How Doctors Think (Answer: Sometimes Poorly). A New Yorker piece on physicians’ cognitive biases : No way, that healthy-looking 45 year-old without risk factors can’t be having a heart attack! It must be… a muscle strain!

Quote from the piece: “For the most part, patients are not known and their illnesses are seen through only small windows of focus and time.” By calling physicians’ attention to common mistakes in medical judgment, he has helped to promote an emerging field in medicine: the study of how doctors think.” Link to the doc’s paper cited in the article .

Next up is Saving the ER for Real Emergencies in the LA Times. Details frequent fliers at ERs (repeat customers who use ERs as their primary care, which costs taxpayers millions), like Mauricio Hernandez. A new program in place in LA is slated to try to educate and change these patients’ ways: it hires health coaches to attend medical appointments with them, and get them to use clinics and primary care. (And saves money in the process, Hernandez’s care alone in 4 months cost $38,000–that’s $100k a year.) The problems are rooted in the typical things we don’t do a great job with: cultural norms, illiteracy, health education, and health care access. Quoting:

Mauricio Hernandez’s belly was swollen like a pregnant woman’s.

Every month for four years, he’d been going to the emergency room at Los Angeles County-USC Medical Center to have his abdomen drained of fluid, the result of cirrhosis caused by years of heavy drinking.

It wasn’t exactly an emergency, but the ER was his only medical care. An illegal Mexican immigrant, Hernandez had learned that emergency rooms legally cannot turn away patients without examining and stabilizing them. He had stopped drinking, he said. But his job unloading big rigs paid little and offered no health insurance.

At each ER visit, he waited from five to 10 hours, received immediate treatment and left with no long-term plan for follow-up care. So his condition worsened, making more ER visits necessary.

Hospital officials estimate that in the first four months of 2006 alone, Hernandez’s ER visits and hospitalizations cost taxpayers $37,500.

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