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.

EMRs are dangerous. Let’s change that.

Hans Duvefelt, MD

Tech

March 10, 2017

The SOAP note isn’t what it used to be. And what it has become needs to be scrapped, because it has made the office practice of medicine cumbersome and unsafe.

In simpler times, when medical records were written by and for doctors, the SOAP note represented a significant leap forward in expanding and organizing office notes and also notes from emergency rooms and walk-in clinics. Before that notes sometimes only documented …

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EMRs are dangerous. Let’s change that.

One day. Two lessons learned.

Hans Duvefelt, MD

Physician

February 19, 2017

My colleague, Dr. L.T. Kim, was off this week and I covered for him.

On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons.

I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency …

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One day. Two lessons learned.

The big picture is critical, but so are the details

Hans Duvefelt, MD

Physician

February 13, 2017

When I read a case report in a journal or whenever a patient comes in to see me about a new symptom, all my senses are tuned in, and I know there is a diagnosis to be made.

But on regular clinic days with “routine” follow ups, I find myself not being as tuned in as I would like to be. I know my patients well; we are all growing older …

My case for no-fault medical care

Hans Duvefelt, MD

Physician

February 6, 2017

As a physician with a strong sense of calling, I always see myself working for each patient, regardless of who pays the bill. Following in the footsteps of role models like Hippocrates and Osler, how could I do anything else?

Ted has been my patient for decades. He can’t seem to lose weight.

John has admitted he doesn’t know how long he can keep doing the kind of work that has supported …

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My case for no-fault medical care

Health care needs a moral wake-up call

Hans Duvefelt, MD

Policy

January 31, 2017

The problem with health care and drug prices in America isn’t that we spend too much money. The real problem is that we believe we are spending “other people’s money.”

Yes, I was raised in Sweden, but no, I’m not a Socialist. The irony is that “free” health care there is more clearly understood to be directly financed by local(!) taxes that can go up if people in that region consume …

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Health care needs a moral wake-up call

Let’s leave clerical work to administrators

Hans Duvefelt, MD

Physician

January 23, 2017

On an ordinary day last month, I saw patients for eight and a half hours. I addressed a dozen computer messages, took four or five calls from outside providers and held innumerable curbside conversations with medical assistants, case managers and colleagues.

I didn’t get to any of the 100+ lab results or 50+ documents in my electronic inboxes. Consequently, the care for several dozens of my patients didn’t move forward.

Many of …

This dirty secret keeps doctors from doing their job

Hans Duvefelt, MD

Physician

January 1, 2017

We are like a restaurant that charges handsomely for sit-down dinners but gives away food for free at the takeout window. And we only pay our providers for serving the dining room guests. If traffic gets backed up at the drive-through, we hold our providers responsible, even though we never planned for our ever increasing demand for takeout.

In simpler times, patients went to the doctor when they felt unwell, and …

Marking a melancholy anniversary

Hans Duvefelt, MD

Physician

December 23, 2016

Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the counter these days.

Today I saw her for a preoperative clearance. She finally decided to get an operation for her chronically sore shoulder. She had injured it many years ago>. In …

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Marking a melancholy anniversary

Listen to your patient’s story: It’s their diagnosis

Hans Duvefelt, MD

Physician

December 14, 2016

Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis.” But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis.

He penned his words in an era when medical information was scarce …

Be the kind of parent you wished yours were

Hans Duvefelt, MD

Physician

December 1, 2016

A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit.

His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was declared normal by the radiologist.

We talked some more about his anxiety and poor sleeping habits. We talked about his late shift at work, and we talked about his late gaming habits …

Doctors are teachers too

Hans Duvefelt, MD

Physician

November 30, 2016

Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room.

The man who felt bad all over had a bilirubin twice the upper …

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Doctors are teachers too

The medical regrets in my life

Hans Duvefelt, MD

Physician

November 8, 2016

“Listen, when I was your age, I did the same thing …”

The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery.

He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling.

“What …

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The medical regrets in my life

Current EMR systems are terrible. (Apple, save us!)

Hans Duvefelt, MD

Tech

October 26, 2016

“Then it’s me and my machine
For the rest of the morning,
For the rest of the afternoon
And the rest of my life.”
– James Taylor, “Millworker”

It’s Friday afternoon, 4:30. I am sitting in front of my computer. My last patient is gone, my prescriptions are done, my messages answered, my office charges submitted and my office notes completed. Now, it’s time to tackle the incoming laboratory results.

Opening up the list of completed …

Why physicians face a serious credibility problem

Hans Duvefelt, MD

Physician

October 24, 2016

A recent issue of the New England Journal of Medicine once again questions two practices that used to be almost the backbone of primary care.

One article is about the low likelihood that prostate cancer detected through PSA screening will shorten a man’s life, even if he chooses just to keep an eye on it.

The other article is about how repeated mammography screening mostly leads to the diagnosis of small and …

Double booking patients is difficult and destructive

Hans Duvefelt, MD

Physician

October 14, 2016

Not only have we shortened medical appointments to 15 minutes — we sometimes double book them.

I get the feeling that non-providers think of this as something fairly ordinary, and even reasonable. But it is often a very difficult and destructive thing to do.

The term “double booking” and the way it looks in an ordinary doctor’s scheduling grid suggest that the physician might possibly be expected to be in two places …

How this doctor handles the pressures of time

Hans Duvefelt, MD

Physician

October 10, 2016

The pressures of time, the complexity of our patients’ needs and today’s documentation requirements can easily make a medical provider feel less than generous these days. We must counteract that in order to carry on as healers.

All day long, I am conscious of the time as I work my way through my long list of 15-minute encounters. But I am also conscious of the fact that the more pressure I …

The lost art of asking questions

Hans Duvefelt, MD

Physician

October 2, 2016

Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example.

In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.

In some cases, this kind of …

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The lost art of asking questions

3 Dutchmen walked into an eye clinic and the rest is history

Hans Duvefelt, MD

Physician

September 29, 2016

As a severe myopic, it is no wonder I have always had a certain interest in ophthalmology. And just the other day I had reason to ponder the peculiar Dutch dominance in the history of optics and ophthalmology.

When I was a nearsighted young school boy in Sweden, my mother brought me on the bus into town every fall to see the eye doctor. He must have been in his eighties, …

How the integration of behavioral and primary care treats pain

Hans Duvefelt, MD

Physician

September 6, 2016

We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more.

This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it …

A failure in transition of care

Hans Duvefelt, MD

Physician

August 28, 2016

Alvion Barr had a four-month delay in his diagnosis.

He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both other doctors were on vacation.

I saw him late Thursday afternoon for a rash, but he also asked what he could do about his heartburn.

“Tell me more about your heartburn,” I said.

What followed …

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A failure in transition of care