It’s been said in the world of business that people only buy two things: good feelings and solutions to problems. In medicine, the single most important factor that brings patients through our doors isn’t a “toward” kind of desire, but an “away” one -- away from feeling bad. More specifically, it is pain and fear that most often cause patients to call and ask for an appointment. They hopefully leave with ...

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A few weeks ago, I saw a patient with shortness of breath during my Saturday clinic. He had been short of breath for a few weeks, and on a couple of occasions, he had also experienced mild chest pain. He has known aortic stenosis, moderate according to his last echocardiogram two years ago. My brain kicked into autopilot, and I asked: “Have you fainted or passed out recently?” It was a ...

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Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with. The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.” With more than fifty calls in my inbox and no memory of what the issue was with Mr. Brown’s current blood pressure, I replied: ...

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There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland. But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 ...

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I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that. I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan ...

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My patient, a rugged sixty year old with massively muscular forearms, gray chest hair at the V of his denim shirt, and a voice that suggested years of liquor and unfiltered cigarettes, lowered his voice and leaned forward. “I’m not usually scared of anything, but for three nights now, ever since I started taking the Levaquin for this pneumonia, I have had the most horrific nightmares. I can’t even talk about ...

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I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients. It has been an interesting journey. Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see everything from sore throats to people who left the emergency room in the middle of a workup ...

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Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work? Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for. A patient with an ugly skin lesion can have it removed if it might ...

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I’ve always likened the job of a primary care physician to that of a chief executive officer of a small business. Family doctors manage the “business” of delivering and coordinating care for more than a thousand patients at an average cost, in the United States, of $8,500 per year: an $8 to $12 million business. Because the actions or inactions of the PCP impact the need for, and cost of, ...

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My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound. Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases. Years ago, working in ...

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