A Country Doctor Writes:

A Country Doctor Writes:

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A Country Doctor Writes:
A Country Doctor Writes:
ACDW: Blog Archive 2008 - present
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ACDW: Blog Archive

ACDW: Blog Archive 2008 - present

Instant access to almost 1,000 posts by Yours Truly, in reverse chronological order - 4 cents a piece...

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Hans Duvefelt, MD
Mar 06, 2023
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A Country Doctor Writes:
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ACDW: Blog Archive 2008 - present
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Archive

  • Practicing at the Top of Your License is Not an Option for Primary Care Physicians

  • A Blast from the Past in My Blog Stats:

  • Bucksport Recovery Community

  • I Love Explaining Medical Things

  • Ask Not What Your Next #EMR Can Do for You, Ask What You Won’t Have to Do for It

  • All Body Parts are Not Created Equal

  • Old Habits Die Hard in Medicine

  • A Country Doctor Writes is Now Also on Substack

  • What Healthcare Needs Today is Professional Grandmothers to Offload Burned-Out Doctors by Delivering Common Sense Advice that Medical Assistants aren’t Allowed to Give.

  • Dear Patient, If You Have to Treat a Cold, Know This:

  • The Unreasonable Burden of Specialty Level Diagnostic Specificity in Primary Care

  • Record Breaker!

  • The Future of Doctoring is Already Here: Do More, Give Less Or Burn Out

  • An Unusual Case of Meralgia Paresthetica

  • Previsit Planning: What, Why and For Whom?

  • Most Read Posts in 2021 (if not ever…)

  • Happy New Year!

  • Medicine, Like Survival and Living Well, is an Art

  • A Country Doctor’s Christmas

  • Doctor Playing Vet

  • A Milestone in Child Mortality: Guns Kill More Kids Than Motor Vehicles Do

  • Seizures: Low P, Low D and Lots of THC

  • Doctors Working for Free

  • Be Thankful for Ordinary Days

  • My First Case of Restless Chest Syndrome?

  • More Pictures From the Life of a Country Doctor

  • The Dangers of EMR-Defaulted Prescription Stop Dates

  • The Broken Promise of Computers in Healthcare: A Doctor From the B.C. Era Explains

  • A Country Doctor’s Life

  • How Much Time Should Doctors Spend With Their Patients?

  • From Warrior to Wise Man: Former Coast Guard Reflecting on the Healthcare Workplace

  • A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)

  • My Fibromyalgia Patient With Chronic Back Pain and Gout Swears That Colchicine is a Miracle For All Three of Her Painful Conditions

  • Award Day

  • Acceptance Speech (long version): 2022 Carol Eckert, MD Memorial Award, Maine Primary Care Association

  • Awarded by the Maine Primary Care Association:

  • Delivering Health Care is Like Practicing a Religion

  • Make it So

  • Your Doctor Remembers Most Things About Medicine, But Not Everything About You

  • Five Plain Truths About Gout

  • I Do Fewer Elective Procedures Now Than When I Started Out. This is Why:

  • A Renaissance For Phrenology? (A Country Doctor Reads 8/24/22)

  • Replay: A DOCTOR’S PARTING WORDS

  • Don’t Be Insulted If I Prescribe Narcan Along With Your Pain Medication

  • The Intrusive, Insensitive Nature of Primary Care

  • 7687

  • Understanding a CBC (Complete Blood Count)

  • Abnormal Lab Tests: Not Always a Sign of Disease

  • Dosing Warfarin: From Flowsheet to Workflow. Is This Progress?

  • A Country Doctor Reads: Consider the Vagus Nerve, No Matter What Seems to be the Diagnosis | The Wall Street Journal

  • A Country Doctor Reads: The Solution Shop and the Production Line — The Case for a Frameshift for Physician Practices | NEJM

  • Changing EMR Again: Goodbye Greenway, Hello Epic

  • The Useless, Almost Drive-Through, Nearly Touchless, Free But Expensive and Wasteful Physical Exam

  • Somebody Stole My Inhaler Idea. Finally!

  • There Are Too Many Back Seat Drivers in Medicine Today

  • Quick and Easy: How to Save Primary Care

  • All These Gut Feelings: A 10-Year Old With Belly Pain

  • Don’t Eat More of Anything (Until You Decide What to Eat Less Of)

  • Why Can You Have Angina With Normal Coronary Arteries? For the Same Reason You Can Have Heart Failure With Preserved Ejection Fraction

  • Another Gut Feeling: A Case of Visceral Hyperalgesia?

  • Big Leg, Little Leg: The Lymphedema That Came and Went (Comments invited)

  • Health Care Through the Back Door: The Dangers of Nurse Visits

  • Since When? Looking for Change: The Heart of the Art of Diagnosis

  • A Very Near Miss: The Worst Bout of Sciatica Ever

  • Notes From My Sick Bed: Cold War, Viruses and History Repeating Itself

  • How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work

  • Hijacked for Public Health Purposes: Previsit Planning and Morning Huddles

  • A Stubborn Rash: When Doctors Don’t Communicate

  • A Country Doctor Practices Bibliotherapy: Books by Prescription

  • Always Looking for Zebras

  • The App That Helps Me Be a More Patient Centered Physician

  • The Misunderstood Medicinal Use of Yogurt

  • I Heard About Chilblains in British Television Shows, Not in Medical School

  • Care Reminders? No Time to Think on the Clinic Assembly Line

  • A Year of Extremes: From Medieval Masks to mRNA Vaccines; From Science Denying Flat Earthers to the Prospect of Civil War

  • I Hate to Encourage Pharmacy Shopping, But I Have to

  • Another Christmas Message

  • Why I Tell My Patients They Can Take Their Levothyroxine With All Their Other Medications, Even With Food

  • Broken Relationships and Sudden Social Isolation are Like Opiate Withdrawal (BOTSA via NYT)

  • What the Pandemic Taught Us About Public Health

  • Why is the Patient Here?

