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Prescribing Antibiotics Over the Phone

With some regularity, patients contact me requesting antibiotics.   Many patients regard this as a casual and routine request, but I don’t.  When I hit the ‘Send’ button authorizing an antibiotic – or any medication refill – I am declaring that I personally agree that the medicine is medically necessary.  In general, I sign off on most routine medication refill requests without issue, unless the patient hasn’t seen me in the past year or so.  I would hesitate to refill if patient communicates that his heartburn is worse and requests that I double the dose of his reflux medicine.  This patient will be asked to see me in the office. There are times that I will prescribe antibiotics without an office visit.   This assumes that there is an existing professional relationship between me and the patient and that the medical facts support sending in a prescription.   There also needs to be a reservoir of trust such that the patient would contact me if his symptoms are not responding.    I wo
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Ozempic for Weight Loss - Safe for Indefinite Use?

Have you ever heard of a drug called Ozempic?   Just kidding.  As we all know, this medicine and numerous related drugs are the rage.  It is classified as a GLP-1 drug.  The percentage of my patients who are taking these drugs is steadily rising.  Of course, initially Ozempic’s purpose was in diabetic management.  Once it was discovered that weight loss was a ‘side-effect’, a new therapeutic mission was discovered.  Indeed, public demand to use this medicine off-label for weight loss has risen sharply.  Currently, there are two GLP-1 agonist medicines that the FDA (Food and Drug Administration) has approved for obesity treatment.  I can promise you that pharmaceutical R & D on similar and next-generation weight loss pharmaceuticals is supercharged.  Why the interest? There is an obesity epidemic in America. The medical, financial and societal consequences of obesity are staggering. Diet and exercise options are insufficiently effective for most individuals. Prior weight loss medi

Independence Day 2024 - Now More Than Ever

A few days hence, Independence Day will be upon us.  This commemorates the date that the Continental Congress adopted the Declaration of Independence.  Two days prior, the Congress voted unanimously to separate from Great Britain, but the document had not yet been printed.  One would hope and expect that this occasion would summon our better angels as we draw together to celebrate the miracle of the American experiment, particularly as authoritarianism abroad has gained strength.   Sadly, division and disunity have established a firm foothold in our national psyche.   Even the very symbol or the United States – the Star-Spangled Banner – has become a separating force.   Recently, an American flag was flying upside down at the home of a Supreme Court justice.    Legal?   Yes.    Unifying and proper?   No. A looming presidential election – heretofore a unifying exhibition of patriotism – has infected us with partisanship and anger.   How can we emerge from this labyrinth?    There

Unnecessary Medical Tests - Where to Draw the Line?

How much medical uncertainty can you tolerate?   Most patients have not given much thought to this consequential issue, but it hovers over them in their doctors’ offices.  This is also an issue for medical professionals.  Indeed, how both sides in the doctor-patient relationship navigate through this will be instrumental in choosing the pathway forward. Medicine is not mathematics.  It’s a murky discipline with incomplete data and moving targets.  Many of your symptoms – fatigue, abdominal pain, nausea, weakness, sleep disturbances – often cannot be reliably explained.  How much testing in such cases is reasonable?  I offer no response as this issue needs to be negotiated between the patient and the physician.  Since patients and doctors have different philosophies and experiences, there will be several correct and reasonable responses.  This is why a second opinion may yield different advice but not necessarily better advice. An 80-year-old patient who has endured much medical t

Father's Day 2024

We do our best to appreciate the blessings that have been bestowed upon us.  On a regular basis, I remind myself to do so as it is human nature to take these things for granted.  When I walk through a nearby park on my own power, breathing fresh air and absorbing the sounds and scenes of nature, I know that I am experiencing a gift. Gazing skyward in the park. As we all know, or will know, the value of something or someone becomes apparent when it is no longer there.   Pause and take notice.   Listen to birdsong.    Send a friend a note.    Hug your dog.    Sing to the radio in the car.    Cherish beauty in the world.    Treasure your time with loved ones. A young boy and his father.

Can Artifical Intelligence Replace Your Doctor?

Artificial intelligence (AI) has moved into physicians’ exam rooms in my institution, albeit on a beta testing basis. Software will be able to listen in to the conversations and then generate an office note.   AI will be able to distinguish among the patient, the physician and others present.   One of the casualties of this innovation is that patients will no longer enjoy the experience of watching the physician spend most of the allotted time pecking on the keyboard without eye contact. Yes, doctors and patients in the AI era will be nostalgic for the good old days when physicians battled and often surrendered to their computer adversaries. Does AI generated office notes sound too futuristic?   We ain’t seen nothing yet.   I suspect that most of AI’s future role in my profession and yours and elsewhere is beyond our imagination.   We're entering a new dimension! At least in the short term, physicians will need to review AI generated notes for accuracy and may be required to

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting any professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   I wonder how far this fake news had extended.    Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and studying, tw