Andrew Coates

Andrew Coates: Facing Death And Hope

Mar 7, 2014

A man in his 90s became very ill and was brought to the hospital by ambulance. The emergency room physician called and asked me to admit the patient to the intensive care unit. I was upstairs in the hospital.

Andrew Coates: The Urgency For Health Reform Returns

Feb 28, 2014

This week NY State of Health, also named "The Official Health Plan Marketplace," put out a press release to celebrate a milestone.

Andrew Coates: Time To Reflect

Dec 6, 2013

December arrives under honking Geese. As the last dying leaves find their way to the ground, frost tints the mornings, snow flurries lick the landscape, and Orion rises before bedtime. Holiday gatherings have begun. Time away from work and school might not allow us a whole day for reflection. But we might each find at least a moment of reverie or pause.

Last week we saw a domestic national news cycle dominated by the "glitches" that derailed the launch of the web-based exchanges where uninsured American people and their small business employers can shop for private health insurance. This week, as stories about private health insurance continue to dominate the headlines, the term "single payer" has bobbed up with increasing frequency.

Andrew Coates: Glitches

Oct 25, 2013

Today, commentator Dr. Andrew Coates discusses the glitches plaguing the Affordable Care Act website.

When I was young I worked as a carpenter's helper here in rural upstate New York. The man I worked for, a treasure of local lore is someone who possesses generous good humor and a gift for analogy. On ladders and roofs, in the back road truck journeys to our jobs and at the sawhorses we would debate the big questions of life and also share the most pedestrian observations about farm and family life.

Coates: Political Divisions Harm Health

Oct 11, 2013

The government shutdown and the disconnect on health care By Andrew D. Coates, M.D., F.A.C.P.

I’d like to offer some thoughts this week about the discussion over health care in Washington. We’re heading into the second week of the federal government shutdown, in which the right wing of Congress has demanded that President Obama step back from his health reform.

This reveals to me the shocking disconnect between the center-stage discussion in Washington and the everyday discussion we have at our kitchen tables, at our jobs, and with our friends.

A Man Who Worked Too Hard

Sep 20, 2013

Influenza rocked our community hospital for weeks this winter just as the first snowstorms came. Our hospital medicine service was swamped with patients. I was working the night shift.

One emergency physician dramatically recounted how a queue of ambulances had clogged the parking lot. Once all of the emergency department beds, hallway spaces, and waiting room seats were taken, patients waited outside in ambulances. With the usual triage system in gridlock, he had climbed into ambulances one by one to help triage or stabilize patients.

Andrew Coates: For The Health Of Each And All

Sep 6, 2013

We physicians earn a place in society that yields great scientific and human insight, the impact of illness upon individual lives. Yet we are encouraged by forces inside and outside our profession to look away from the big picture.

Andrew Coates: On Democracy

Aug 30, 2013

My mother and my public school teachers taught me that the foundations of democracy were based upon centuries of struggle to protect personal dignity from the abuses of the state. 

Andrew Coates: A Profession Full Of Human Beings

Aug 23, 2013

A long time ago when I was about to apply to medical school and struggling with college courses in organic chemistry and calculus and the like, a friend pointedly mocked my desire to become a physician.

Andrew Coates: Medicine As A Beleaguered Profession

Aug 3, 2013

A young friend and keen analyst of social change made the observation that it seems that physicians, when it comes to the contemporary state of our profession, seem a bit in shock, as if suffering a grief reaction. She referenced the stages of grief elucidated by Elisabeth Kubler-Ross -- denial, anger, bargaining, depression and acceptance.*

Writing in the Journal of the American Medical Association at the beginning of July, a cardiologist and Professor of Medicine at the University of Colorado School of Medicine, Dr. Lawrence Hergott calls upon his fellow physicians to fight for their profession by fighting for their own souls. "I have seen that the preservation of the soul of medicine is also the preservation of the soul of the physician, and that both are essential," he tells us.

Recently one of my patients, someone in a very frail state, insisted upon discharge the next day, over my objections. The patient's spouse was facing cancer and now was the time to be at home, not in the hospital.

It is common for people to assume that President Obama's Affordable Care Act will lead to universal coverage, after all that was its stated aim.

Andrew Coates: Celebrating Our Nurse Colleagues

Jun 14, 2013

I practice hospital medicine.

Recently the nurses at our hospital voted to give me an award. They told me about it, discreetly, one by one, ahead of the official notice from the administration. These caregiving colleagues, upon whom our patients in the hospital depend every day, took the time to let me know that they also depend upon me. Wow. A true honor.

Andrew Coates: Immigrants heavily subsidize Medicare

May 31, 2013

This week the prestigious journal Health Affairs published a new study that shows that "immigrants, particularly noncitizen immigrants, heavily subsidize Medicare." The lead author is Harvard-based Dr. Leah Zallman; her co-authors include co-founders of Physicians for a National Health Program, Drs. Steffie Woolhandler and David Himmelstein, among others.

Andrew Coates: Scribbling In The Chart

May 24, 2013

William Faulkner, the great American writer who was born in New Albany, Mississippi, wrote screenplays to support his family, although he didn't really like the job, and referred to it as "mere scribbling."

In two recent essays Dr. Arthur Kleinman, the eminent Harvard anthropologist and psychiatrist, writes in the world's leading medical journals about caregiving as a moral experience.

Andrew Coates: The Court of Public Opinion

May 3, 2013

Last week I had the privilege to visit West Virginia. I've been there before. My first impressions, made years ago, returned. If our everyday consciousness results from our everyday experience, it must be intense to live in West Virginia. There the phrase "king coal" leapt to mind at every turn.

Andrew Coates: A Near Miss

Apr 26, 2013

Many years back during my residency training, on my first overnight as the senior admitting resident, I got a call from an emergency physician at a tiny rural hospital. Her patient had pulmonary emboli -- blood clots to arteries of the lungs. She proposed to transfer the patient to our hospital, where closer monitoring would be available.

Andrew Coates: The Human Consequences of Austerity

Apr 22, 2013

I live in upstate New York. If you're hearing this, chances are you do too.

Andrew Coates: Medicare And Medicine As A Profession

Apr 12, 2013

Medicare is the publicly funded health benefit package that covers most necessary care for older Americans and people with disabilities.

Helen Keller famously wrote that "Life is either a daring adventure or nothing."  She continued: "To keep our faces toward change and behave like free spirits in the presence of fate is strength undefeatable."

In a small news article this week in the New York Times Nina Bernstein reported that a provision of the New York State budget to allow for- profit hospitals was been dropped after opposition from the Assembly leadership, specifically the intervention of Assemblyman Richard Gottfried, chair of the Assembly's Health Committee.

"Kicking the can down the road" is an idiom that means to defer something crucial in hopes that the problem will become someone else's responsibility. The other day it occurred to me that "kicking the can down the road" has become a trademark of contemporary governments worldwide -- from the European debt crisis, to the so-called sequester, to the decision to defer changing the tax on New York's wealthy until a non-election year.