By HANS DUVEFELT Almost every day I catch a suspicious fax needing my signature. Often it is an out of state vendor who wants my permission to provide a back brace for a diabetic patient, a continuous blood glucose monitor for a non-diabetic or a… Read More »Please Sign Below: Fraudsters Phishing for Physician Signatures
By HANS DUVEFELT Every patient is unique, with some common basic and measurable features and parameters. For a couple of decades now, healthcare has professed to be patient centered. But the prevailing culture of “quality” (and the reality of getting paid for what you do)… Read More »The Parallel Realities of Health Care: Ratio and Intellectus
By HANS DUVEFELT A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep for such procedures work on the brain and don’t concentrate in the shoulder joints at all. An ingrown toenail can… Read More »The Pain Is In Your Brain: Your Knees Know Next to Nothing
By HANS DUVEFELT A while back I was able to completely stop my mastocytosis patient’s chronic hives, which the allergist had been unable to control. I did it with a drug that has been on the market since 1969 and is taken once a day at… Read More »Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks
By HANS DUVEFELT The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions is necessary to document and review when following a patient through their treatment. In the old paper charts, particularly when… Read More »The Art of the Chart: Documenting the Timeline
Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
By HANS DUVEFELT The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed is not on our formulary or the dose is exceeding our limits.” Well, which is it? Nine times out of… Read More »Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
By HANS DUVEFELT The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies to the life of a doctor, too. Personally, I have to do Windows, the default computer system of corporate America,… Read More »“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
By HANS DUVEFELT The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days for a repeat CBC. But she had a late Friday appointment and there was no way we would get a… Read More »The Art of Clinical Decision Making: Friday Afternoon Dilemmas
By HANS DUVEFELT Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 points higher than ever before. In Walter’s case, he turned out to have an acute thyroiditis that caused many other… Read More »The Art of Asking: What Else is Going on?
By HANS DUVEFELT “I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes me consider that they may have something serious going on. The worst thing you can do is give false reassurance… Read More »The Art of Listening: When the Inner Voice Whispers
By HANS DUVEFELT I love cars and dislike computers. My car takes me where I need to go, but it also gives me pleasure along the way. I have had it for just about ten years now and I have driven it almost 300,000 miles.… Read More »Driverless Cars or Keyboardless EMRs? Which Do We Need Most?
By HANS DUVEFELT Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe. Medicine has started to move from an in-person only profession to one that finally recognizes that… Read More »The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine
By HANS DUVEFELT Sooner, rather than later, we will be driving electric cars because of the environment. We use energy efficient light bulbs and recyclable packaging for the same reason. And there is a growing debate about the environmental impact of what kind of food… Read More »Stewardship: We Worry More About the Environment than Our Own Bodies
By HANS DUVEFELT A doctor’s schedule as typical EMR templates see it only has “Visit Types”: New Patient, 15 minute, 30 minute. But as clinicians we like to know more than that. One patient may have a brand new worrisome problem we must start evaluating… Read More »The Art of Listening: Beyond the Chief Complaint
By HANS DUVEFELT Interviewing celebrities can make you a celebrity yourself, and it can make you very rich. So there’s got to be something to it or it would be a commodity. The world of media certainly recognizes the special skill it takes to get… Read More »Physicians’ Communication Skills are Overlooked and Undervalued
By HANS DUVEFELT Meaningful Use was a vision for EMRs that in many ways turned out to be a joke. Consider my list of Meaningful U’s for medical providers instead. When electronic medical records became mandatory, Federal monies were showered over the companies that make… Read More »Meaningful U’s
By HANS DUVEFELT He cancelled his followup 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… Read More »I Cured My Patient, But What Was His Diagnosis?