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EXECUTIVE SUMMARY (the don’t waste my time, just tell me what to do section):

  1. Go to https://www.healthcare.gov/marketplace-in-your-state/ and find the health insurance marketplace for your state.
  2. Get really confused, and just get a sense of how many blinding options there are.
  3. Regroup. Breathe. Go to https://healthinsuranceratings.ncqa.org/ and see that some health insurance companies in your state seem to be better than others. Write down the names of the good ones.
  4. Look at this helpful chart to see if you are a low consumer of health care that should get something more on the bronze/silver end of the spectrum or a high consumer of health care that should get something on the gold/platinum end of the spectrum. …

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I only have two settings — “not interested” or “completely obsessed.” This works well for my line of work, since you do not want a surgeon that is only casually interested in how to repair your rotator cuff tear. It does not bode well for my marriage, however, since my mistaken assumption is that my wife has the same desire to nit pick and perfect every recipe she makes. I am grateful that she has met me in the middle and allowed me to speak up on some recipes that are really exceptional … but just need a little tweaking. …


I mentioned in a previous article that there are problems that simply do not make any sense … even if you’re the expert that’s trying to explain it to someone else. Problems with the acromioclavicular (AC) joint fit into that category very (not)nicely.

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The AC joint is the space between your collarbone and the hook part of your shoulder blade, called the acromion. The top and bottom of the two bones should be lined up with each other, stabilized by ligaments, which are the strong bands of tissues that connect bones to other bones. …


“As pandemic coronavirus disease 2019 (COVID-19) continues to accelerate, the French Health Minister, Olivier Véran, has confused matters by claiming on Twitter that anti-inflammatory drugs like ibuprofen or cortisone could aggravate the infection. However, scientific evidence does not indicate that nonsteroidal anti-inflammatory drug (NSAID) consumption puts patients who otherwise might have mild or asymptomatic infection by severe acute respiratory syndrome … at risk of more severe disease. People taking NSAIDs for other reasons should not stop doing so for fear of increasing their COVID-19 risk.”

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https://www.flickr.com/photos/jeepersmedia/16167132496

As we continue to navigate the evolving COVID-19 situation, I am hearing patients tell me that they are afraid to take NSAIDs because they make you more likely to get the virus. This is simply not true. If you get the virus, you get it from contact with the virus, not from a medicine that has been in your cabinet for weeks or months. …


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As we brace ourselves for the inevitable surge of coronavirus cases, we all must do our part to minimize any unnecessary contact, so that we can make our best possible effort at flattening the curve so that our health care system has the capacity to keep up with the number of people that need to be treated. To that end, I am transitioning as many of my office visits as possible to virtual visits, and cancelling all of my patients who I think in good conscience can have surgery at a later date and still have the same outcome.

This crisis will leave us with a gap in care not just for the people whom we have seen and identified have a need for treatment that must wait, but also for people that will go on suffering with problems for which they would otherwise have sought out treatment. I have considered writing this article before with the intent of reaching people who have resigned themselves to potentially treatable shoulder pain, but today I woke up at 5am and could not fall back asleep because of the sense of urgency to let people know that they should not be seeing the doctor this week for the shoulder pain they have had for years, and to give them something that would be a reasonable place to start while we are getting better prepared to see people virtually. …


I have been sitting on this data for three years because it is not ready for prime time. …


Despite having worked in health care for the last 18 years, I am still constantly in awe of what modern medicine is able to do. One of my favorite patients is a man who sustained cancer of the esophagus (the organ responsible for the involuntary portion of the swallowing mechanism that smoothly massages food down past the vital organs in the chest and into the stomach). Esophageal cancer is associated with a very high rate of morbidity and mortality, related to both the disease process itself and the invasive treatments that are needed to eliminate the disease. In the case of my patient, I am grateful to his physicians and surgeons, who were able to not only remove the cancer but reconstruct his esophagus so that he can eat normally. He tells me that the only difference in his quality of life is that he needs to sleep sitting up a bit, or else the acidic contents of the stomach can leak up into the esophagus, creating irritation of his neo-esophagus. …


After four years of medical school, six years of orthopedic surgery residency, and a year of subspecialty training in shoulder surgery, I went out into practice in 2013 with a healthy apprehension that there was still so much more to know than what I could have reasonably learned over the course of 11 years. Even the most experienced surgeon only knows a certain subset of the sum of all that is known, and all that is known is only a certain subset of all that is knowable, and all that is knowable is only a certain subset of the knowledge that would be helpful in diagnosing and treating patients. That doesn’t, however, mean that we don’t know anything. We do try to offer patients an honest assessment of what we think they have from a diagnostic standpoint, as well as what we think they should do about it from a therapeutic standpoint. Inevitably, we will get asked by patients and colleagues, “how do you know that?” — instead of getting defensive and falling back on a “do you know who I am?” …


Remember the patient that I mentioned in my last post, who signed up for a tendon transfer? Turns out that his rotator cuff was repairable, and he has done very well with his recovery … so far. As someone who is scientifically minded who wants clear answers from his craft, this frustrates me because I wish the human body were more predictable. As someone who cares very much about this patient and wants him to have a great outcome, this worries me because I share with him the hope that the decisions we make together will result in a good outcome for him. Whether I am evaluating the situation with my mind or my heart, I am dissatisfied with the uncertainty of my advice, which is inescapable since I am giving people my expert opinion and not facts from a book. If we were giving people facts, they could look it up on Google or WebMD. …


If you have read my introductory story, you already know that I am quite comfortable with uncertainty. The beautiful simplicity of the standard model of particle physics, with its mise en place of ingredients waiting to be formed into all forms of matter, betrays a complexity that is exemplified by the reality that we accept the uncertainty of not knowing the location or velocity of quantum particles until we measure them. When we measure their location, we do not know the velocity. When we measure their velocity, we do not know their location. …

About

Mena Mesiha MD

Shoulder specialist orthopedic surgeon, happily married father of 3 awesome kids, always looking to learn and find new ways to make a difference

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