A Country Doctor Writes:

Notes from a doctor with a laptop, a housecall bag and a fountain pen

A COUNTRY DOCTOR WRITES:
A COUNTRY DOCTOR TALKS:
Hans Duvefelt, MD
Archive

Archive

Doctors Working for Free
Be Thankful for Ordinary Days
My First Case of Restless Chest Syndrome?
More Pictures From the Life of a Country Doctor
The Dangers of EMR-Defaulted Prescription Stop Dates
The Broken Promise of Computers in Healthcare: A Doctor From the B.C. Era Explains
A Country Doctor’s Life
How Much Time Should Doctors Spend With Their Patients?
From Warrior to Wise Man: Former Coast Guard Reflecting on the Healthcare Workplace
A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)
My Fibromyalgia Patient With Chronic Back Pain and Gout Swears That Colchicine is a Miracle For All Three of Her Painful Conditions
Award Day
Acceptance Speech (long version): 2022 Carol Eckert, MD Memorial Award, Maine Primary Care Association
Awarded by the Maine Primary Care Association:
Delivering Health Care is Like Practicing a Religion
Make it So
Your Doctor Remembers Most Things About Medicine, But Not Everything About You
Five Plain Truths About Gout
I Do Fewer Elective Procedures Now Than When I Started Out. This is Why:
A Renaissance For Phrenology? (A Country Doctor Reads 8/24/22)
Replay: A DOCTOR’S PARTING WORDS
Don’t Be Insulted If I Prescribe Narcan Along With Your Pain Medication
The Intrusive, Insensitive Nature of Primary Care
7687
Understanding a CBC (Complete Blood Count)
Abnormal Lab Tests: Not Always a Sign of Disease
Dosing Warfarin: From Flowsheet to Workflow. Is This Progress?
A Country Doctor Reads: Consider the Vagus Nerve, No Matter What Seems to be the Diagnosis | The Wall Street Journal
A Country Doctor Reads: The Solution Shop and the Production Line — The Case for a Frameshift for Physician Practices | NEJM
Changing EMR Again: Goodbye Greenway, Hello Epic
The Useless, Almost Drive-Through, Nearly Touchless, Free But Expensive and Wasteful Physical Exam
Somebody Stole My Inhaler Idea. Finally!
There Are Too Many Back Seat Drivers in Medicine Today
Quick and Easy: How to Save Primary Care
All These Gut Feelings: A 10-Year Old With Belly Pain
Don’t Eat More of Anything (Until You Decide What to Eat Less Of)
Why Can You Have Angina With Normal Coronary Arteries? For the Same Reason You Can Have Heart Failure With Preserved Ejection Fraction
Another Gut Feeling: A Case of Visceral Hyperalgesia?
Big Leg, Little Leg: The Lymphedema That Came and Went (Comments invited)
Health Care Through the Back Door: The Dangers of Nurse Visits
Since When? Looking for Change: The Heart of the Art of Diagnosis
A Very Near Miss: The Worst Bout of Sciatica Ever
Notes From My Sick Bed: Cold War, Viruses and History Repeating Itself
How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work
Hijacked for Public Health Purposes: Previsit Planning and Morning Huddles
A Stubborn Rash: When Doctors Don’t Communicate
A Country Doctor Practices Bibliotherapy: Books by Prescription
Always Looking for Zebras
The App That Helps Me Be a More Patient Centered Physician
The Misunderstood Medicinal Use of Yogurt
I Heard About Chilblains in British Television Shows, Not in Medical School
Care Reminders? No Time to Think on the Clinic Assembly Line
A Year of Extremes: From Medieval Masks to mRNA Vaccines; From Science Denying Flat Earthers to the Prospect of Civil War
I Hate to Encourage Pharmacy Shopping, But I Have to
Another Christmas Message
Why I Tell My Patients They Can Take Their Levothyroxine With All Their Other Medications, Even With Food
Broken Relationships and Sudden Social Isolation are Like Opiate Withdrawal (BOTSA via NYT)
What the Pandemic Taught Us About Public Health
Why is the Patient Here?
The Healing Power of Even Virtual Human Connection
There is Comfort in a Name
This Time, it’s Different: The Man Who Cried Wolf and the Doctor Who Listened
Is This Really a Time to Give Thanks?
Dumbing Down Doctors: A Profession Without a Language
Old Information
A Kind Review of My Books in FAMILY MEDICINE
Behind the Mask
My Patient Has Hepatitis C. He Tested Positive Five Years Ago And Nobody Told Him
A Wasted Peer-to-Peer Call for my WellCare Patient
