Author's posts
A physician moving back and forth along the Teflon spectrum
I guess I should take it as a compliment when patients come to see me after visiting a specialist and ask me a bunch of difficult specialty-related questions. “Did you ask the specialist that?” I typically ask, and the answer will be a plain “no.” I’ve…
Hospitals are no longer an important part of the social safety net. That’s a problem.
“Admission diagnosis: causa socialis” In my training in Sweden, it was not unusual to admit patients to the hospital for social reasons: an elderly person who could no longer manage at home, a person whose social network fell apart, and so on. “Social …
Health care is on a different trajectory from most other businesses. Why is that?
Health care is on a different trajectory from most other businesses today. It’s a little hard to understand why. In business, mass market products and services have always competed on price or perceived quality. Think Walmart or Mercedes-Benz, even the…
Suboxone for pain makes sense. Why don’t more doctors prescribe it?
Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them. Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that …
Doctors overcorrect too often
Back when cholesterol target numbers ruled unopposed (before 2013), we all checked fasting lipids every three months. Before 2012, we also checked liver function quarterly in hapless riders on the cholesterol pill merry-go-round. That year the FDA anno…
We need more behavioral health treatment in primary care
I don’t know how many times a patient has told me, “I was in therapy once, and it didn’t help.” My response is always: “That’s like saying ‘I saw a movie once and I didn’t like it’.” That usually breaks the ice just a little. In primary car…
Transdiagnostic therapies in primary care
I learned a new word recently: transdiagnostic, which refers to something that is applicable across a spectrum of conditions. It seems that this is becoming an increasingly popular concept in treating anxiety disorders. No wonder. As I researched this …
When patients can’t tell you their symptoms
Today I had a followup appointment with a young adult male with severe intellectual disabilities. He is barely verbal. Several weeks ago his caregiver told me that this young man often pointed to his chest and would say “hurt” or “heart,” they weren’t sure which. He also seemed to have gotten pickier about his food, […]
Primary care does what Google can’t
Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on. People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the […]
Medicine is a word with 3 meanings
Everybody is a stakeholder these days in what we broadly call medicine, or health care. But there is little agreement on what medicine is and what the priorities of the health care “industry” should be. I propose this breakdown of medicine into three separate phenomena. 1. Micromedicine 2. Macromedicine 3. Metamedicine Let me explain: Micromedicine: […]