  • The Healing Power of Even Virtual Human Connection

  • There is Comfort in a Name

  • This Time, it’s Different: The Man Who Cried Wolf and the Doctor Who Listened

  • Is This Really a Time to Give Thanks?

  • Dumbing Down Doctors: A Profession Without a Language

  • Old Information

  • A Kind Review of My Books in FAMILY MEDICINE

  • Behind the Mask

  • My Patient Has Hepatitis C. He Tested Positive Five Years Ago And Nobody Told Him

  • A Wasted Peer-to-Peer Call for my WellCare Patient

  • Confusing Numbers in Medicine

  • “I Just Want an X-ray”

  • A Back Door to Treatment

  • N 95 Mask As Screening For COPD?

  • “Has a Bad Cold, Please Call”

  • An Anxious Man With Coronary Plaque

  • Don’t Take an Aspirin and Call Me in the Morning

  • Dear Uncle Marcus (Welby):

  • We Use Too Many Medications: Be Very Afraid of Interactions

  • How to be an Expert: Narrow Niche or Novel Juxtaposition

  • A Country Doctor Reads: New Swedish Psychiatry Celebrities on Incels and Narcissists

  • Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target

  • A Gut Feeling: Could This Case Really Be That Simple?

  • We Shouldn’t Tolerate Sloppy Allergy Lists

  • American Primary Care is a Big Waste of Time (When…)

  • Still Smiling At “A Moving Target”

  • I Am a Decision Maker, Not a Bookkeeper

  • A Country Doctor Reads: THOUGHTS OF A TEENAGER (and a Blast From the Past)

  • Swedish Telemedicine Psychiatric Prescribing

  • A Man With Sudden Onset of Gastroparesis

  • Labor and Delivery

  • Anxiety, Worry or Fear? Disappointment, Grief or Depression?

  • Friday Afternoon: Elevated D-dimer. Ho, Hum

  • Cold Feet

  • Progress Note: August 31, 2021

  • We Are Living in the Dark Ages, and Night May Soon Fall

  • Burnout? Not Even Close!

  • Wading Through Unsorted Requests: I Don’t Care If You Call Them “Tasks” Or “Jellybeans”, It’s the Stupidest Thing About EMRs

  • Speaking of Bile: We Should Consider It More Often

  • Revitalizing the U.S. Primary Care Infrastructure | NEJM

  • I Just Diagnosed a Case of SOD, Although I Admit I Wasn’t Quite Familiar With It

  • “That New Medicine You Prescribed…”

  • A Woman With Classic Angina and Two Test Abnormalities: Artifacts, Really??

  • Whose Medical Necessity Is it Anyway?

  • Add a Medication, Don’t Switch (Yet)!

  • Health Insurance is a Stumbling Block in Many Patients’ Thinking

  • Self Care During the Pandemic

  • A Country Doctor and the Ancient Wisdom of a Samurai Physician

  • Medical Imaging is Less Revealing and More Subjective Than Patients Think

  • In a Perfect World, Ancient Drugs Would Not Cost More and More Over Time

  • “Patient Requests 90 Day Supply”

  • The Lazy Man’s Guide to Calorie Counting

  • The Middle Age Creep

  • A Country Doctor Writes eBook Price Drop

  • EHRs Are Workarounds, Rerouting the Way Physicians Work

  • Getting to the Doctor When You’re Sick and Scared

  • “I Thought I’d Wait Until My Appointment”

  • Anxiety? It’s All in Your Head. Your Sinuses, to Be Exact

  • Practicing Where the Action Is

  • When Dogs Lick Their Wounds

  • The Power of Silence (Reflections on Writing)

  • An Easy Choice

  • The Case of the Stop and Go Pills

  • Set It and Forget It: My Successful First Use of Ambulatory Blood Pressure Monitoring

  • Patient: “Another Doctor Said Keto Was Bad For Diabetics” – Me: “Let Me Tell You the Story of the Flex Fuel Man”

  • Funny Examples of Swedish Medical Terminology

  • “Fruit is God’s Candy”

  • The Art of Diagnosis: Go With Your Gut, Dig Deeper, Step Back or Start Over

  • When I Escalated His GERD Treatment, My Patient Got Worse. Now I Know Why

  • “This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder

  • Another Birthday Reflection

  • Fatigue, Tinnitus, Dizziness and Dyspnea. What’s the Diagnosis?

  • Can the Practice of Primary Care Medicine ever be Practical Again?

  • I Actually Love Technology

  • Habits for Health and Happiness

  • The Gift of Time

  • The Art and Soul of Medicine Exist in the Ordinary

  • The Science of Clinical Intuition

  • To Understand What You Already Know

  • There is a Word for People Like Me: AMBIVERT (A Personal Reflection)

  • The Call to Be a Primary Care Doctor

  • The Annual Physical: Is it Worth Having?

  • My Blog is Setting Many Records, Except One, a Surprise Hit from 2015

  • Does Tramadol Create More Cold Blooded Killers?

  • The Complete Workup: Virtue or Waste?

  • Another Quick Listen

  • TSH, T3 and T4: The Conductor and the Orchestra

  • A Lesson Learned is a Lesson Remembered

  • “Nothing Acute”

  • The Perils of Being First

  • NNT: The Number Needed to Treat in Order to Prevent One Bad Event

  • HYPERTENSION is Like Driving a 5-Speed in 4th Gear

  • Doctor-Patient Relationships: I Don’t Babysit – I Want to Empower

  • BANANAS: Potassium, Calories and Constipation

  • Hey, Doc, What Do I take For a Cold? Nothing!

  • Peak Flow Meter, Tuning Fork and Blank Pieces of Paper: Things I Would Rather Not Practice Without (Besides My iPhone)

  • Allergies and Hives

  • Why I Seldom Recommend Vitamins or Supplements

  • Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?

