Mea sententia...

Ironing out a diagnosis

Rachel called about her elderly father, Blaine, better known to me as Bucky. She requested a ‘nerve pill’ to calm him down at night and a referral to a neurologist to test for dementia.

Why bother

A professional colleague and I were discussing (bemoaning) how hard it is to do quality primary care. She asked why I bothered to keep pushing for change in the face of so much institutional resistance and evidence that it was pointless. I told her, what we put up with is what we end up with.

In return, I asked her why she didn't push back and demand change if she is so unhappy about the way things are?  

Her response: "Well, I watch you, and I can see that it is pointless."


 

I teach to remain a learner

Teaching in our local family practice residency is one of the most enjoyable parts of my week. When a colleague recently asked why I liked it so much, it took some reflection to answer.

If you don't ask, they won't tell

In medicine, unlike much of the world, it is the questions one doesn’t ask that lead to trouble. When taking a medical history, the biggest enemies are time and fear. Time, because there is never enough to ask all the questions, listen carefully to all the answers, and pursue all the possible clues. Fear, because the natural reluctance to ask certain questions is a trap.

Strep carriers and the slippery slop

I was taught that being an asymptomatic carrier of strep in the throat was not associated with either illness or risk of complications. That’s not always true. The schedule said ‘strep throat x 5 weeks and diarrhea.’  Handing me the encounter form, my nurse warned me: ‘Mom’s not a happy camper.’

Those other questions...

Throughout our medical training we are told again and again that the most important task is an accurate diagnosis. And we hear it at CME lectures and read it in journals. An accurate diagnosis is certainly essential if one wants to offer successful and safe treatment.  But it is not enough to ask and answer: “What is the diagnosis?”

There are several other questions that every experienced clinician asks - and answers - with every visit. Or should ask. We skip these questions at considerable risk to our patients.

Communication failure

George Bernard Shaw said: “The single biggest problem in communication is the illusion that it has taken place.”  

Ignorance and black cats

Science is not a linear or predictable path to truth.

When the doctor is biased

recent commentary in the New York Times eloquently addressed the phenomenon of psychiatric diagnoses biasing clinicians and resulting in poor care. One concern that arose in the comments was that this might increase the likelihood that patients would withhold crucial diagnostic and therapeutic information, to their detriment. 

Wisdom of a centenarian

I made an extra trip to the nursing home to visit him on his hundredth birthday. 

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