Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails. Sometimes the broader use of a medication leads to additional FDA approved indications. One good example is bupropion, Wellbutrin, for smoking cessation. It even got a new name for that indication, Zyban, ...

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My first job after residency was in a small mill town in central Maine. I joined two fifty something family doctors, one of whom was the son of the former town doctor. I felt like I was Dr. Kiley on Marcus Welby, MD. I didn't have a motorcycle, but I did have a snazzy SAAB 900. Will was a John Deere man, wore a flannel shirt and listened to A Prairie Home ...

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I keep thinking about the dichotomy between covering a lot of ground and getting to the point. The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be turned into standing orders and simply get shifted off my plate. I have just created a letter that anybody can send ...

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I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups. He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back ...

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Most Saturdays, I join a therapy session down the hall from where I do my walk-in clinic. A patient of mine has a weekly session just before the Alcoholics Anonymous meeting at noon in our big conference room. Last weekend he told my behavioral health colleague that the people in the AA group who have the most solid recovery seemed to be the ones who claimed to carry a lot of ...

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How long does it take to diagnose guttate psoriasis versus pityriasis rosea? Swimmers ear versus a ruptured eardrum? A kidney stone? A urinary tract infection? An ankle sprain? So why is the typical “cycle time,” the time it takes for a patient to get through a clinic such as mine for these kinds of problems, close to an hour? Answer: Mandated screening activities that could actually be done in different ways and ...

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A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties are divided up. If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the ...

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Jeanette Brown had lost twenty pounds, and she was worried. “I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine: A normal weight, diet controlled diabetic for many years, her glycosylated hemoglobin had jumped from 6.9 to 9.3 in three months while losing that much weight. That is exactly what happened to my mother some years ...

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There is a lot of talk about team-based care nowadays, and I had seen some shining examples of that, most recently when a patient at my clinic had a suicide in the family. But at the same time, there are so many decisions – judgment calls, really – that we make every single day where there isn’t anywhere near enough time to involve team members. I talk to patients all the time ...

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I haven’t counted how many times this happens every month, but I find it annoying. I send a prescription for a drug (sometimes not even expensive) to the pharmacy and soon after, I get a fax asking me (or my medical assistant) to go online and print a prior authorization form to complete and fax to the insurer, or answer numerous qualifying questions on the screen, or (worst of all) 
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