Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them. Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that in a bit. In my seven years of prescribing Suboxone for opiate addiction, I have often observed how potent a pain reliever this medication is, even in fairly low doses. More ...

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Back when cholesterol target numbers ruled unopposed (before 2013), we all checked fasting lipids every three months. Before 2012, we also checked liver function quarterly in hapless riders on the cholesterol pill merry-go-round. That year the FDA announced there had not been enough reports of statin-induced liver problems to recommend routine monitoring. I have many colleagues who still do this, and who also routinely monitor routine labs quarterly ...

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I don’t know how many times a patient has told me, “I was in therapy once, and it didn’t help.” My response is always: “That’s like saying 'I saw a movie once and I didn’t like it'.” That usually breaks the ice just a little. In primary care, we certainly run into a few patients with chronic mental health problems that could use some long-term, in-depth counseling. But usually, patients in my practice ...

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I learned a new word recently: transdiagnostic, which refers to something that is applicable across a spectrum of conditions. It seems that this is becoming an increasingly popular concept in treating anxiety disorders. No wonder. As I researched this word, I read this:

As of 2013, there are twelve anxiety-disorder diagnoses and over twenty-five subtypes and categories of these disorders, with specific treatments for about half of them. Research has ...

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Today I had a followup appointment with a young adult male with severe intellectual disabilities. He is barely verbal. Several weeks ago his caregiver told me that this young man often pointed to his chest and would say “hurt” or “heart,” they weren’t sure which. He also seemed to have gotten pickier about his food, and would literally pick at the food on his plate as if examining it. His ...

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Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on. People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the essence of being a physician, what people ask for when they come to see us. Most ...

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Everybody is a stakeholder these days in what we broadly call medicine, or health care. But there is little agreement on what medicine is and what the priorities of the health care “industry” should be. I propose this breakdown of medicine into three separate phenomena. 1. Micromedicine 2. Macromedicine 3. Metamedicine Let me explain: Micromedicine: one on one, real doctoring Doctors from antiquity have served their patients one on one, as individuals. Osler, the father of modern ...

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I saw two patients with a chief complaint of bubbles in their urine this month. One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK. Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV ...

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Few things in primary care give patient and doctor mutual and instant gratification. It’s been a while since I reduced a “nursemaid's elbow” or a spontaneous shoulder dislocation other than my own, or a finger dislocation, but those all count. I once wrote about curing deafness in a man with a movement disorder by flushing ear wax more or less on the run as he bobbed around the exam room. That ...

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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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