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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
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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

Memorial Day 2024 - A Time to Reflect...

Tomorrow is the last Monday in May, Memorial Day, now a federal holiday whose origins began in the postbellum era.  My father was among the Greatest Generation having served for 39 months during WWII.  Fortunately, he remained stateside. Presently, no one in our family is wearing the uniform.  We are not mourning a fallen soldier.  But many families are.  For many of them, every day is Memorial Day. I’ve been writing this blog for 15 years.   Several posts have criticized our government, politicians, various industries and even my own profession.   What might my fate be if I were blogging from some other nations? American Military Cemetery in Normandy Freedom is not free.   Authoritarianism seems to be on the rise, even here at home. To all those who are honoring the memory of a loved one who served, we can never thank you enough. May their memory be a blessing  

Electronic Medical Records Fail Patients and Doctors

Patients have many legitimate gripes about the medical profession.  Medical professionals have our own list of pesky frustrations.  Overall, the profession is operating well, but there are well known deficiencies and flaws that are correctable and yet never seem to be addressed.  This is a frustrating reality, particularly for physicians who are wired to improve and correct what can be fixed.  Yes, the system is complex.  Yes, there are competing stakeholders who are angling to protect their power and economic interests.  Yes, despite an explosion of nurse practitioners and physicians’ assistants, patients still cannot obtain timely appointments.  Yes, many medicines are too expensive even for folks who have insurance.   Yes, medical bills are simpler than they used to be, but remain downright inscrutable for many of us.  Yes, electronic medical record (EMR) systems are omnipresent, but why isn’t there a universal EMR so that allows any physician to access all of a patient’s records?

Tough Questions to Ask Your Doctor

Physicians handle thousands of questions annually. We respond to inquiries from patients, their families, insurance companies, nurses, professional colleagues, pharmacies, our staff and even strangers.  This is, of course, a part of our job, and it consumes a substantial amount of our time and energy. Questions come via homing pigeon Questions come via telegraph Was Alexander Graham Bell Calling his Doctor for a Question? And, responding to questions is not as easy as you may think.   Words matter and a clumsy word choice or an omission can wound instead of heal.   Here are some of the challenges we face when a medical inquiry is directed toward us. We may not know the answer. We may misunderstand the question and may misfire with our response. We may have incomplete data and need to calibrate our response accordingly. We may not be aware of the questioner’s true intent and anxiety.  For example, the question may seem innocent, e.g., “Is it normal