Mea sententia...

Mea Sententia translates roughly as 'My Opinion' and has been my intermittent blog since 2011. Much of my writing is about medical issues, but my topics range through philosophy, behavioral and decision making, management, humor, and personal/family anecdotes.


The sale (a metaphor involving 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.

A few years ago, when he made his usual offer and I declined, he looked at me for a very long moment, and then said:

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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.

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A 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.

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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.

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The suboptimal ED evaluation

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


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Father's Day thoughts

It’s been four years since my Dad died.

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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. 

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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. 

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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.)

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PCP pet peeves

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

Just to be clear, the overwhelming majority of specialist consultants DON’T do this. But some do it occasionally and a few do it as a matter of routine. Every time it happens, it rankles.

A few examples:

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