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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“Listen, when I was your age, I did the same thing …” The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery. He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling. “What ...

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“Then it’s me and my machine For the rest of the morning, For the rest of the afternoon And the rest of my life.” - James Taylor, “Millworker” It’s Friday afternoon, 4:30. I am sitting in front of my computer. My last patient is gone, my prescriptions are done, my messages answered, my office charges submitted and my office notes completed. Now, it’s time to tackle the incoming laboratory results. Opening up the list of completed ...

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A recent issue of the New England Journal of Medicine once again questions two practices that used to be almost the backbone of primary care. One article is about the low likelihood that prostate cancer detected through PSA screening will shorten a man’s life, even if he chooses just to keep an eye on it. The other article is about how repeated mammography screening mostly leads to the diagnosis of small and ...

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Not only have we shortened medical appointments to 15 minutes — we sometimes double book them. I get the feeling that non-providers think of this as something fairly ordinary, and even reasonable. But it is often a very difficult and destructive thing to do. The term “double booking” and the way it looks in an ordinary doctor’s scheduling grid suggest that the physician might possibly be expected to be in two places ...

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The pressures of time, the complexity of our patients’ needs and today’s documentation requirements can easily make a medical provider feel less than generous these days. We must counteract that in order to carry on as healers. All day long, I am conscious of the time as I work my way through my long list of 15-minute encounters. But I am also conscious of the fact that the more pressure I ...

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Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example. In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism. In some cases, this kind of ...

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As a severe myopic, it is no wonder I have always had a certain interest in ophthalmology. And just the other day I had reason to ponder the peculiar Dutch dominance in the history of optics and ophthalmology. When I was a nearsighted young school boy in Sweden, my mother brought me on the bus into town every fall to see the eye doctor. He must have been in his eighties, ...

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We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more. This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it ...

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