Medicine

For content related to the science and practice of medicine

Behind the curtain...

As I watched my 17 month old granddaughter decode the world, it was impossible not to marvel at the enormity of the task and wonder what was going on behind that so expressive face as she processes the flood of sights, sounds, feelings, tastes, experiences, and consequences. Some predictable, but many not.

 

Reflections on retirement

Since I retired, I have repeatedly been asked two questions. “How do you like retirement?” and “Don’t you miss practicing medicine?”

Building boats and EHRs

Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.

Before you build or buy a boat, you need a defined goal and a process:

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. 

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

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.  

Retirement message to my colleagues

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

Doing nothing - but doing it right

It’s always easier to do something than to do nothing. Doctors often offer treatments for things they know are what we call ‘self-limited’ meaning that they will clear up all by themselves.  I think this form of unnecessary treatment reflects an awareness that although many things resolve without intervention, both doctors and patients are driven to DO SOMETHING. Though it is usually tempered by the wish to do something as benign as possible, sometimes doing nothing is the best choice. The trick is knowing how to do nothing properly.

Humility and medical guidelines

We have LOTS of guidelines and recommendations. We could use LOTS more humility.

The Advisory Committee for Immunization Practices (ACIP) issued a recommendation in September of 2014 that pneumococcal vaccine naive individuals 65 and over get a Prevnar13 followed by a Pneumovax 6-12 months later, and that those who have had a Pneumovax get a Prevnar13 a minimum of 12 months after their Pneumovax.

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