Author's posts
The art of asking where it hurts
Norman Grant was a new patient. He had chronic back pain, not helped by surgery or a dozen injections after that. It all started with an industrial accident in 2001. He had settled his case and was on chronic OxyContin, which far from kept him function…
The art of asking where it hurts
Norman Grant was a new patient. He had chronic back pain, not helped by surgery or a dozen injections after that. It all started with an industrial accident in 2001. He had settled his case and was on chronic OxyContin, which far from kept him function…
Thinking like a plumber when adjusting medications
Recently, I solved a medical dilemma by changing the medication that seemed to have nothing to do with my patient’s problem. Ethan Blake is a thin-boned, soft-spoken man with atrial fibrillation and a history of high blood pressure. He lives alone and …
The American food conspiracy
Everybody knows how to operate smartphones and understands complex modern phenomena, but many Americans are frighteningly ignorant about basic human nutrition. I am convinced this is the result of a powerful conspiracy fueled by the (junk) food industr…
The art and uncertainty of triage
Last week, I became involved in two situations of pain between the eyes that seemed to potentially be presentations of very serious medical conditions. Autumn took a call from her sister late on Friday afternoon. Her sister had been tested for COVID th…
When words mislead in the exam room
Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same language we do. If we “run with” whatever keywords we pick up from our patient’s chief complaint, we can easily get …
Meet the physician who loves his job
I only applied to one medical school. Maybe that was hubris, but I didn’t think so at the time. Then, in a moment of sudden insecurity, I asked myself, “What if I don’t get accepted?” During the six months between my military service and the beginning …
Where’s Waldo: Finding what’s important in the medical record
I did a peer review once of an office note about an elderly man with a low-grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported, and there was a long narrative section that blended active medical…
We need to give more thought to informed consent
Using a treatment without having any understanding of how it works is often thought of as unscientific, and suggesting that a placebo can help a sick patient has until now been viewed as unethical. The New England Journal of Medicine just published an …
I cured my patient, but what was his diagnosis?
He canceled his follow-up appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to my clinic when he had lawns to mow and chores to do. Less than two weeks before that, he was sitting on the exam table in my off…
