Hans Duvefelt is a family physician who blogs at A Country Doctor Writes: and the author of A Country Doctor Writes: CONDITIONS: Diseases and Other Life Circumstances.
Norman Grant was a new patient. He had chronic back pain, not helped by surgery or a dozen injections after that. It all started with an industrial accident in 2001. He had settled his case and was on chronic OxyContin, which far from kept him functional. But as of January 1, his insurance was no longer covering that drug. He only had two weeks left of it.
He told me he …
Recently, I solved a medical dilemma by changing the medication that seemed to have nothing to do with my patient’s problem.
Ethan Blake is a thin-boned, soft-spoken man with atrial fibrillation and a history of high blood pressure. He lives alone and prefers to shovel his own driveway. He also loves to walk his springer spaniel in the woods behind his house. He is in great physical shape.
At his routine follow-up …
Everybody knows how to operate smartphones and understands complex modern phenomena, but many Americans are frighteningly ignorant about basic human nutrition.
I am convinced this is the result of a powerful conspiracy fueled by the (junk) food industry. Here are just a few examples:
Milk has been advertised as a healthy beverage. It is not. No other species consumes milk beyond infancy. Milk-based products like ice cream and yogurt are on top …
Last week, I became involved in two situations of pain between the eyes that seemed to potentially be presentations of very serious medical conditions.
Autumn took a call from her sister late on Friday afternoon. Her sister had been tested for COVID the day before and told Autumn she instantly felt a severe pain between her eyes and developed a nosebleed as soon as the nasal swabbing was completed. The nosebleed …
Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same language we do. If we “run with” whatever keywords we pick up from our patient’s chief complaint, we can easily get lost chasing the wrong target.
Where I work, along the Canadian border, “Valley French” expressions tripped me up when I first arrived. The flu, or in French, le …
I only applied to one medical school. Maybe that was hubris, but I didn’t think so at the time. Then, in a moment of sudden insecurity, I asked myself, “What if I don’t get accepted?”
During the six months between my military service and the beginning of classes at Uppsala University, I worked as a substitute teacher in my hometown, teaching second to eleventh grade depending on where there was a …
I did a peer review once of an office note about an elderly man with a low-grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported, and there was a long narrative section that blended active medical problems and ongoing specialist relationships. There was also a lengthy review of systems under its own heading.
In an over ten-page long printout, the final diagnosis was …
Using a treatment without having any understanding of how it works is often thought of as unscientific, and suggesting that a placebo can help a sick patient has until now been viewed as unethical.
The New England Journal of Medicine just published an article about placebo (making you feel better) and nocebo (making you feel worse) effects, two of the most intriguing aspects of the supposedly scientific practice of …
He canceled his follow-up appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to my clinic when he had lawns to mow and chores to do.
Less than two weeks before that, he was sitting on the exam table in my office, again and again nodding off, waking up surprised every time his wife prodded him. The stack of printouts from the emergency …
Some people have high cholesterol but not much atherosclerosis. We think of their arteries as having nonstick surfaces. We know inflammation can predispose to plaque formation and plaque rupture, which is the trigger of most heart attacks.
We know statin drugs can prevent and reverse plaque buildup, and make existing plaque sturdier and less likely to rupture. These drugs lower blood levels of inflammatory substances. Most doctors focus on their cholesterol-lowering …
I have noticed several articles describing how antibiotic development has bankrupted some pharmaceutical companies because there isn’t enough potential profit in a ten-day course to treat multi-resistant superbug infections.
Chronic disease treatments, on the other hand, appear to be extremely profitable. A single month’s treatment with the newer diabetes drugs, COPD inhalers, or blood thinners costs over $500, which means well over $50,000 over an effective ten year patent for each …
I looked at a free book chapter from Harvard Businesses Review today and saw a striking graph illustrating what we’re up against in primary care today, and I remembered a post I wrote eight years ago about burnout skills.
Some things we do, some challenges we overcome, energize us, or even feed our souls because of how they resonate with our true selves. Think of mastering something like …
He did a double-take as we passed on our small town sidewalk the other day.
“Hey Doc, I didn’t recognize you dressed like that, without your …”, he gestured to where my tie or stethoscope would have been. I was wearing a cafe-au-lait colored T-shirt and faded Levis.
“Did you hear about the appointment with the cardiologist yet,” I asked.
“It’s in two weeks,” he answered. “Tell me, Doc, how serious is this …
An excerpt from A Country Doctor Writes: CONDITIONS: Diseases and Other Life Circumstances.
“Welcome back. How was your trip? Or exile … you were away for a long time.”
“Almost a year,” my nine o’clock patient answered. A woman just over forty, she looked tan and physically strong. …
Opiates relieve pain and can transport people to their apparent happy place. So does marijuana. Lyrica, the seizure-turned-pain medication, caused enough of a buzz in early study participants that it became a controlled substance. The anesthetic ketamine is now used for treatment-resistant depression.
Years ago, we had to be very specific about the location and classification of our patients’ pain. When pain then became a self-reported vital sign and chronic opioid …
We have all heard that 90 percent of the time, a patient’s history provides the diagnosis before we even perform a physical exam or order any tests. At the same time, much of our reimbursement used to hinge on how many body systems we examined.
Like so many other things in the new reality we find ourselves in, what constitutes a proper medical visit has suddenly changed and will probably continue …
It took a 125-nanometer virus only a few weeks to move American health care from the twentieth to the twenty-first century.
This had nothing to do with science or technology, and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face …
It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.
This has been the bread and butter of counselors for years. People will faithfully attend and …
We knew that the most powerful way to provide substance abuse treatment is in a group setting. Group members can offer support to each other and call out each other’s self-deceptions and public excuses, oftentimes more effectively than the clinicians. They share stories and insights, car rides, and job leads, and they form a community that stays connected between sessions.
Participants with more experience and life skills may say things in …
Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark …
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