  • A Short Video For Patients Based on My Warfarin Post:

  • Three Challenges in the Art of Prescribing Warfarin

  • Serving is No Longer a Useful Term, Especially For Snack “Foods”

  • Working Too Hard Doesn’t Cause Burnout. Having to Do the Wrong Thing Does

  • Revisiting the Advantages of aSOAP Notes: The Best of the Paper Chart and Old School Photography

  • Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare

  • The Art of Medicine is Not an Algorithm

  • Food is a Hot Potato

  • New Book: SAMPLES – Recent Writings on the Art of Medicine. $2.99 on Amazon

  • Suboxone Saves, Builds and Rebuilds Lives

  • Morgellons? I Made the Diagnosis of DP. Now I Have to Figure Out How to Manage it.

  • “Tell Me More”

  • What Does Your Patient Need to Hear You Say Right Now?

  • Five Weight Loss Myths I am Constantly Fighting

  • Cholesterol Guidelines and the Bachelor With Platform Shoes – 13 Years Later

  • Screening for Depression: Then What?

  • Some People Don’t Think Like Doctors (!)

  • My Latest Post on A Country Doctor Talks:

  • New Symptoms With Old Explanations

  • Why I Don’t Order Fasting Bloodwork Anymore

  • My First VLOG: A Country Doctor Talks

  • THESE WERE NOT COMPUTER BOTS: My Patient Said he Had Bugs Crawling Under his Skin

  • Please Sign Below: Fraudsters Phishing for Physician Signatures

  • The Parallel Realities of Health Care: Ratio and Intellectus

  • Other Super Drugs in My Personal Black Bag of Tricks

  • THE PAIN IS IN YOUR BRAIN: Your Knees Know Next to Nothing

  • Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks

  • The Art of Clinical Decision Making: Friday Afternoon Dilemmas

  • Find me on Facebook

  • The Art of the Chart: Documenting the Timeline

  • An Uncommon Cause of Shortness of Breath

  • A Double Hit of Imperfect Technology and Massive Centralization

  • The Art of Diagnosis: Teasing Out the Timeline

  • Canada’s Buttergate: Invasion by a Trojan Cow

  • “I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”

  • The Art of Listening: When the Inner Voice Whispers

  • How I Write

  • It Pays to Play Dumb Sometimes

  • The Art of Asking: What Else is Going on?

  • Driverless Cars or Keyboardless EMRs? Which Do We Need Most?

  • Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers

  • “I Don’t Cook” is an American Epidemic (But A Country Doctor Cooks)

  • The S-Word (Social) Suddenly Has a Place In American Medicine

  • Why We Need Good Primary Care Physicians

  • The Art of Asking: What’s Your Biggest Fear?

  • The Art of Prescribing (Or Not)

  • The Art of Explaining: Starting With the Big Idea

  • There Are Three Kinds of Primary Care, Not to Be Confused With Each Other

  • The Art of Asking: Show Me Where it Hurts

  • This is Not Health Care

  • The Art of Triage: What’s the Worst Thing This Could Be?

  • The General Public is Meant to be Deceived: The American Food Conspiracy

  • The Art of Tinkering: The Man With Cold Fingers

  • Quality in Healthcare: Cultural Competence, Diagnostic Accuracy or Patronizing Insensitivity?

  • A Country Doctor’s New Year’s Resolution

  • I Can’t Stop Blogging

  • Stop Bashing Nurse Practitioners: The Dunning-Kruger Effect is Everywhere

  • A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine

  • The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine

  • Featured Again in Sweden’s Journal of General Medicine

  • The Art of Listening: A Not-So-Simple UTI

  • The Art of Listening: Cause and Effect

  • The Art of Listening: Beyond the Chief Complaint

  • Stewardship: We Worry More About the Environment than Our Own Bodies

  • CRAZY AMERICA: Health Insurance Covers Testing When You Are Well But Not When You Are Sick

  • PATIENTS: Sufferers, Consumers or Something In Between?

  • I Still Love Being a Doctor – KevinMD

  • Swedish Analysis: Dark Triad Personality and Denying the Dangers of Covid-19

  • Courts Interpret Laws Differently – Even the Supreme Court, Depending on Individual Justices. Compare that with Interpreting Medical Science!

  • Physicians’ Communication Skills are Overlooked and Undervalued – Today’s Exclusive on The Health Care Blog

  • Where’s Waldo: Finding What’s Important in the Medical Record – KevinMD

  • How we Deliver Medication Information – a Reblog on KevinMD

  • “It’s the Interface, Stupid” Revisited: If X-Box Can, Why Can’t our EMRs?

  • My Latest on KevinMD – 7/26/20 on ACDW

  • A Country Doctor Writes: IN PRACTICE : Starting, Growing and Staying in the Medical Profession – eBook and Paperback

  • If We Can’t Have a Universal Electronic Health Record, We at Least Need a Single, Universal, Medication List Plug-In

  • Local TV Story on First Book in “A Country Doctor Writes” Series

  • Book Update: Labor Day Release Will Have New Title

  • CONDITIONS Paperback Bulk Orders

  • More Profit in Treating Chronic than Acute Diseases – Today’s Post on KevinMD.

  • One of My Burnout Posts on Today’s KevinMD

  • Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback – My Latest Post on The Health Care Blog

  • Driving With James Taylor

  • Take the Poll: Should I Narrate My Book for Audible?

  • A Country Doctor is in Australia – Medical Observer

  • I Cured My Patient, But What Was His Diagnosis?

  • Aren’t We All Somewhere On the Spectrum of Disease? – The Deductible

  • A Country Doctor Writes: CONDITIONS – Now Also in Paperback

  • Oats: Junk Food or Health Food? Ingredients are Only the Beginning

  • July 4 Book Release Update

  • When a diagnosis leads to sadness instead of triumph – KevinMD

  • A Country Doctor Talks – KevinMD

  • Participating in the greatest miracle a physician is privileged to be part of – KevinMD

  • There’s a code for pain, but what’s the code for suffering? – KevinMD

  • First Book Available for Pre-Order

  • Will Telemedicine Make Us Better Diagnosticians? – KevinMD

  • The New Normal is Still Unknown, on Earth as it is in Healthcare – The Health Care Blog

  • Post Scriptum

  • A Dozen Years of Writing About Doctoring

  • Meaningful U’s

  • A Country Doctor Reads: Why Walking Matters – The Wall Street Journal

  • My Patients with Anxiety and PTSD are Handling Covid-19 Better than Most

  • Will the Covid-Induced Telemedicine Scramble Change Primary Care Forever?

