The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab. Printing a requisition from our EMR is a multi-step process that involves ...

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The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed. Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives. Then there are several cumbersome explanations about the appeal ...

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Primary care is a messy business. Nobody has just one simple problem, and no patient has all the typical symptoms for their diagnosis. Most don’t even tell us everything that’s going on. And most don’t follow their treatment plan completely. But this may be OK, since we often change our minds about what is right or wrong in the practice of medicine. Knowing what constitutes success in front line medicine is ...

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Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that? Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren ...

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shutterstock_73822633 Perhaps doctors should be more like the president. After all, we also carry the ultimate responsibility for our constituents, even though we, too, have team members who do part of that work. The way I understand things to work at the White House, those other team members collect, review and prioritize the information the president needs in order to manage his, and all ...

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shutterstock_114332227 I am a foreign born, foreign trained doctor, serving many patients from an ethnic minority, whose native language I never mastered. So, perhaps I am in a position to reflect a little on the modern notion that health care is a standardized service, which can be equally well provided by anyone, from anywhere, with any kind of medical degree and postgraduate training. 1. ...

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It’s been thirty years since Dr. Pete shook my hand on graduation day and slapped my back, his gravelly voice mumbling a wisecrack that couldn’t quite hide his emotions. I was the first foreign medical school graduate in our small residency program and he had trusted me, just as I had trusted him, through three years of hard work and many challenges. Our residency program was only a few years old, and my ...

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I keep six honest serving-men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. - Rudyard Kipling Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done. What else could explain why IT people tell doctors what “workflows” ...

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shutterstock_177177977 A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could ...

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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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