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Choosing the Right Doctor for You.

As my readers know, I have been a parsimonious practitioner during my entire career.   By this, I mean that I believe that less medical care leads to superior medical outcomes.   I have devoted several dozens of posts on this subject within this blog.   This is my medical philosophy.    Other physicians who see the world differently would challenge me suggesting that I deny patients necessary diagnostic tests and treatments.   Personally, I think that I have the better argument, but so do they. Interestingly, over time patients tend to select and stay with physicians who share similar philosophies.   For example, a patient who believes that regular diagnostic testing, frequent labs, a CAT scan now and then, prescriptions for various symptoms is unlikely to remain my patient because of a philosophical gulf between us.     If that individual, for example, expects antibiotics – as his former physician obediently provided – for what the patient believes is ‘diverticulitis’, and I demur

Was the J & J Vaccine Pause Necessary?

 I am not a public health expert.  But I have learned this past year that one need not have any public health knowledge in order issue advice and opinions.  How ‘bout some hydroxychloroquine with a bleach chaser? I trust our public health experts and have largely hewed to their advice, although I’m not sure that they have hit the bullseye every time.    As expected, they have modified their advice over time in response to new knowledge.   This is not a flip-flop – this is how science works. And millions of folks have completely rejected their advice for all kinds of reasons.   We’ve all seen photos of patrons who were piled into bars or kids on spring break who were recklessly partying on.   Masks optional. Others, in contrast, were pushing back on the Center for Disease Control and Prevention (CDC) arguing that the rules were not strict enough.   We’ve seen the teachers’ unions refuse to return to classrooms despite CDC guidance assuring that it was safe to do so, as long as pro

Is My New Doctor Qualified?

When one applies for a job or a position, it is expected that the interviewer will assess if the applicant has the necessary skill set and experience. Doesn’t this make sense?  Consider these examples. A clarinetist applies for a position in a symphony orchestra.   While many criteria will be assessed, he will surely need to audition to demonstrate his musicianship.   Would he ever be hired without playing a note? A college student wants to join the swim team.   The applicant can expect to show off her speed and technique as she cuts across the pool.   Would any coach accept a new swim team member without watching her swim? A journalist for a town paper applies for a job at a large metropolitan newspaper.   The interviewing editor will surely review the applicant’s prior work product to gauge his competence and suitability for the new position.   Would an editor bring on a new reporter without ever reviewing his writings? A college graduates applies to the State Department as a

Overutilization of Colonoscopy - An Unusual Suspect

A week or so before writing this post, a patient came to my office requesting a colonoscopy.   Nothing newsworthy so far.   An individual wanted a service that our practice routinely provides.   Yet, I was reluctant to accede to her seemingly reasonable request.    She wanted a screening examination of her colon in search of a benefit that humans have pursued for as long as humans have existed – peace of mind.   I have found that ordinary folks are often confused by the meaning of the term screening.   Screening exams can be performed on various organs of the body.   When a physician uses the term screening, it means that the patient is not having any symptoms whatsoever.   For example, if I advise a colonoscopy on a patient who is having rectal bleeding or diarrhea, this is considered a diagnostic exam, not a screening test.     "You're paying the bill?  I'll have the steak!" Why does this matter?   Insurance companies often reimburse screening and

Are We Ready for the Next Pandemic?

 While most of us prefer order and routine, life can turn course unexpectedly and randomly.  Of course, we all know this.  For many of us, our occupation, our choice of mates or where we live are the result of some chance occurrence, not the product of diligent planning.   Indeed, this reality adds some excitement and wonder into our existences.  Would we really want to live according to a prescribed routine like a train schedule?   For me, I am most satisfied when my days include my daily routine pleasures seasoned with some spontaneity.  I suspect that this is true for most of us.  However, we differ in the ratio of random/routine that we prefer.   Some of us plan a trip, for example, with each day carefully planned while others prefer to simply land in their destination and explore untethered to a guidebook or a rigid schedule. And no force can set order aside more forcefully than nature.   Here is the scene from our window earlier this week.   Does this look like a typical spring

Should Doctors Pay Patients When We Are Late?

Some time ago, I flew with my youngest kid, then a high school senior, on a college visit.  He’s the last of 5 youngsters, so I’ve had my share of these visits to various centers of knowledge where young minds are molded to face uncertain and unknown futures.   While I’ve never found these visits to be substantively valuable, they were of great value to me as it was fun to be with them on these exciting excursions. The Hallowed Halls of Higher Learning Photo Credit The formats of the school presentations are superimposable.  There’s an information session, which serves as an infomercial that tries to draw students to apply.  Schools favor receiving large volumes of applicants so that their acceptance rate will be lower and they will appear to more selective than they actually are.   How cynical of me to suggest that there are forces in academia that might be pursuing a self-serving agenda! These sessions are led by effervescent young cheerleaders who present a power po

Why I Don't Advise Patients to Quit Smoking

I don’t advise patients to quit smoking. I don’t exhort alcoholics to stop drinking. I don’t preach to my obese clientele to slim down. And I don’t lecture patients to get the COVID-19 vaccine. This may be the point were some readers are wondering, “What kind of doctor are you?” For the record, I do not endorse or advise cigarette smoking, alcohol addiction, obesity or careless behavior during the pandemic.   I favor temperance in my own life.   I exercise.   I am attentive to my BMI. And I wear a mask and have received my COVID-19 injections with enthusiasm. But it has never been my style, either professionally or beyond the office, to tell people what to do.   Once folks reach a certain age, which for many are the teenage years, you just can’t make them do stuff.   Every parent understands this.  This does not mean that I don’t have influence over people who trust me.   I do and I use it.   However, i t’s a process issue.   How best can we help individuals make sound deci