read more »

Some Good News and Some Bad News

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Since the advent of the Affordable Care Act in 2009 over 20 million previously uninsured people have gained health insurance coverage. This has had a number of positive impacts on access to care and health outcomes which I’ve covered in previous blogs. But as we all know, there have also been challenges. The Supreme Court… Read more »

Children at Risk

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While the scope the opioid crisis has become apparent to most people in this country, most of our broad understanding of the challenges we face are a result of its impact on adults.  Relatively little is known about how children are affected and what we have known is often based either on extrapolation from data… Read more »

Hard Choices

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Many of us who are committed to universal access to healthcare have celebrated some of the successes of the Affordable Care Act, like 20 million more Americans having health insurance, but a recent UPI report reminds us that our healthcare system is far from perfect.  In a December 17 article they reported the results of… Read more »

More is More, and Less.

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During the debates about healthcare in the last 2 years one argument that was made by Senator Ron Johnson of Wisconsin against Medicaid expansion was that more people with access to health care resulted in more opioid prescriptions and made the crisis of addiction worse. Most people working in healthcare argued that the origins of… Read more »

Burnout Differential Diagnosis

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The term ‘burnout’ has become prevalent in both discussion of the healthcare delivery environment and in medical literature. It is vitally important and threatens the stability of our healthcare system, and most importantly our primary care practices across the country.  Burnout most generally refers to providers (especially physicians, nurse practitioners and physician assistants) but can… Read more »

Better Halitosis Than No Breath At All

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That was one of my Dad’s favorite aphorisms, and a recent article brought that particular quote to mind. “Adverse events associated with opioid-containing cough and cold medication in children” was published in April’s online version of Clinical Toxicology. Opioid containing cough syrups (Robitussin AC, Tussionex and others) have been around for a long time and… Read more »

Diseases of Despair

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Much of my work and much of the public’s attention in the last several years has been focused on the opioid crisis, and properly so.  But addiction (or substance use disorders) are the result of a complex mix of genetics, environment and exposure to the substance. The environment includes the stability of the household and… Read more »