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Why Healthcare in America is So Expensive Part 2 – Surgical Equipment

February 27, 2017 5 comments

With this essay we embark on a journey through the world of medical cost.   In my last essay, I argued that while our government struggles to create a system that pays for the healthcare system we have, the true problem is the outrageou
s cost of that system, not how we pay for it.

Today, we will examine the surgical equipment industry, and how expensive i
nnovation and technology is valued over actual contribution to patient outcomes, and how every incentive exists to make medical equipment as expensive as possible.

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A few years ago, I was involved in a project with a number of students from Georgia Tech’s biomedical engineering department.   I had an idea to solve a basic problem in laparoscopic surgery, and these students were charged with cSurgical-Instruments-11.jpg
reating a prototype solution to the idea.  We came up with an elegant solution to an issue that occurred in every laparoscopic surgery in this country, and eventually the students presented this idea as their senior project for their degrees.

Subsequently, I approached my University’s Technology Transfer department (the group that helps faculty to commercialize their ideas.)  We went through a process of idea disclosure with the hope that the University would help me to bring this idea to market.  In the end, though, it fizzled.    They said they weren’t interested in developing the idea.  So I approached several industry groups.   Again, no interest.  Over time I talked with three different groups that develops ideas, and no one was interested.

The kicker of all of this is that the lack if industry interest had nothing to do with the utility of my invention.  In fact, all parties agreed that the idea was great and the solution was elegant.  They also agreed that they could imagine the device in practice.   The problem wasn’t that the device wasn’t a good one, it was that the device was too simple, and too inexpensive to manufacture.  I had imagined a device that would probably cost about 5 dollars in every surgical pack.  In the end, the development market had little interest in such a device, given what it costs to develop bring a device to market and the likely payout at the end.  This thing actually saved money in time and in replacement of more expensive equipment already in use in the OR.   But what I found out was that there wasn’t much interest in devices that causes industry to make less money.

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Healthcare Reform Has It Wrong: Why American Health Care is So Expensive Part 1

February 19, 2017 5 comments

Having been a physician now for 16 years, I have had a first hand view at the variety of healthcare reforms and regulation put into place over that time.   Most recently, the Affordable Care Act has been at the center of our attention, but it is by no means the only thing the government has done over that time.

One-Dollar-Bills.jpgToday, President Trump and the Republicans are working to repeal the Affordable Care Act, and possibly replace it with something else (Something Great if you listen to Trump.)  I have mixed feelings about this.  I think that the ACA did some good things, but also got some things wrong.  At its fundamental core, by forcing all people to buy healthcare through a private insurer (albeit through a government funded network), it was trying to create universal coverage.  Unfortunately, the ACA struggled to get healthy people who would pay more than they consumed to enter the system, thus creating a system where there were often more claims than premiums.

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Thoughts on Hemodynamic Instability, Laparoscopy, and Ectopic Pregnancies

As a young physician, I was taught that when a patient presents with a ruptured ectopic pregnancy and was hemodynamically unstable, the corimagesrect course was to perform a laparotomy for immediate control of the bleeding.  At that time (around the year 2000), complex laparoscopy was not really in wide practice, a
nd a physician who suggested that they could control bleeding laparoscopically as quickly as they could via laparotomy would have been met with skepticism.  In some cases, a physician suggesting a laparoscopic approach to the problem might be blocked by the atten

ding anesthesiologist, who often holds veto power over certain surgical decisions.  The idea was that the bleeding needs to be stopped quickly, and the way to do that is a laparotomy.

But over time, our ability to do things quickly and effectively via laparoscopy has changed, and I think our understanding of hemodynamic instability in young women has changed as well.

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Academic OB/GYN Podcast Episode 38 – The Endometriosis Podcast Launch

Cross Post of Episode 1 of our new project The Endometriosis Podcast!   Dr Fogelson and new co-host Libby Hopton discuss new literature on endometriosis and answer question from the endometriosis patient community.  Topics include endometriosis research production, BPA and endometriosis incidence, outcomes after resection of bladder endometriosis, and more!

