My new glasses were years overdue. The eye doctor understood perfectly my request that the focal point and pupillary distance for my iPad reading glasses had to match my habitual reading style – right under my nose. The result couldn’t be more pleasing. The other day my wife squinted over her iPad and said “I don’t know if I’m getting a cataract or if I just need new glasses. My right ...

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Talking with an insurance doctor, who denied a vertebroplasty for my patient with a spontaneous compression fracture, I started thinking about the dilemma of defining what a doctor-patient relationship is. A couple of years ago a local doctor with a dwindling private practice joined an Internet medical site that promoted drugs like Viagra and offered online consultations with physicians who prescribed the medications when they felt it was appropriate. The state ...

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Fear is more pain than is the pain it fears. - Sir Philip Sidney In our specialist age it has, in fact, become a major function of the general physician to examine thoroughly, to explain simply, to reassure as far as may be, and to protect his patients from unnecessary medical or surgical interventions. - John A Ryle, MD, 1948 in the Journal of Mental Science, published by The Royal Medico-Psychological Association Re-reading my ...

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shutterstock_87599194 Lately, my virtual inbox in our electronic medical record has seen a surge in requests for prescriptions for the vaccine against herpes zoster, shingles. This has made me think a lot about our responsibility as physicians to inform patients about the evidence behind our recommendations – but who informs the patients when doctors are kept out of the loop or put under ...

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It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was Morbus Crohn, chart notes ...

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In 2009 I wrote a post titled “Quality or Conformity," where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most. That phenomenon is called ...

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Today I am going to write about how the US could save up to 10% on its healthcare bill. The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion. A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have ...

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As a Swede, I know all about socialized medicine. I grew up with it and I learned my trade in it. I worked under budget constraints, treatment protocols and formularies in the late 70′s and early 80′s while American doctors were essentially practicing the way they wanted here. I remember one of my surprises when I arrived in this country: I had learned in medical school that trimethoprim-sulfa was the drug ...

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I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch. I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit. I often questioned why my colleagues’ patients would sometimes end up in ...

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shutterstock_130000862 Countless times during the course of my day, some person, entity or task vies for my time and attention. “If I could just have a minute of your time” begins a request to also see the spouse of a scheduled patient, a sales pitch from a pharmaceutical “rep” or home oxygen vendor, a phone call from a visiting nurse, a message from a ...

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A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases. The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients. Sir William Osler wrote: ...

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The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet: "The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about ...

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I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply. “Medical provider” is part of the Newspeak of America’s industrialized medical machine. ...

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“Where there is love of humanity there will be love of the profession.” -Hippocrates Reading some of the blog posts and comments on the Internet, you might get the impression that a majority of American doctors hate their jobs. Actually, according Family Practice News, only 35% of my colleagues are unsatisfied with their careers, but that is still a remarkable number. Are Hippocrates’ words implying an answer to why some doctors today don’t ...

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To do nothing is sometimes a good remedy. -Hippocrates Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence. Edna has been my ...

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In my forays into the history of medicine I came across these six little words by Hippocrates. They seem strangely modern, almost like something you might find on a Hallmark-card for today’s medical school graduates. I don’t know how old the translation is and I couldn’t understand the original text if I tried – but these simple words really touched me when I ...

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"Doctor Pete" was fifty-one when I started my residency in family medicine. "Family practice" we called it then, and I think I liked that name of our specialty better. It implies continued learning and brings to my mind visions of practicing a down-to-earth craft. I had interviewed with his predecessor the summer before and was really impressed with him and the program. I ranked it as my first choice in the ...

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New medicines are like new fashions in clothing. They are introduced with great fanfare. Most turn out to seem fairly ordinary after a few years. Some are quickly forgotten or discarded and make us say: “What was I thinking?” Evaluating a new drug is difficult, for the pharmaceutical and scientific communities as well as for us clinicians. It often takes years of general use before a drug can really prove its ...

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We often speak of the importance of continuity of care, but there is confusion about what this really means. When I first joined our small clinic twenty-five years ago, continuity was the reason every medical group in the five town area had its own night-call roster. This way, patients who called after hours could reach a doctor from their own doctor’s office. Even if the covering physician didn’t know the patient, ...

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Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of ...

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