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Ten principles for clinicians

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.  During my 30+ years as a family doc, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten core principles I have found useful, with some comments and exposition.

1. It’s always about the patient

The Reason

At the suggestion of a colleague, I submitted one of my blog posts to the FMEC ‘This I believe’ contest. To my surprise, it was selected as an award winner, and this past Sunday, October 22nd, I attended their annual Northeast meeting to read my essay (accompanied by a slide show of my photographs) and receive my award.

An updated Covid risk calculus

Covid is still very much with us, and will remain a significant public health problem for the foreseeable future. However, the Covid landscape has changed substantially over the nearly 4 years since it arrived. I recently spent some time reviewing and updating my assessment of my risk and my process for deciding what I am comfortable doing.  

I will start with my understanding of my personal risks, which I divide into three categories: acute or short-term risks, chronic risk related to long Covid (PASC), and long-term risks from Covid’s impact on other disease processes.

Successful safe socializing in the era of SARS-CoV-2

I was invited to a New Year's Eve Day gathering of some friends who have met annually for a couple decades or more, but who had not met during the pandemic. Our group number 25-30, all in our 70s now. The invitation said masks were 'welcome' but said nothing more about precautions. I was thrilled and excited, but also puzzled at the lack of mention of testing.

Covid and RAT testing: Timing is everything!

A friend recently shared online that he was at Day Seven of a flu that had been ‘kicking my butt all week’. With fever, sweats, cough, fatigue, muscle aches. He’s a smart and responsible guy and had RAT-tested himself twice at the onset of his symptoms and assumed because his two RATs were negative and his symptoms were consistent with Influenza A which was known to be present in his areas, it meant it he didn’t have Covid.

I suggested he retest himself (the explanation is below) and he reported a definite and nearly immediate positive:


Responding to the 'but 99% survive' argument

Among the many candidates for arguments against taking action to protect our families, friends, colleagues, neighbors, communities and country from COVID, none make me angrier than the "but 99% survive" gambit. This argument is numerically illiterate (Mark Twain said “It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so”), racist, ableist, and inhumane. Let me explain.

An Obsession with Metrics

I precipitated a recent online discussion about healthcare’s obsession with measurement (quality metrics is the current buzz phrase) when I quoted two aphorisms that highlight some problems with metrics and targets:

Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure,"

Campbell's Law: "The more a metric is used, the more likely it is to "corrupt the process it is intended to monitor."

One comment rubbed me the wrong way because it implied that measurement reduces harm: