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
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
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 MATTHEW HOLT Kelsey Mellard is CEO of Sitka, one of the emerging companies that’s providing specialty consults online to primary care docs. They’ve been building a specialty care network that can be accessed by asynchronous video, slightly different to some of their competition. Most… Read More »Kelsey Mellard, CEO Sitka
By ANISH KOKA A recent email that arrived in my in-box a few weeks ago from an academic hailed the latest “paradigm shift” in cardiology as it relates to the management of stable angina. (Stable angina refers to chronic,non-accelerating chest pain with a moderate level… Read More »The Paradigm Shift That Wasn’t: The ISCHEMIA Trial
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 SAURABH JHA and JEANNE ELKIN Mr. Smith’s pneumonia was clinically shy. He didn’t have a fever. His white blood cells hadn’t increased. The only sign of an infection, other than his cough, was that his lung wasn’t as dark as it should be on… Read More »1896 – The Birth of Radiology
By HANS DUVEFELT I sometimes tell patients “I work for the government”, but sometimes I say the opposite, “I work for you”. Herein lies a dichotomy that is eating away at primary care in this country, like a slow growing cancer. I suspect everybody is… Read More »Quality in Healthcare: Cultural Competence, Diagnostic Accuracy or Patronizing Insensitivity?
By YASMIN ASVAT An estimated 1.8 million people in this country may face a cancer diagnosis this year, in what has already been a bleak year of isolation and loss. While news of the COVID-19 vaccine rolling out across the U.S. offers hope in a year of 311,000 deaths, 11… Read More »3 Patient Lessons: What Cancer Patients Teach Me
By HANS DUVEFELT, MD Growing up in Sweden without a Thanksgiving holiday, Christmas has been a time for me to reflect on where I am and where I have been and New Year’s is when I look forward. I have written different kinds of Christmas reflections before:… Read More »A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine
By MICHAEL E. LIPKIN and RUSSELL S. TERRY, JR. Burnout has always been a concern in medicine, and that concern has been amplified by the added stress of COVID-19. Many months into an unpredictable and distressing situation, we have both hung on to our mental… Read More »Two Surgeons—a Veteran and a Newcomer—Talk Fighting COVID Burnout
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 Insurance is the wrong word for what we have here. Our private health insurance system’s prioritization of sometimes frivolous screenings but non-coverage for common illnesses and emergencies is a travesty and an insult to typical American middle class families. State Medicaid insurance for… Read More »CRAZY AMERICA: Health Insurance Covers Testing When You Are Well But Not When You Are Sick
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 MIKE MAGEE The patient/health-professional relationship is fundamentally grounded in science and trust, and involves the exchange of compassion, understanding and partnership. The Covid-19 pandemic has challenged this relationship by acutely increasing the nation’s burden of disease, creating new barriers to face-to-face contact, and injecting… Read More »Health Professionals Are Tomorrow’s Health Journalists. Here is a Code of Ethics to Guide Us and Trump’s White House Doctor.
By MIKE MAGEE The patient/health-professional relationship is fundamentally grounded in science and trust, and involves the exchange of compassion, understanding and partnership. The Covid-19 pandemic has challenged this relationship by acutely increasing the nation’s burden of disease, creating new barriers to face-to-face contact, and injecting… Read More »Health Professionals Are Tomorrow’s Health Journalists. Here is a Code of Ethics to Guide Us and Trump’s White House Doctor.
By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. When patients need a copy of their medical records, most start the process by calling their doctor’s office and asking… Read More »How Can Patients Get Medical Records from a Closed Medical Practice?
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 HAYWARD ZWERLING I walked into my exam room to see a patient I first met two decades ago. On presentation, his co-morbidities included poorly controlled DM-1, hypertension, hyperlipidemia, and a substance abuse disorder. Over the years our healthcare system has served him well as… Read More »Talking Politics in the Exam Room: A Physician’s Obligation to Discuss the Political Ramifications of Science with Patients
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?
By SHVETALI THATTE Late one evening, a trauma patient, a mother of three, comes through on an ambulance. She’s having trouble breathing, despite the breathing tube lodged in her throat. Dr. Nikhil K. Murthy, the neurosurgeon on the case, assesses the situation and orders a… Read More »Why is a 1980 Drill in my 2020 Brain?
By HANS DUVEFELT, MD Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing healthcare institutions are more and more starting to look like shopping malls. They were once traffic magnets, so large that… Read More »Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback
By SYLVIE STACY, MD, MPH As a physician and writer on the topic medical careers, I’ve noticed extensive interest in nonclinical career options for physicians. These include jobs in health care administration, management consulting, pharmaceuticals, health care financing, and medical writing, to name a few.… Read More »Medical Education Must Adapt to Support the Broadening Role of Physicians
By RUCHI GUPTA, MD, MPH The average American elementary school class includes two students living with one or multiple food allergies. That’s nearly six million children in the United States alone. And these numbers are climbing. There was a staggering 377 percent increase in medical… Read More »Everyone has a role to play: Reducing your child’s risk of developing food allergies
By MICHEL ACCAD, MD I recently participated in a debate opposing me to Professor Adam Cifu on the topic of “Evidence-based medicine in the age of COVID.” The debate took place on an episode of Dr. Chadi Nabhan’s Outspoken Oncology podcast. Dr. Saurabh Jha was the… Read More »Equipoise and Its Problems
By CHADI NABHAN, MD, MBA, FACP “The goal for me and for my clinical and research colleagues is to put ourselves out of a job as quickly as possible”. This is how Mikkael Sekeres ends his book “When Blood Breaks Down” based on true stories… Read More »“When Blood Breaks Down”: It Can Break Your Heart