It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic. He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it ...

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Now, I’m just a country doctor, but I have to say I find it very hard to understand why folks in this country, on one hand, keep talking about a doctor shortage in primary care and, on the other hand, keep piling sillywork on those of us who are still here. The net effect is that the doctor shortage is going to be a whole lot worse than it has to ...

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She didn’t seem obviously depressed as I entered the room. “So, we have you taking a good dose of both antidepressants now,” I said. “How are you doing?” “I feel about the same.” “Have you done anything lately that could have made you feel a little better?” “I’m not sure …” “I’ll give you some examples. They can be different things for different people. It could be reaching out to a friend, helping a neighbor, ...

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My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore. I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed. Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each ...

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The patient, I surmised, was the one in the wheelchair with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter. I introduced myself. I had been right about the other woman being her daughter. It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a ...

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My voice recognition software insists on typing “when needed” when I say “PRN,” and the other day I saw an orthopedic note that said, “before meals joint.” I was sure that the straight-laced orthopedic surgeon did not intend to tell the world anything about anybody’s cannabis use. Instead, it was obvious he had spoken the words “AC joint,” meaning acromioclavicular (on top of the shoulder). But AC can also mean ...

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When a new doctor joined our clinic, she spent a week learning our electronic medical record. She had used two other systems before, so she was no stranger to EMRs, but that’s how different they can be. That’s crazy! EMRs should be like cars, which range from the likes of Smart, Mini Cooper, and Skoda to Mercedes Maybach, Rolls Royce, and Porsche. They range from simple to sophisticated, from nimble city cars ...

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“I was surprised when the emergency doctor at Cityside Hospital said he was going to call you to discuss my case," Farmer Carr said when I saw him today. “I figured you’d be asleep at that hour.” I smiled as I recalled the cell phone call that had come in at 9:30 the night I had sent him back to the hospital for a reassessment. “No, I was sitting in my camping ...

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  Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment. Physicians work hard to diagnose and treat their patients, ...

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“I am not on call,” Dr. Brian Stoltz said over a lot of background noise through what must have been the speakerphone in his car. “I know,” I said. “Cityside ER said there is nobody on call for ophthalmology this weekend. I have a 54-year-old woman with intense tearing, discomfort and only 20/70 vision in her right eye.” “And she’s not a patient of our office?” “No, she has only had to see ...

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