  • Covid-19 is Bringing Out the Worst Dishonesty in Some Patients

  • A Country Doctor Reads: Why Sweden isn’t Restricting Personal Freedom During the Covid-19 Pandemic – Svenska Dagbladet

  • Why Do Patients Trust their Doctor? Because He or She is a Competent Mensch

  • A Country Doctor Reads: How South Korea Flattened the Curve – The New York Times

  • A Country Doctor Reads: Job Crafting for Character – Harvard Business Review

  • American Telemedicine Has Gone Viral

  • Depression in Modern Times: We Have Many Friends and Followers, But Low Perceived Social Support Scores Can Make Us Sick

  • Black Box Warnings: Time to Reconsider Our Disease=Drug Reflex?

  • Hope is a Contagious Force of Healing

  • As Physicians Today, We Must Both Represent the “System” and Disregard it

  • American Primary Care and My Soviet Era Class Trip: Sensing the Inevitable Collapse of a Top Down Bureaucracy

  • The Science of Placebo and Nocebo Effects Puts the Doctor-Patient Relationship on Par With the Effectiveness of the Pharmaceuticals We Prescribe

  • Medicine is Child’s Play: Where’s Waldo, Spot the Difference and Whack-a-Mole

  • “The Four Horsemen of the Medical Apocalypse”: It’s All About Inflammation

  • Atherosclerosis and Nonstick Frying Pans: Newfangled Medications or Time Tested Lifestyle?

  • My Favorite Visit: “25 Minutes with More than 50% Spent on Counseling and Education”

  • Medical Records in Primary Care: Keeping the Story of Phone Calls and Medication Changes with Less than Perfect Tools

  • Asinine, Backasswards Colonoscopy Insurance Rules Make Patients Decline Medically Necessary Testing

  • Ad Usum Proprium: Physician, Treat Thyself!

  • “I Want Complete Labs Ordered Before My Physical”

  • Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway?

  • As a Doctor, I Should be a Keener Observer and Notice the Pathology All Around Me

  • Chronic Disease Drugs are Big Business, Antibiotics are Not

  • Tell Me Again Why We Should Screen for Early Alzheimer’s?

  • Doctoring at Christmas

  • The Public Health To-Do List is Choking Doctors and Jeopardizing Patients’ Lives

  • Thou Shalt Not Try to Outsmart Me

  • The Liability of Outside Provider Orders and What Could be Done About It

  • The Polyvagal Theory: The Science Behind Therapeutic Relationships, Stress Related Illness and Long Term Effects of Trauma

  • Changing EMR – Seamless Continuation, Dreaded Chore or Fresh Start?

  • Ten Building Blocks of Therapeutic Relationships

  • Screen Sharing With Patients

  • If Nothing Else Works, Try a Horse

  • Clinical Depth: The Power of Knowing More than the Minimum

  • Revisiting the Concept of Burnout Skills

  • Leveraging Time by Doing Less in Each Chronic Care Visit

  • More and More Pills for 25-30% Better Odds of This, That and The Other – Some Patients Want That, and Some Will Run the Other Way

  • Let Patients Lead – Explaining Addiction and Recovery to Families

  • We Have Lost Track of the Natural History of Disease

  • Patients Are the Real Healers

  • Sickle Cell Disease and Phenylketonuria (PKU): You May Have the Genes, But Your Diet Determines Your Symptoms

  • Ordering Tests Without Using Words: Are ICD-10 and CPT Codes Bringing Precision or Dumbing Us Down?

  • A Country Doctor Reads: September 20, 2019 – Full Circle With Sertraline, Airmanship and Mastery in Medicine, EMR Notes Exaggerate Comprehensiveness

  • Despair and Happiness in America and in Medicine

  • A Country Doctor Reads: September 14, 2019 – Life Forms Inside Us are Controlling Our Behavior

  • I Have a Strong Relationship with my Bank but I Almost Never Go There. How Could this Translate to Primary Care?

  • A Country Doctor Reads: September 7, 2019 – Workarounds in Healthcare, Empathy in he Age of the EMR, US vs Swedish Postoperative Pain Management

  • When Was the Last Time You Saved Somebody’s Life?

  • Magnesium Deficiency: An Undiagnosed Epidemic Behind the Epidemics of Heart Disease and Diabetes

  • A Country Doctor Reads: August 31, 2019 – Polypill for CVD risk reduction; Assisted living is a money-making fantasy; Why doctors should read business journals

  • Vertigo is a Symptom, Not a Diagnosis, and it’s Sometimes Caused by Loose Rocks Inside Your Head

  • Cultivating Charisma in the Clinical Encounter (and emulating Marcus Welby, M.D.)

  • A Country Doctor Reads: August 17, 2019

  • Whom Does the EMR Serve? Who Owns and Who Needs THE STORY?

  • Passed a Stress Test With Flying Colors and Had a Heart Attack on the Way Home, How Could That Happen?

  • A Country Doctor Reads: August 10, 2019 – High Blood Pressure is High Blood Pressure, No Matter Where or When

  • A Day of Practicing Medicine Without the Computer

  • A Country Doctor Reads: July 28, 2019

  • How Much Should Physicians Touch?

  • “Thanks for Your Time”: Einstein’s Relativity in the Clinical Encounter

  • A Country Doctor Reads: July 21, 2019 – Big Data

  • Everybody Seems to be an Expert, Except Your Family Doctor?

