For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’s husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s? Now other people have tried to hijack the word “huddle” for a completely ...

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Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less. Put differently, if 100 patients were treated with Brilinta for a year, at a cost ...

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I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know. When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like LAB, ER, ...

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One of the ways a doctor can document the value of an office visit is by keeping track of the number of symptoms the patient has and the number of items included in both the review of systems and the physical exam of the patient. This way, for example, we can get paid more if we do an extensive evaluation of a dizzy patient by looking for both inner ear, cardiovascular ...

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“Any recent antibiotics? Steroids?” I asked my last patient of the day, a healthy looking young woman with what she described as a yeast infection that was driving her crazy. She’d had many of them, and they were always coming back, but she had only used over the counter topicals. I knew she needed oral medication, but I asked one more question: “Any trouble with high blood sugars?” Her answer eliminated any ...

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I don’t regularly make any New Year’s resolutions, but this year I am tossing around a couple of ideas. One reason is that I have so many things going on that I need to be clever about how I use my time. I work four days a week at my regular clinic, and I also work two long days at a clinic in far northern Maine. In addition, there are many ...

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Four and a half years ago I read an editorial in JAMA, the Journal of the American Medical Association, that etched a short phrase into my memory. These five words seemed so profound and poignant that I really think they almost define primary care medicine today, perhaps with the alliterative addition of the word “teach”. Dr. Abigail Zuger wrote of how the computer had changed the dynamic in the ...

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“I made myself a hypodermic injection of a triple dose of morphia and sank down on the couch in my consulting room ... I told her I was all right, all I wanted was twenty-four hours’ sleep, she was not to disturb me unless the house was on fire.” – Axel Munthe, MD, The Story of San Michele (1929) When people in this country mention the opioid epidemic, most of the time it is ...

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It’s just after six o’clock on a Sunday morning in December. The barn animals have fresh hay and warm water. My wife and the dogs are asleep. The cats are gathered around me as I sit down to write. One of them has jumped up in my lap and is pawing and clawing my jeans. The fire is roaring in the wood stove, but the 1790 room is still cold. I ...

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Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.” This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and ...

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