Author's posts
The art of off-label prescribing
Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails. Sometimes th…
Despite the talk about team-based care, physicians today are isolated
My first job after residency was in a small mill town in central Maine. I joined two fifty something family doctors, one of whom was the son of the former town doctor. I felt like I was Dr. Kiley on Marcus Welby, MD. I didn’t have a motorcycle, b…
Physicians are problem solvers and artists
I keep thinking about the dichotomy between covering a lot of ground and getting to the point. The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be t…
A diagnosis of pneumonia in a rehab facility: We can do better
I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups. He fell and broke his hip. Then he went to skilled re…
The role of hatred in medicine
Most Saturdays, I join a therapy session down the hall from where I do my walk-in clinic. A patient of mine has a weekly session just before the Alcoholics Anonymous meeting at noon in our big conference room. Last weekend he told my behavioral health …
Physicians can’t do everything for everybody in every visit
How long does it take to diagnose guttate psoriasis versus pityriasis rosea? Swimmers ear versus a ruptured eardrum? A kidney stone? A urinary tract infection? An ankle sprain? So why is the typical “cycle time,” the time it takes for a patient to get …
Is primary care an unnecessary roadblock?
A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties…
This story happens every week in clinics like mine and it’s got to stop
Jeanette Brown had lost twenty pounds, and she was worried. “I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine: A normal weight, diet controlled diabetic for many years, he…
In the era of team-based care: Some decisions have to be made alone
There is a lot of talk about team-based care nowadays, and I had seen some shining examples of that, most recently when a patient at my clinic had a suicide in the family. But at the same time, there are so many decisions – judgment calls, really – tha…
We need RVUs for obtaining a prior authorization
I haven’t counted how many times this happens every month, but I find it annoying. I send a prescription for a drug (sometimes not even expensive) to the pharmacy and soon after, I get a fax asking me (or my medical assistant) to go online and print a …
