INSIDE THE MEDICAL BLOGOSPHERE, physicians analyze the latest research, sound off on current events, even pen short stories. Here, three perspectives on the monetary and ethical costs of care.


Adapted from a Jan. 29, 2006, posting on by family physician “Sydney Smith.”

My local grocery store is opening a QuickClinic. For $39 they’ll take care of colds, flu, minor injuries, pinkeye and the like. They’ll also take out your sutures and clean your ears. They’ll screen for diabetes, anemia and cholesterol, among other things.

My office can’t compete with $39 visits. But then, I’m expected to do a lot more than just “treat and street,” and rightly so. I know quite a few doctors who are more than a little upset about the competition. There’s no sense fighting it, though. The clinics exist because there’s a perceived demand for them.

It should be interesting to see how they pan out. They’re still more expensive than most co-pays. And I’m not entirely convinced that the volume of uninsured patients (or those with health savings accounts, for that matter) is high enough to sustain a practice based solely on cash payment. Then, too, these aren’t standard practices. They’re subsidized by the retailers who think of them as a means to bring customers to their stores (and pharmacies).

Perhaps this will be the new model of health care as the number of doctors declines: primary care by nurses and pharmacists and specialty care at hospitals. I don’t necessarily think that’s the best model.


Adapted from a March 6, 2006, posting on by Los Angeles doctor “Maurice.”

When my second-year medical student asked a patient whether he had been following his doctor’s prescribed dosage schedule for the anticoagulant warfarin, he said no. He had been taking only half the dose to “let the pills last longer.” Why? He didn’t have enough money to buy both the warfarin and the important pills his wife needed.

Here is some sort of system failure. The patient is unable to comply because of medical costs, but yet when he falls ill as a result of his noncompliance, someone will need to pay for the hospital readmission that will amount to many times more than the cost of the pills. This example is but one drop in the sea of rising medical costs and the burden on those who can’t afford these costs.


Adapted from a Feb. 10, 2006, posting on an internist’s blog,

I often wonder what goes through the minds of Israeli doctors when they are forced to attempt to save a bomber after he has just taken so many innocent lives. They may say that they’re just doing their jobs. But professionals are also human beings who exhibit anger and resentment. Can one honestly say that those feelings will have no consequence on the type of care the patient receives?

Should physicians be forced to disclose when they feel anger toward patients? And should they then be forced to sign off the case? After all, we don’t trust lawyers to set aside their biases, even in cases involving simple money matters. Should we trust physicians when it comes to human life?