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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A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis. It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made ...

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Many physicians have become world famous writers, and in Greek mythology, Apollo was the god of both poetry and medicine. I can personally think of many prominent physician writers I have come across in my reading over the years: There was the 12th-century rabbi Maimonides, Copernicus in the 15th century and the poet John Keats in the 1700s. In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan ...

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It is not unusual to see a patient for a timely transition of care visit after a hospital admission and within a minute of entering the exam room know with all the bones in your body that this person needs to go back into the hospital. The funny thing is that when that happens, if the patient has Medicare, we may indirectly suffer financially from such “avoidable readmissions.” We belong to ...

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How would you like to double your chances of winning the lottery? Just buy two tickets! Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment? Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk. For example, I just ...

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I’ve finally found my groove with our EMR. Maybe I’m even starting to like it. A few weeks ago I got a new iPad, this time a Mini, which lets me type with two thumbs the way some people text on a smartphone, and the voice transcription is good enough as long as you avoid fancy jargon and unusual generic drug names. Yesterday as I sat next to a patient and ...

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