  • A Patient in the Lobby Refuses to Leave: Medical Emergency, Unhappy Customer or Active Shooter?

  • A Country Doctor Reads: July 12, 2019

  • The Stages of a Man’s Life

  • A Country Doctor Reads: July 6, 2019

  • Medicare PSA Screening Reversal: Yesterday’s Quality Measure is Today’s Rejected Claim

  • I Wish My Clinical Hunches Were Wrong More Often

  • My New Life

  • Psychiatrist: My Medicine Raised Our Patient’s Blood Sugar, Can You Help? PCP: That’s a Dump!

  • Our Profession is Deprived of its Language

  • A Country Doctor Reads: June 1, 2019

  • Is Hate Ever Therapeutic?

  • Beyond the Other Viagra: Curiosities in Off-Label Prescribing

  • A Country Doctor Reads: May 19, 2019

  • The Folly of Self Referral

  • A Country Doctor Reads: May 11, 2019

  • Brief is Good

  • A Country Doctor Reads: May 4, 2019

  • Today’s Doctors: Colleagues or Free Agents?

  • The ABCs of Beginning a Clinical Encounter

  • A Country Doctor Reads: April 27, 2019

  • Drug Rehab, Life Hab (ilitation)

  • A Country Doctor Reads: April 20, 2019

  • If You Are a Doctor, Act Like One

  • I Am Not an InstaDoc*; This Is Not InstaMedicine*

  • A Country Doctor Reads: April 13, 2019

  • Treatment of Peritendinitis Crepitans: Heparin or Prednisone?

  • A Country Doctor Reads: March 30, 2019

  • PDSA for Dummies

  • A Wonder Drug of Ill Repute

  • A Country Doctor Reads: March 23, 2019

  • The Power of Focus

  • No Information Exchange, Major Diagnostic Delay

  • A Country Doctor Reads: March 16, 2019

  • An Accidental Cure

  • The Cruelty of Managed Medicare

  • A Country Doctor Reads: March 9, 2019

  • A Science of Uncertainty and an Art of Probability

  • A Country Doctor Reads: March 2, 2019

  • Almost All We Do is Treat Symptoms

  • A Country Doctor Reads: February 23, 2019

  • A New Word for Discharge Summaries?

  • “Let Food Be Thy Medicine and Medicine Be Thy Food”

  • A Country Doctor Reads: February 16, 2019

  • Medicine is Not Like Math

  • Paralyzed by Insurance Drug Formularies? Don’t Forget Cash!

  • A Country Doctor Reads: February 9, 2019

  • The Dangers of Practicing Medicine Without Context

  • The Man with Brown Fingernails

  • A Country Doctor Reads: February 2, 2019

  • Checking Boxes

  • Unavailable Antidotes

  • A Country Doctor Reads: January 26, 2019

  • A Spot-On Analogy

  • Outlook and EMRs: Culture Clash in the Medical Office

  • A Country Doctor Reads: January 19, 2019

  • Inhaler Cures GERD?(!)

  • The Perfect Office Note? SOAP, APSO or aSOAP?

  • A Country Doctor Reads: January 13, 2019

  • How I Will Work Smarter in 2019

  • Stop Trying to Hijack Medical Huddles! Haven’t You Heard of Constant Contact?

  • Blogging While Driving

  • There Are Few Shortcuts to Health

  • Physicians are Influencers

  • Curiosity, Antidote to Burnout

  • Touching the Mezuzah – Revisited

  • The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers

  • Don’t Do Chronic Care in December

  • I Love Calling Patients – And I Don’t

  • Ask the Professor

  • Sometimes You Just Gotta Treat It

  • Reruns

  • HELP ME!

  • Distance, an American Health Disparity

  • The Elfins Return

  • Medicalization and Demedicalization in US Healthcare

  • Will Technology Keep Us From Thinking?

  • A Country Doctor Reads is Moving

  • Teflon Doctors and Velcro Patients

  • Suboxone for Pain? Not in Maine

  • Flirting With Functional Medicine

  • How Often Should Doctors Check Labwork?

  • What is a Dose of Psychotherapy?

  • Where is Relationship, Authority and Trust in Healthcare Today?

  • Helping Patients Accept Their “Imperfections”

  • Transdiagnostic Treatment Approaches in Primary Care

  • When the Patient Can’t Tell You

  • You Are What You Eat – Revisited

  • Be the Doctor Each Patient Needs

  • Fundamentals of Medicine: Diagnosis and Guidance (Not Just Treatment)

  • Dear [CEO]: The Letter I Gave My Boss This Week

  • M3DICINE: A Word With 3 Meanings

  • Endocarditis or Not? A Saturday Triage Decision

  • Two Cases of Bubbly Urine

  • Only Pain and Fear Bring Patients to the Doctor

  • Instant Relief

  • Lists of Three: Unforgettable Lessons from Medical School

  • If Not a Doctor, Then What?

  • A Rare Form of Deafness or a Trivial Case of Congestion?

  • Medicare Knows Everything About My Patients, But Hopes I Will Forget

  • Guidelines: When Satan Reads the Bible

  • Be the Guide, Not the Hero

  • Comprehensiveness is Killing Primary Care

  • Myopic Versus Hyperopic Views on Physicians’ Work

  • The Art of the Message

  • Too Many Chest Pains

  • The Art of Covering

  • Demonic Dreams and Irreversible Psychosis from Commonly Prescribed Big Gun Medications

  • What is Healthcare and Who Deserves it?

  • My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients

  • Doctors and CEOs Need Time to Think

  • Saturday Clinic

  • Self-Driving Cars are Like Most EMRs

  • Getting it Right

  • Primary Care Needs a New Business Model

  • My Neurology Professor’s Migraines

  • Facial Recognition in My Own Practice?

  • The Case For Professional, Not Just Personal, Resilience

  • Bread and Butter Medicine

  • Upselling in Medicine: Would You Like a Pap Smear with that Ankle Brace, Ma’am?

