My colleague, Dr. L.T. Kim, was off this week and I covered for him. On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons. I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency ...

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When I read a case report in a journal or whenever a patient comes in to see me about a new symptom, all my senses are tuned in, and I know there is a diagnosis to be made. But on regular clinic days with “routine” follow ups, I find myself not being as tuned in as I would like to be. I know my patients well; we are all growing older ...

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As a physician with a strong sense of calling, I always see myself working for each patient, regardless of who pays the bill. Following in the footsteps of role models like Hippocrates and Osler, how could I do anything else? Ted has been my patient for decades. He can’t seem to lose weight. John has admitted he doesn’t know how long he can keep doing the kind of work that has supported ...

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The problem with health care and drug prices in America isn’t that we spend too much money. The real problem is that we believe we are spending “other people’s money.” Yes, I was raised in Sweden, but no, I’m not a Socialist. The irony is that “free” health care there is more clearly understood to be directly financed by local(!) taxes that can go up if people in that region consume ...

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On an ordinary day last month, I saw patients for eight and a half hours. I addressed a dozen computer messages, took four or five calls from outside providers and held innumerable curbside conversations with medical assistants, case managers and colleagues. I didn’t get to any of the 100+ lab results or 50+ documents in my electronic inboxes. Consequently, the care for several dozens of my patients didn’t move forward. Many of ...

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We are like a restaurant that charges handsomely for sit-down dinners but gives away food for free at the takeout window. And we only pay our providers for serving the dining room guests. If traffic gets backed up at the drive-through, we hold our providers responsible, even though we never planned for our ever increasing demand for takeout. In simpler times, patients went to the doctor when they felt unwell, and ...

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Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the counter these days. Today I saw her for a preoperative clearance. She finally decided to get an operation for her chronically sore shoulder. She had injured it many years ago>. In ...

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Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis." But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis. He penned his words in an era when medical information was scarce ...

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A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit. His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was declared normal by the radiologist. We talked some more about his anxiety and poor sleeping habits. We talked about his late shift at work, and we talked about his late gaming habits ...

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Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room. The man who felt bad all over had a bilirubin twice the upper ...

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