Mea sententia...

Mea Sententia (which translates roughly as 'My Opinion') 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 persona/family anecdotes.
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On the road to shared office visits

This is a repost of something I wrote in 2012 about how I discovered that doing collaborative officie visit notes with patients transformed the process for both the patient and myself.


 

Nearly a year ago I embarked on an adventure that has been changing how I practice medicine. It is also changing how medicine feels. 

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Memo to my successor

You are about to have the honor and great pleasure of working with a group of patients I have come to know and respect over the years. While I cannot tell you how to practice medicine, I feel no reluctance to tell you what made it so worthwhile for me.  

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Retirement message to my colleagues

Here is the letter I sent my colleagues upon my retirement from active practice in December 2015.

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Shared decision making in action

Shared decision making based on both evidence and patient preference is popular in the medical literature of late.  I don’t understand why anyone would object.

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The weather delay

Some of the best and most unexpected moments I’ve had in medicine have involved children.

Sitting on her mother’s lap while I elicited the story of her illness, this particular three year old had seemed relaxed, social and quite articulate. Taking a cue from how attached she seemed to be to Mom and her obvious unusual maturity for age, I tried to be clever when it came time for the exam. “Do you want your Mom to help you up onto the table so I can check your ears and lungs, or are you big and strong enough to do it yourself.”

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The knee injury

The computer generated routing slip on the exam room door said he was there because of a knee injury. That turned out to be only partly true.

 

When I entered the room, he was sitting comfortably on the exam table. I introduced myself, we shook hands, and as I sat down at the computer to open the EHR to his chart, I started with my usual fairly open-ended question:

Me: So, what brings you in today and how can I help?

Him: I hurt my knee this past weekend. (Note: this was a Wednesday.)

Me: Tell me about it.

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Dragonflies

Beauty is where you find it. Here are some photos of dragonflies…. Click here for the slide show.

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Physician burnout

I see and hear about more and more unhappy physicians, some of whom become happy former-physicians. It makes me reflect on my own circumstances.

Research suggests that the four major underlying contributors to physician dissatisfaction and burnout are

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Screening doesn't save lives.

I received a memo recently from an institution, extolling the virtues of its screening programs. It was entitled:

Screening Saves Lives. 

It was in large block capitals. I call bullshit on this.  Screening does not save lives. FULL. STOP.

This simplistic and self-serving public relations material is a typical example of common screening fallacy, that screening is an action that saves lives. This is worth deconstructing.

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Colorectal Cancer Screening: unFIT for prime time?

It can be amusing when people mistake the map for the territory (sometimes called the reification fallacy). When it harms my patients, though, it pisses me off. And it isn’t just me, or my institution: two physician friends (in other states) tell me they are seeing it as well.

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