Sponsored by TrueLearn.  For a 10% discount on your order use the code “academicobgyn”

 

Academic OB/GYN Podcast Episode 38 – The Endometriosis Podcast Launch

 

A Holiday Message from Nicholas Fogelson and Academic OB/GYN

Merry Christmas and Happy Holidays from Nicholas Fogelson and Academic OB/GYN!   Dr. Fogelson is available for clinical consultation at the Pearl Women’s Center in Portland, OR at 503-771-1883.  He is a better gynecologic surgeon than he is a rapper.  And he’s not completely terrible at rap so there’s that.

The Important of Estrogen Replacement after Surgical and Natural Menopause

November 11, 2016 2 comments

Last night the Portland OB/GYN Society, of which I am the current president, had the honor of hosting Dr Philip Sarrel to speak on the important topic of replacing estrogen in women who have experienced surgical menopause at an early age.   His talk was fantastic, and illustrated the extreme importance of replacing estrogen in any woman who has experienced an unnatural loss of estrogen early in her life, and the ongoing benefit of estrogen replacement after menopause as well.   I encourage you to review this video, which describes the findings of his research and his point of view, which I entirely agree with.

What was truly striking to me was the number of women who have had their ovaries removed at an early age.  It saddens me, as I know that in many cases this is because of pelvic pain and endometriosis.  While oophorectomy often does improve and in some cases even eliminate endometriosis pain, with proper resection of the the disease we can often achieve substantial and even complete pain relief while preserving ovarian function.

This is definitely worth a watch.

Categories: Gynecology, Uncategorized

A Political Letter

November 9, 2016 7 comments

Nicholas Fogelson, MD

140 NW 14th Ave

Portland, OR 97206

11/9/2016

Dear President-Elect Trump,

I am writing to reach out to you, something I have never been inspired to do for a president-elect in the past.   First, congratulations on your hard fought victory, and to your family.  It was a surprise for many of us.

While it was probably a happy morning in your campaign and family, it was a pretty dark morning in my household.   Our family was very supportive of Secretary Clinton, and felt that she was the best choice for the president.  In particular, my wife was a ardent supporter, making hundreds of calls of the Secretary’s behalf.   As a Canadian, she was quite looking forward to a continued progressive movement in our country.

We have lived through disappointing elections before, but this one is different.   Unlike the general discontent we felt when Bush defeated Gore, today there is a lot of fear.   Fear not that the country will not go in the political direction we wanted, but fear that the country will go into hell itself.  The person you presented yourself as during the campaign was not a person who seemed to be able to be an effective President.  Particularly your presented views on muslims, your seemingly sexist and misogynistic comments towards women, and your views towards Mexicans as well.  These things just don’t seem to be what our country should be moving towards, no matter whether you are a Democrat or Republican.

It has been my feeling and hope that during the election you have created this image for the pure purpose of galvanizing a certain segment of society and achieving the victory you now have.  It is my true hope that now you are President-Elect, that these incredibly difficult positions can be shed and you can focus on a productive and positive future for our country.  It is my hope that these things we saw were actually a very purposeful act, a charade of sorts, and not truly who you are as a person.

My wife and I are both physicians.  I am a sub specialist surgeon in the care of women with endometriosis.  For the first time in our lives, we are literally considering whether or not the United States is where we want to live our lives.  If you end up being a relatively effective conservative president that pushes Paul Ryan’s agenda more or less, we will go on being Democrats who probably vote against you in four years.  But if instead you normalize racism, promote a military stance that invites nuclear war, and make it generally acceptable for people to be awful human beings, we would have to consider leaving.  And it wouldn’t just be us.  It would be a lot of people like us, people who can’t associate with the values you promoted during the campaign.  And that would be a terrible thing for our country.

I truly wish you and your family the best, and for success in your presidency.  You will now be the most powerful person in the world.  I’m sure that already this weighs on your shoulders.  Though I voted against you, you are now my President.   Please be worthy of that title.

Sincerely,

Nicholas Fogelson, MD

Portland, OR

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