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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“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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