I have been getting lots of requests for my opinion about where we are and what is coming.
The first question is: How bad will the coronavirus epidemic be in the U.S.?
The short answer is, we don’t know – but it could be pretty nasty. An important point, though, is that we are not helpless here. This is not like predicting a weather event where we cannot control where the hurricane …
A doctor’s coronavirus straight talk
This past summer an article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients, so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just, and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, …
It shouldn’t be so hard for patients to correct their medical record
Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.
During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, …
10 rules every primary care doctor should read
Our job — though many of us actually see it more as a calling than a job — is to care for patients.
Documentation is a process whose primary purpose is to support the patient care process. Coding, billing, population management, meaningful use and many other processes may be important to an institution but are of little or no use (and provide …
The absurd barriers to good patient care
There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this …
A physician responds to OpenNotes critics
Sometimes the health care system just does not work.
I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …
An epic fail when it comes to mental health
The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients. Perhaps because it is (happily) not a daily event, or perhaps because it is so much more personal, clinicians do not talk much about what they have learned from being a patient themselves. The other end of the stethoscope is a good place to learn about medical care.
During the diagnostic phase of my …
The best physicians learn from their patients
As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let …
I work for my patient because I care for my patient
“The best defense is a good offense.”
This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.
During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors.
“So, tell me, I know it’s hard to manage both full time school and a part …
Apply folk wisdom to your family practice patients
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”
I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery …
I learned the value of listening to the patient
Shortly after 3:00 I was listening to Chloe’s precise clinical description: her daughter, Mysti, had been fine and “in her usual state of rambunctious health” despite a runny nose and a low grade temperature of 99.8 to 100.6 that mom had not felt warranted treatment because she was eating and drinking and playing normally, and sleeping despite a very mild cough when she lay down.
That morning she had noticed a …
Mistaken identity at the family physician office
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