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.

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.”

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.

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

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

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.

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.

We couldn’t find her sneakers anywhere. They weren’t in the travel bag, under the bench in the mudroom, in either car,  at friends’ houses, in the closet or under the bed. After two days, we gave up and bought a new pair sneakers.

A recent 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.

"The art of progress is to preserve order amid change and to preserve change amid order. "

(Alfred North Whitehead)