  • Progress in Weekly Increments

  • On a Personal Note

  • Brilinta or Clopidogrel, Maximum Benefit or Social Responsibility?

  • From EMR to Paper to EMR

  • Triage at the Front Desk

  • My Suboxone License is Capped at 100 Patients, Should My Opioid License Also Be?

  • One More Question

  • Doceo, Ergo Sum

  • Thou Shalt Do More Physicals

  • Hanging Up the Stethoscope

  • Pneumonia is a Disease. Is High Cholesterol or Osteoporosis?

  • A G.O.M.O.

  • Talk, Think, Listen and Type

  • How I Will Work Smarter in 2018

  • The Other Opioid Epidemic

  • Routine Physicals, Routine Labs

  • A Christmas Wish

  • Reengineering Primary Care (Again)

  • A Lousy Diagnostician

  • Between Patients: The Myth of Multitasking

  • Appendagitis – Not a Typo

  • Another Thanksgiving Reflection

  • Always Ask

  • Wasted Education

  • A Blackmail Attempt

  • The Codes that Disappeared

  • Too Early or Timely Diagnosis

  • How to Write Like a Dockter

  • Give Specialist Doctors a Break!

  • A Boomerang Patient

  • Annual Evaluations

  • The “Patient Centered” Medical Appointment: You Know the Drill

  • Cave: Ignoring the NNT

  • A Physician’s Lack of Self Awareness

  • A Flex Fuel Man

  • Caught Between two Paradigms

  • Driving my Mini (iPad)

  • An Old, New Diagnosis

  • A Dream Job

  • Thank Goodness(?) for Technology

  • From Group Practice to Herding Cats

  • The Dunning-Kruger Effect

  • Patients from Away

  • A Week with no Lab Coat

  • Alarm Fatigue

  • Medical Records for Amnesiacs

  • A Lesson Learned

  • A Moving Target

  • Quality Medicine: Showing the Math

  • Acts of Kindness

  • A Pearl From Medical School

  • The Real Reason Behind EPCS?

  • Horse Medicine

  • EMRs: It’s the Interface, Stupid*

  • Where Does it Hurt?

  • There but for the Grace

  • Everybody is Special

  • A Bug in His Ear

  • Imagining a Doctor Shortage

  • The Power of ACT

  • Peer to Peer

  • All or Nothing

  • Stop Excessive Measurement

  • Why Can’t We Speak Our Own Language?

  • Remembering the Inpatient Workup: All the Tests to the Patient’s Bedside

  • Medicine is a Love that Finds Us

  • EMRs Should Be Like Rental Cars

  • “Did You Read My Chart?”

  • A Day in the Life of Sir William Osler

  • Dropping the SOAP Note

  • Friday’s Lessons

  • Not On Call

  • Diagnoses Right Under My Nose

  • Doctors Should Be Paid Like Athletes

  • Everything Goes Through Me

  • The Illusion of “Other People’s Money”

  • Don’t Ask Me to Work for the Other Side

  • The Meaningful Use Paradox

  • An Anniversary of Sorts

  • One Shot Medicine: The Stilted Pseudo-comprehensiveness of American Primary Care

  • A Thanksgiving Reflection

  • Primary Care Has a Dirty Little Secret

  • “When I Was Your Age…”

  • If 911 Worked Like a Medical Office Phone System

  • Today’s Medicine has no Credibility

  • Double-Booking the Doctor is Half-Booking the Patient

  • Something Extra

  • Return visit: A Samurai Physician’s Teachings

  • The Art of Asking

  • Three Dutchmen Walked Into an Eye Clinic

  • Return Visit: Changing the Subject

  • Doctoring, In Simple Terms

  • Return Visit: A Shot in the Arm

  • Opiates, Pain and Integration

  • A Motherless Child Without a Father

  • A Failed Transition of Care

  • “Just in Time” Information – Lessons from Manufacturing

  • No Better

  • The Intricacies of Antidepressant Interactions

  • A Fifteen Minute Man

  • EMRs, PCMH and OCD are Limiting Access to Care

  • Role Play

  • A Country Doctor, Duped

  • A Transformative Visit

  • Don’t Squeeze, Tie, Slap or Bite the Hand that Feeds You

  • A Day of Real Doctoring

  • From Learned Professionals to Skilled Workers: The Dangerous De-professionalization of Medicine

  • 35 Years of Burnout

  • A Really Bad Bruise

  • Inside and Out

  • An Outsider’s View of Cardiology

  • Cave: The Patient Who Suggests a Diagnosis Before Telling You His Symptoms

  • Specialists in Diagnostics

  • An Invitation

  • A Straight Face Test for Health Care: Would Patients Pay for This?

  • The Interview

  • All I Want For Christmas: Seven Things I Wish My EMR Could Do

  • Night Call

  • “This is America, You Don’t Have to Do Anything!”

  • Not on a Silver Platter

  • Art and Archetypes in Medicine

  • Husbands and Wives

  • The Reinvented Wheel, Now Square

  • A Sore Thumb

  • It’s Time We Stop Comparing Health Care to Manufacturing

  • Absolution

  • The Legend of the Avoidable Hospital Readmission

  • A Black Hole

  • A Very Careful Driver

  • “And Stay Away From Doctors”

  • Missing the Old A&P

  • The Man With the Shrinking Lung

  • Humming Jeopardy

  • Normal Blood Pressure

  • Medical Anamnestics

  • Border Doc

  • Does Lightning Strike Twice?

  • A Near Miss, Technology Notwithstanding

  • The Sick Game of Medicare D Formularies

  • When a Housecall is Worth a Thousand Tests

  • Outdated Equipment

  • All the President’s Mail

  • The Man with the Up and Down Blood Pressure

  • The Art of Antibiotic Selection

  • It’s Time We Talk: A Doctor is a Doctor is a Doctor, Right?

