Internal medicine, American health care, and especially medical education

Ten years, even though I have been typing this blog for the entire time, it really seems incredible.  I did not imagine 10 years ago that I would still be ranting and people would be reading.  My counter tells me that I have had 2.8 million visitors.  This does not include those who follow on twitter – 1626 followers and 2576 tweets – or read the blog on facebook.

I do plan to continue for now as I still find blogging fun, intellectually stimulating, and a great hobby.

Thanks for reading all these years.  I hope to continue making this a worthwhile read.

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How has blogging helped your patients?

As I struggled to imagine an answer to this question, I had to consider doctoring then and now.  This answer is all opinion, as I could not do a randomized trial of blogging versus not blogging.

I guess blogging has helped, because I believe blogging has made me more thoughtful.  I probably read a bit more, because I am looking for blogging subjects.

But this is really a weak answer.  I can think of many reasons to justify blogging, but helping my patients is really not one.

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A faithful reader writes:

What drug or therapy released in the last 10 years has had the greatest positive impact?

This question stumped me for several days.  I tried to think of a new drug that I use a great deal.  Most new drugs now have important niches.  I considered rifaxamin for hepatic encephalopathy, ceftaroline for complex skin infections or dabigatran for anticoagulating patients with atrial fibrillation.

I thought, and this morning the answer came.  The most important advance in the last 10 yrs is the Walmart $4 drug list!  Several things about this list.  They have forced every competitor to have a similar list.

Prior to the Walmart list, patients paid more for generics and were more resistant to taking generics.  Walmart branded generics!  They, almost single handedly made generics acceptable to the great majority of patients.

Most important, they gave us an option to treat poor people.  We see so many patients who have poor adherence because their medications are so costly.  When we are discharging patients and tell them that we will prescribe all Walmart drugs we often see tears of joy.  Patients worry about money and Walmart and their competitors have given us the ability to give them good news about buying their meds.  

So I have changed the question a bit, but believe I have written the proper answer.

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