In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate. The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one ...

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As of July 1, pharmacies in Maine cannot honor paper or telephone prescriptions for controlled substances, from OxyContin down to Valium, Lyrica, and Tylenol with codeine. EPCS, or electronic prescribing of controlled substances, is a double security step in the prescription process built into EMRs, electronic medical records. It involves another password entry and the use of one-time passwords from a small number generator issued to each prescriber. It has been said ...

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“Noncardiac chest pain” was Laurie Black’s discharge diagnosis. Her chest CT angiogram didn’t show a pulmonary embolus, her troponins were negative for a heart attack and her nuclear stress test was negative for coronary ischemia. “So what do you think it was?” she asked while I read through her hospital discharge summary. “I don’t know. Show me where the pain was,” I answered. “It started on my back, on the left side, and ...

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He had been in for a physical the day before. Like so many people, he seemed to have this need to run half a dozen minor bodily symptoms past me, while I worked my way through the agenda of screening colonoscopy, whether or not to test his PSA, calculating his ten-year cardiovascular risk, talking about alcohol use, screening for depression and so on. I remember his left leg pain. He had had ...

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I was scheduled to attend a medical director's retreat the other day, but because of a horse emergency the day before, I had to stay home, so I offered to skip the retreat and see patients instead. It would have been almost an entire day hearing about trauma informed care and the lifelong impact of adverse childhood events. As a primer, the conveners of the seminar emailed a “dear doctor” letter ...

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It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic. He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it ...

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Now, I’m just a country doctor, but I have to say I find it very hard to understand why folks in this country, on one hand, keep talking about a doctor shortage in primary care and, on the other hand, keep piling sillywork on those of us who are still here. The net effect is that the doctor shortage is going to be a whole lot worse than it has to ...

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She didn’t seem obviously depressed as I entered the room. “So, we have you taking a good dose of both antidepressants now,” I said. “How are you doing?” “I feel about the same.” “Have you done anything lately that could have made you feel a little better?” “I’m not sure …” “I’ll give you some examples. They can be different things for different people. It could be reaching out to a friend, helping a neighbor, ...

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My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore. I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed. Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each ...

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The patient, I surmised, was the one in the wheelchair with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter. I introduced myself. I had been right about the other woman being her daughter. It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a ...

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