  • Three Dimensional Doctoring

  • Equanimity and the 25% Rule

  • It’s Time We Talk: Why Should Doctors Treat the Well and Nurses the Sick? – Part Two

  • It’s Time We Talk: Why Should Doctors Treat the Well and Nurses the Sick? – Part One

  • Nailing the Diagnosis, Failing the Patient

  • Checklist or choke list?

  • Requests Denied

  • It’s Time We Talk About Who Should Do What in Healthcare Teams

  • A Swedish Patient

  • It’s Time We Talk About What Healthcare Really Is: Public Versus Personal Health

  • And Then, What Happened?

  • A Rash of Rashes

  • Where is the Mind?

  • Cave! Ultracrepidarianism

  • Doctors Speaking Accountanese

  • Angry Docs

  • Suddenly Expensive Generics

  • “I Also Tame Wild Horses”

  • The Great Imposter

  • Less is More, More or Less

  • Calling Mrs. Kafka

  • Is it the Devil or God in the Detail?

  • Neither Doctor nor Priest

  • A Country Doctor in his Sixties

  • Context, Always

  • Med School, Day One (1974)

  • Medicine is Easy, but Metamedicine is Hard

  • Primary Care is Personal and Passionate

  • Primary Care is not General Motors

  • Primary Care is Messy

  • Incentive, Bribe or Kickback?

  • Primary Care isn’t Brain Surgery

  • Exit Diagnosis

  • The Art of Diagnosis

  • Recapturing Abundance

  • Be Prepared

  • The Ghosts in the Exam Room – Part 2

  • The Ghosts in the Exam Room – Part 1

  • The Red Blues

  • What’s in America’s Medicine Cabinets?

  • Free Blood Pressure Check

  • Treating Symptoms

  • A Tight Squeeze

  • How Should Doctors Get Paid? – Part 5

  • How Should Doctors Get Paid? – Part 4

  • How Should Doctors Get Paid? – Part 3

  • A Fire In the Belly

  • “I Hate Coming Here”

  • Let Doctors be Doctors

  • The Illusion of Electronic Prescribing

  • An Act to Eliminate Constipation

  • How Should Doctors Get Paid? – Part 2

  • Never Assume – Indeed!

  • How Should Doctors Get Paid? – Part 1

  • Never Assume

  • Bedside Manner and the Pendulum Effect

  • Aequanimitas – Doctors Stirred, not Shaken

  • Monocular Vision in Horses and Physicians

  • Epicrisis

  • The Art of Being Sick

  • Wrestling the Rooster

  • From Scribbles to Scribes: Newspeak and Foma in the Medical Record

  • Good, Strong Heart Beat – 140 and Regular

  • Children Who Never Grew

  • One Visit, One Problem?

  • Signed, Harvey Cushing

  • Pain and Suffering

  • Twenty Questions

  • When the Doctor is the Treatment

  • Doctors Without Heroes

  • A Country Doctor Acquitted

  • Hippocrates’ First Aphorism

  • “I am here, Doctor”

  • Low Tech Medicine

  • Albert Schweitzer, Action Hero

  • Practicing Medicine Requires a Patient Relationship

  • “Aaah, it’s Good to be Back!”

  • Saturday’s Child: A Country Doctor Reads Hillman and Chopra

  • What is Osteoporosis?

  • “Examine Thoroughly, Explain Simply”

  • Morbus Propedeuticus

  • Avoiding Retirement

  • The Night Before Surgery

  • Fifty-Fifty Propositions

  • What a Country Doctor Should Write

  • Quality or Conformity Revisited

  • What if Physicians Worked for Free?

  • A Samurai Physician’s Teachings

  • Doctoring in the Here and Now

  • Absolute Risk

  • Controlling Physician Behavior: From Socialized Medicine to Social Marketing

  • Sharing Territory

  • A Country Doctor’s Unlived Life

  • A Minute of My Time

  • The Art of Prognosis

  • Touching the Mezuzah

  • The Secret Of Life

  • A Country Doctor Watches Marcus Welby, M.D.

  • Blood – The Doctor Giveth and the Doctor Taketh: Myths, Beliefs and Evidence

  • Rural Medicine – Not Just Runny Noses

  • Journey’s End

  • QS, Ad Lib and PRN

  • Art, Science and Charity in Medicine

  • The Art of the Referral Letter

  • When To Take Medication

  • Negative Expectations

  • Cell Phones Welcome

  • A Doctor By Any Other Name?

  • Life and Death

  • A Country Doctor Practices Telemedicine

  • The Art of Listening: Narrative, Hermeneutics and the Electronic Medical Record

  • The Gift of Healing: Pastor Graf and Henri Nouwen

  • Jumping to Conclusions

  • Today’s Masterpiece

  • “I’m Sorry Mrs. Jones, But You Have Albuminurophobia”

  • How to Clicker Train Your Doc

  • Morbus Iatrogenicus

  • Squandered Jing

  • A Part-Time Healer

  • Never Mind

  • A Christmas Message to All Physicians from Sir William Osler

  • A Far Too Typical Visit

  • An Amended Diagnosis

  • Off Course

  • The Gift of One Day

  • The Virtues of Oligopharmacy

  • Whom Does the Medical Record Serve?

  • In Manu Medici: The Art of Administering and Prescribing Medications

  • Following the Path of the Soul

  • Patient Centered or Evidence Based Medicine – Can we really have both?

  • A Cleansing

  • Lifetime Nutritional Balance

  • A Drug Launch Lunch

  • “I Know Your Type”; Doppelgänger and Archetypes in Everyday Medicine

  • Dear Patient,

  • The Counterintuitive Concept of Burnout Skills

  • A Memorial Day Memento

  • An Angry Diabetic

  • Calling It Quits

  • A Snowbird’s Return

  • A Reluctant Interventionist

  • A Sore Spot

  • The Art of Scheduling: Air Traffic Control in the Medical Office

  • Intuiting Alexithymia

  • Clinical Instinct

  • A Letter from the Board of Medicine

  • An Embarrassing Allergy

  • Regrets

  • Useless Medicine

  • A Judgment Call

  • The Dance (2011)

  • “Why Am I So Dizzy?”

