Hans Duvefelt, MD

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.

2 patients who are part of the history of medicine

Hans Duvefelt, MD

Conditions

January 9, 2014

I have two patients with phenylketonuria (PKU). Both are about my age. Laura, a non-verbal, slender woman with weathered features but the mind of a very young child, lives in the community. Her sister, Regina, has lived all her life in a nursing home. She doesn’t have a wrinkle in her face, and seems mostly unaware of her surroundings.

The two girls were born several years before Dr. Robert Guthrie developed …

A dying breed: When the perfect consultant retires

Hans Duvefelt, MD

Physician

January 7, 2014

Marc Lachance is the perfect consultant. Ten years my senior, he had more than mastered his specialty by the time I came to the area. He had also established himself as a mentor to Cityside Hospital’s residents and many young physicians who sent him referrals or called him for curbside consultations.

Marc used to live in a rambling farmhouse not far from where I live. But then his elderly father, widowed and …

Medicine is like twenty questions

Hans Duvefelt, MD

Conditions

December 20, 2013

Adrian Bell didn’t look dehydrated, but his diarrhea had come and gone for a week and a half when I saw him a few weeks ago.

“Is anyone else sick with the same thing?” I asked, beginning my usual line of questioning.

“No,” answered Eleanor, his wife.

“Have you had any water to drink from a new or unknown source, or have you traveled away from home?”

“No,” both answered in unison.

“Any new foods …

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Medicine is like twenty questions

Treating pain without addressing suffering

Hans Duvefelt, MD

Physician

December 12, 2013

Suffering ceases to be suffering in some way at the moment it finds a meaning.
-Viktor Frankl

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.
-William Osler

Back in the 1990s when pain was the newest vital sign, physicians were mandated to treat it, often with powerful medications and without truly understanding the cause and significance of the …

What happens to medicine when it has no heroes?

Hans Duvefelt, MD

Physician

December 4, 2013

A few years ago, a medical journal piece about electronic medical records with built-in decision support announced that the days of super-physicians and master diagnosticians were over.

Being a doctor isn’t very glamorous anymore, and being a good one seems rather obsolete with so many guidelines and protocols telling us what to do.

A hundred years ago, William Osler, a practicing physician, had single-handedly written the leading textbook of medicine, reformed medical …

Acquitted of cholesterol guideline insubordination

Hans Duvefelt, MD

Conditions

November 24, 2013

A family physician in the northernmost part of the United States was acquitted last week of charges stemming from years of guideline insubordination.

Interviewed this weekend by members of the local press while he was cleaning the stall of his favorite horse, the silver-haired doctor declined making comparisons between the manure he was shoveling and the now-abandoned numeric cholesterol guidelines, and would not comment on his former accusers’ fall from their …

Do we really need greater numbers of lesser trained physicians?

Hans Duvefelt, MD

Policy

November 10, 2013

My Swedish medical school curriculum was 5 1/2 years, but I remember during a third-year class trip to the Soviet Union hearing that some doctors over there had a much shorter education. My classmates and I were at first surprised to see physicians staffing ill equipped ambulances, riding the streets of Moscow with critically ill patients and no equipment to deliver care. We concluded that physician labor was cheap and …

Tales of two nights before hip surgery

Hans Duvefelt, MD

Physician

October 23, 2013

On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order — the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted.

Every step was deliberate, slow and painful. Whenever he …

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Tales of two nights before hip surgery

Balance bedside assessment with high-tech testing

Hans Duvefelt, MD

Physician

September 20, 2013

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 …

The role of physicians is set to evolve again

Hans Duvefelt, MD

Physician

September 11, 2013

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 …

In our efforts to be thorough, we are probably causing more harm

Hans Duvefelt, MD

Physician

August 30, 2013

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 …

Many medical interventions are 50/50: Who informs the patient?

Hans Duvefelt, MD

Physician

August 16, 2013

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 …

Do you worry about the diseases you learn in medical school?

Hans Duvefelt, MD

Conditions

August 7, 2013

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 …

Quality is a word that lacks universal meaning

Hans Duvefelt, MD

Policy

July 9, 2013

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 …

What if doctors worked for free?

Hans Duvefelt, MD

Policy

June 15, 2013

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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What if doctors worked for free?

The dark side of social marketing to physicians

Hans Duvefelt, MD

Physician

May 24, 2013

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 …

What is the role of the physician in today’s health care system?

Hans Duvefelt, MD

Physician

May 15, 2013

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 …

What is each minute of my time is really worth?

Hans Duvefelt, MD

Physician

April 9, 2013

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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 …

Rural medicine is the most stimulating kind of primary care

Hans Duvefelt, MD

Physician

October 26, 2012

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: …

Marcus Welby, MD is still relevant today

Hans Duvefelt, MD

Physician

June 17, 2012

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 …

Hans Duvefelt, MD

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