Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. A slender, middle aged man, ...

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Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists. From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s ...

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Team-based care is one of today’s buzzwords without real substance, because unless the payment systems change, only the physician members of the team can bill for their work. Few people seem to be concerned with the simple but essential question of how physicians spend their time and how medical offices are paid. As a primary care physician who doesn't do any major procedures, and who in 2014 is essentially paid fee ...

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What is going on with generic drug prices? Fran Barker called today. She was in a panic because the cost of her monthly prescription of 150 mg amitriptyline tablets had gone up to $130 from $13 the month before. Amitriptyline has been available in this country since 1961, and the 100 mg strength was on Walmart’s list of $4/month drugs the last time I looked at it a few months ...

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“Doctor, what do you think of alternative medicine?” a patient with chronic fatigue syndrome asked me the other day. She was interested in doing something more for her severe fatigue. “Would acupuncture help me?” I paused and, as I have done many times before, answered that my training and most of my clinical experience has been in Western, allopathic medicine. (Ironically, the word “allopathic” was first used as a derogatory term ...

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You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan. I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the ...

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Cholesterol is bad. Cholesterol is an essential building block for important hormones. Eggs are bad. Eggs are a complete protein food. Salt is bad. Salt is essential for life. High blood pressure kills people. No blood pressure defines death. High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks. Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems. Too little vitamin B12 causes nerve damage. Too ...

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We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. - Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst. The expression, “the devil is in the details” implies that the details can ...

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Question: What do you do when presented with abnormal lab results? Answer: Ask lots of questions. The nursing home just sent over a urinalysis on a patient of Dr. Carlyle. I am covering his practice for a few days. The test showed that an 82-year-old woman had 3+ white blood cells in her urine. “NKDA” was written in the margin, indicating she had no allergies. I sighed internally and called the nursing home. ...

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Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine. But in today’s practice of medicine, that’s not enough. Physicians, ...

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