  • An Incomplete Workup

  • Two Red Herrings

  • A Red Herring

  • “I Need A Doctor When I’m Sick!”

  • “Will You Be My Doctor?”

  • The Art of Measuring Blood Pressure: Pseudohypertension, Oscillations and the Silent Gap

  • A Deadly Interaction

  • Welcome Stranger

  • Changing the Subject

  • Night Flight

  • B.C.

  • Holiday Cheers

  • Brand Name Drugs and Generic Prescribers

  • Guy Talk

  • Signing Off

  • “Mommy, I’m Going to Die!”

  • No Refill

  • The Oldest Disease

  • One Track Minds

  • Amy Laughs With The Angels

  • All is Well; Over and Out

  • Finding the Way

  • The Long Journey

  • The Call

  • Fearing the Worst

  • Playing the Odds

  • Mechanical Voices

  • Fecal Occult Blood Tests Illustrate What’s Wrong With Health Care Today

  • Dinner With A Homeopath

  • Bitter Medicine

  • Doing Nothing

  • A Walking Time Bomb

  • “Cure Sometimes, Treat Often, Comfort Always”

  • Shooting From The Hip

  • The Minimum Effective Dose

  • “Would You Take Me Back?”

  • “You Give Me Hope”

  • Too Good to be True

  • Why Not to be an Early Adopter

  • “Dog Ain’t Right”

  • Happy Birthday, Country Doctor

  • Meals on Wheels

  • “Treating to Target”

  • “That Doctor Is A Nurse!”

  • Continuity of Care

  • A Bad Case of Congestion

  • “Needs Prior Auth”

  • The Last Supper

  • Feeling Like A Doctor

  • The 15-Minute Hour

  • Beyond the Male Menopause

  • One-Liners

  • Abnormal Chemistries

  • Switching Places

  • The Emperor’s New Bones

  • A Quick Listen

  • Time, Money and Midlevels

  • “But I Still Have Chest Pain!”

  • Invisible Ties

  • A Work Excuse

  • Decision Support, Professionalism and the Lost Art of Healing

  • Off The Record

  • What Are We Doing?

  • Problem List Problems

  • A Negative Stress Test

  • “You Don’t Know Me!”

  • A Cancelled Appointment

  • A Terminal Case

  • Noah’s Journey

  • The Jig Is Up

  • Snap Diagnosis

  • A Bad Case of Nerves

  • Face-to-Face

  • “Choices, Gentlemen”

  • Scrubs, Ties and Stethoscopes

  • Attitude!

  • A Posthumous Blessing

  • The Art of the Intramuscular Injection

  • Quality or Conformity?

  • Saying No

  • Thanksgiving Potpourri

  • See You Next Time

  • Starting Over

  • Who Needs a Physical?

  • A Hero’s Pain

  • A Real Pain

  • The Shadow of the Object

  • If You Find It, You Own It

  • Trouble at 6 O’clock

  • The Power of Words

  • “Thank You, Father”

  • A Thirty Year Anniversary, And I Missed It

  • Basic Knowledge

  • Who Wants To Know?

  • Dear Doctor D,

  • An Empty Stall

  • Yesterday’s Children

  • A Tale of Two Sisters

  • My Most Expensive Instrument

  • Thicker Than Water

  • An Imaginary Mentor

  • One Strike, You’re Out!

  • Proof of Chickenpox

  • Oh, By the Way, Doc

  • The Apostolic Nature of Our Profession

  • A Shot in the Arm

  • My Annual Checkup

  • A Physician’s Funeral

  • Clinical Pneumonia or Virtual Health?

  • A Negative Workup

  • Instant Feedback

  • Our Last Visit

  • All My Children

  • An Easy Keeper

  • Local Firefighter Gives Doctor Thanksgiving Pie

  • Loss of Power

  • When I’m Sixty-Five

  • What Do I Call You, Doc?

  • A Change of Heart

  • A Nice, Clean Doublewide

  • A Train Wreck* With Two Car Wrecks

  • The Concept of Risk

  • All God’s Children

  • No More Headaches!

  • A Day Without a Diagnosis

  • The Good Mother

  • “Doctor, What Would You Do?”

  • An Innocent Looking Rash

  • Twinkle’s Back!

  • It’s Only Pressure

  • You Are What You Eat

  • Happy Hour

  • One Last Signature

  • Left Behind (In the Dust)

  • Playing Doctor

  • My Father’s Eyes – The Photographs

  • Visions of Little People

  • A Concurring Second Opinion

  • The Dreaded Visit with Priscilla Pye

  • My Father’s Eyes – The Song

  • An Anxious Daughter

  • My Senior Colleague

  • A Little Man

  • Another Young Man

  • Orthorexia Nervosa – Too Much of a Good Thing

  • Altered Vision

  • Choices in Swedish Health Care

  • Is There a Doctor On Board?

  • Friday’s Child

  • Doctor Fix-It

  • Tuesday Evening House Call

  • Shadow Syndromes

  • Physicians and Chiropractors – Like Priests and Rabbis

  • Catch-up Time

  • A Doctor’s Parting Words

  • A Doctor’s Advice

  • The Doctor’s Doctor

  • Clara’s Sinus Headaches

  • Physician, Heal Thyself!

  • The Correct Diagnosis – Ten Years Later

  • Adverse Effects

  • Thoughts on My In-Room Cup of Coffee

  • Losing a Patient Twice

  • A Country Doctor Stops In Brookline

  • Sally’s Dilemma

  • Caleb Didn’t Limp Yesterday!

  • Time’s Up!

  • Chocolate – Good or Bad?

  • Caleb, Our Horse with a Limp

  • My Nurse’s Mother

  • A Cobbler’s Mistake

  • New Doctors: Too Few, Too Many or Too Late?

  • Cholesterol Guidelines and the Bachelor with Platform Shoes

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