My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
Treating patients with chronic pain is one of the more challenging tasks 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.
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:
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.
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.
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.
When this happens, I never know whether I should be frightened or enraged.
It’s been four years since my Dad died.
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.
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.)