There are two versions of “the conversation” we have with men: One is for teenage boys, and it is about wet dreams, sexually transmitted disease, unwanted pregnancy and at one point also about testicular self-examinations. Those have now been edited out of the script, which makes sense to me since I have seen only three cases of that in forty years of practice, all but a couple of them diligently ...

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It wasn’t even nine o’clock when the screen on my laptop suddenly froze. From that moment until my last patient left the building, my clinic had no internet. For my part, the day went pretty smoothly, mostly because of some of my own work habits. It also helped that it was a warm, sunny day, and my schedule was on the light side. Others have frowned at my old-fashioned work habits, ...

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It’s a funny world we live in. Lots of people make a handsome living, defining their work and setting their own fees and hours with little or no formal education or certification There are personal and executive coaches, wealth advisers, marketing experts, closet organizers, and all kinds of people offering to help us run our lives. In each of these fields, the expectation is that the provider of such services has his ...

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In business literature, I have seen the phrase “getting paid for who you are instead of what you do.” This implies that some people bring value because of the depth of their knowledge and their appreciation of all the nuances in their field, the authority with which they render their opinion or because of their ability to influence others. This is the antithesis of commoditization. Many industries have become less commoditized ...

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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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