Author's posts
It’s the physician’s job to think of worst-case scenarios
I saw two patients with a chief complaint of bubbles in their urine this month. One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK. Even though she was […]
A case of instant gratification in primary care
Few things in primary care give patient and doctor mutual and instant gratification. It’s been a while since I reduced a “nursemaid’s elbow” or a spontaneous shoulder dislocation other than my own, or a finger dislocation, but those all count. I once wrote about curing deafness in a man with a movement disorder by flushing ear […]
Real doctoring means mitigating the fear patients have
It’s been said in the world of business that people only buy two things: good feelings and solutions to problems. In medicine, the single most important factor that brings patients through our doors isn’t a “toward” kind of desire, but an “away” one — away from feeling bad. More specifically, it is pain and fear […]
Behold the power of clinical triads
A few weeks ago, I saw a patient with shortness of breath during my Saturday clinic. He had been short of breath for a few weeks, and on a couple of occasions, he had also experienced mild chest pain. He has known aortic stenosis, moderate according to his last echocardiogram two years ago. My brain […]
The problem with telephone messages in primary care
Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with. The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.” With more than fifty calls in my […]
The many ways to describe chest pain
There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland. But there are even more words than that for “chest pain” among my patients, many of whom […]
Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that. I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and […]
Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that. I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and […]
The double-edged power of the medications we prescribe
My patient, a rugged sixty year old with massively muscular forearms, gray chest hair at the V of his denim shirt, and a voice that suggested years of liquor and unfiltered cigarettes, lowered his voice and leaned forward. “I’m not usually scared of anything, but for three nights now, ever since I started taking the […]
How urgent care rejuvenates this primary care doctor
I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients. It has been an interesting journey. Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see […]
