The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends -- so he told me at every visit. His visits ...

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I just didn’t like the looks of him. It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in ...

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The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish. The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of ...

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"Do you mind telling your legions how long you intend to work?" Certainly. The short answer is, “Indefinitely.” The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts. First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my ...

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I am furious. For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don't do it at all. The United States Preventive Services Task force reviewed the literature and ...

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Once upon a time, women with suspicious breast masses were put under general anesthesia for surgery not knowing whether they were going to wake up with or without their breast. If the biopsy showed cancer, the surgeon went right ahead with the mastectomy. No time to lose.  It’s cancer, you know. Breast reconstruction? Don’t be silly. No one does that. You should feel lucky to be alive! Can you imagine? Doctors ...

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Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean. Specialist’s recommendation (ortho, seen for fracture):

Frequent falls resulting ...

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Why one doctor throws away insurer mailings There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against. I received the following mailing:

We want you to screen our members for cancer.  Please do these things:
  • Call the member to discuss colorectal, skin, and prostate ...

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It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up. I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different ...

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A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”. As I read her screed against  the ND who conducted a cursory history and exam before checking off $750 worth ...

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