Today's thought

Do you know the difference between education and experience? Education is when you read the fine print; experience is what you get when you don't. Pete Seeger

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Mea sententia...

Jul 29, 2014

Narcotic contracts, a terrible idea

Treating patients with chronic pain is one of the more challenging tasks in primary care: how to measure pain, how to quantify disability and quality of life, how to balance to benefits of pain relief with the potential risks of medication, that it is usually multifactorial rather than simple, how to manage the almost always associated significant mood disorder.  (If you hurt all the time and can’t sleep, guess what happens?) Some of the most troublesome issues, however, are not clinical. I recently wrote about the increasingly common - but problematic - use of urine drug screens (UDS).  Similar issues underlie the (mis)use of ‘narcotic contracts’ as a requirement for prescribing opioids for chronic pain.

 

Categories: Medicine

Jul 22, 2014

Urine drug screens (UDS) in primary care

Ordering periodic urine drug screens (UDS) on patients being treated with opiates for chronic pain has become so common it is now the de facto standard of care. That doesn’t mean it benefits patients. 

 

Categories: Medicine

Jul 15, 2014

The sale (a story of chaps)

Every year when I brought my chain saw in to be serviced and have the blade sharpened, Reggie tried to get me to buy a set of chaps. They weren’t cheap, and, while I was not the least bit sanguine about the destructive power of the saw, I used it infrequently, only in good conditions, and with care. The chaps were a garish orange, and I always declined.  Reggie always shrugged, looked disgusted, and rang up my bill.

 

Categories: Medicine

Jul 08, 2014

Friction in primary care

I love taking care of patients and have enjoyed my 37 years (and counting) as a primary care physician.  When I stop, it won’t be because I am rich, bored, or have lost interest. It won’t be because I am tired (though I am). It will be because of friction.

 

Categories: Medicine

Jul 01, 2014

Requiem for the 15 minute appointment slot

The 15 minute appointment slot is dead.  To borrow from Monty Python, it is not resting, stunned or pining for the fjords, but definitely deceased, stone dead, is no more, has ceased to be, expired and gone to meet 'is maker, a stiff, bereft of life, run down the curtain and joined the bleedin' choir invisible.

 

Categories: Medicine

Jun 28, 2014

Medical quality and the World Cup

As medical institutions roll out one new broken quality protocol after another, I have struggled for a way to point out the irrationality of this approach. Reading some commentary about the US attempt to achieve excellence in international soccer during the recent run-up to the World Cup gave me an idea.

 

Categories: Medicine

Jun 22, 2014

The inadequate ED evaluation

When this happens, I never know whether I should be frightened or enraged.

 

Categories: Medicine

Jun 15, 2014

Father's Day thoughts

It’s been four years since my Dad died. Sometimes I think of it as ‘only’ four years ago, and sometimes I think of it as a long four years ago.  But I still think about him often and he remains a daily presence for me, through the things he stood for and the way he lived. A few examples come quickly to mind on Father’s Day.

 


Jun 08, 2014

Information in medicine

Information is the currency of medical care. Transparency is the way it is vetted. Communication is the way it is shared.  Collaboration is the way it generates patient-centered outcomes. The right information must always be available to the right people at the right time in the right format.

And, by ‘available to the right people’ I don’t just mean the PCP or the consultant.

 

I mean the patient. 

 




 

Categories: Medicine

May 29, 2014

West Paris Snowy Owl

Today on the trip from Auburn (Maine) to Montpelier (Vermont) my wife spotted the Snowy Owl she had heard was hanging out near the Elk Farm just north of Snow Falls.  It was sitting on some wires over Moose Lake Brook. Check below for my photos…

 

Categories: Photography

May 29, 2014

Seven questions to ask before a test

When your clinician suggests a test, here are seven questions you should consider asking. (And if you are a clinician, you should be asking yourself these questions before you recommend the test.)

 

Categories: Medicine

May 22, 2014

PCP pet peeves: doing the consultant's work

Ask any primary care clinician for a list of pet peeves and one of the top three will be: “Doing my consultant’s work.”

 

Categories: Medicine

May 15, 2014

The spam sign

Obsessive compulsive disorder (OCD) is both familiar and common.  This week in the office, I came across a manifestation that I think warrants reporting. I call it the Spam Sign.

 

Categories: Medicine

May 08, 2014

The postcard relationship

I met Wes when were both counsellors at the same summer camp in Rhinebeck, NY. I had just graduated from high school and he was a graduate student, a gifted musician, and willing to help me find my way through a troublesome summer.

 


May 01, 2014

Association, causation, and the worship of surrogates

I am constantly amazed at how many smart people in medicine and in medical leadership or policy positions fail to grasp the difference between association and causation, and end up focused on a surrogate rather than the issue.

 

Categories: Medicine

Apr 29, 2014

This won't end well...

We live in a society absolutely dependent on science and technology and yet have cleverly arranged things so that almost no one understands science and technology. That's a clear prescription for disaster. (Carl Sagan)

 

Categories: Science

Apr 22, 2014

Don't let them Pick(er) on you!

I have a message for my colleagues and co-workers: don’t let them Pick(er) on us.

 

Categories: Medicine

Apr 15, 2014

Patient education or marketing?

The distinction between marketing and patient education can be very subtle.  Or not.

 

Categories: Medicine

Apr 08, 2014

In praise of the history

In medical school, I was taught to TAKE a medical history in such as way that I didn’t MAKE a medical history.

 

Categories: Medicine

Apr 01, 2014

The interview tell

It was the summer before my last year of medical school and I was traveling around the US for family practice residency interviews. My wife and I were staying with some of her college friends while I looked at a program in Denver.

 

Categories: Medicine
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