Confusing Numbers in Medicine
“I Just Want an X-ray”
A Back Door to Treatment
N 95 Mask As Screening For COPD?
“Has a Bad Cold, Please Call”
An Anxious Man With Coronary Plaque
Don’t Take an Aspirin and Call Me in the Morning
Dear Uncle Marcus (Welby):
We Use Too Many Medications: Be Very Afraid of Interactions
How to be an Expert: Narrow Niche or Novel Juxtaposition
A Country Doctor Reads: New Swedish Psychiatry Celebrities on Incels and Narcissists
Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target
A Gut Feeling: Could This Case Really Be That Simple?
We Shouldn’t Tolerate Sloppy Allergy Lists
American Primary Care is a Big Waste of Time (When…)
Still Smiling At “A Moving Target”
I Am a Decision Maker, Not a Bookkeeper
A Country Doctor Reads: THOUGHTS OF A TEENAGER (and a Blast From the Past)
Swedish Telemedicine Psychiatric Prescribing
A Man With Sudden Onset of Gastroparesis
Labor and Delivery
Anxiety, Worry or Fear? Disappointment, Grief or Depression?
Friday Afternoon: Elevated D-dimer. Ho, Hum
Cold Feet
Progress Note: August 31, 2021
We Are Living in the Dark Ages, and Night May Soon Fall
Burnout? Not Even Close!
Wading Through Unsorted Requests: I Don’t Care If You Call Them “Tasks” Or “Jellybeans”, It’s the Stupidest Thing About EMRs
Speaking of Bile: We Should Consider It More Often
Revitalizing the U.S. Primary Care Infrastructure | NEJM
I Just Diagnosed a Case of SOD, Although I Admit I Wasn’t Quite Familiar With It
“That New Medicine You Prescribed…”
A Woman With Classic Angina and Two Test Abnormalities: Artifacts, Really??
Whose Medical Necessity Is it Anyway?
Add a Medication, Don’t Switch (Yet)!
Health Insurance is a Stumbling Block in Many Patients’ Thinking
Self Care During the Pandemic
A Country Doctor and the Ancient Wisdom of a Samurai Physician
Medical Imaging is Less Revealing and More Subjective Than Patients Think
In a Perfect World, Ancient Drugs Would Not Cost More and More Over Time
“Patient Requests 90 Day Supply”
The Lazy Man’s Guide to Calorie Counting
The Middle Age Creep
A Country Doctor Writes eBook Price Drop
EHRs Are Workarounds, Rerouting the Way Physicians Work
Getting to the Doctor When You’re Sick and Scared
“I Thought I’d Wait Until My Appointment”
Anxiety? It’s All in Your Head. Your Sinuses, to Be Exact
Practicing Where the Action Is
When Dogs Lick Their Wounds
The Power of Silence (Reflections on Writing)
An Easy Choice
The Case of the Stop and Go Pills
Set It and Forget It: My Successful First Use of Ambulatory Blood Pressure Monitoring
Patient: “Another Doctor Said Keto Was Bad For Diabetics” – Me: “Let Me Tell You the Story of the Flex Fuel Man”
Funny Examples of Swedish Medical Terminology
“Fruit is God’s Candy”
The Art of Diagnosis: Go With Your Gut, Dig Deeper, Step Back or Start Over
When I Escalated His GERD Treatment, My Patient Got Worse. Now I Know Why
“This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder
Another Birthday Reflection
Fatigue, Tinnitus, Dizziness and Dyspnea. What’s the Diagnosis?
Can the Practice of Primary Care Medicine ever be Practical Again?
I Actually Love Technology
Habits for Health and Happiness
The Gift of Time
The Art and Soul of Medicine Exist in the Ordinary
The Science of Clinical Intuition
To Understand What You Already Know
There is a Word for People Like Me: AMBIVERT (A Personal Reflection)
The Call to Be a Primary Care Doctor
The Annual Physical: Is it Worth Having?
My Blog is Setting Many Records, Except One, a Surprise Hit from 2015
Does Tramadol Create More Cold Blooded Killers?
The Complete Workup: Virtue or Waste?
Another Quick Listen
TSH, T3 and T4: The Conductor and the Orchestra
A Lesson Learned is a Lesson Remembered
“Nothing Acute”
The Perils of Being First
NNT: The Number Needed to Treat in Order to Prevent One Bad Event
HYPERTENSION is Like Driving a 5-Speed in 4th Gear
Doctor-Patient Relationships: I Don’t Babysit – I Want to Empower
BANANAS: Potassium, Calories and Constipation
Hey, Doc, What Do I take For a Cold? Nothing!
Peak Flow Meter, Tuning Fork and Blank Pieces of Paper: Things I Would Rather Not Practice Without (Besides My iPhone)
Allergies and Hives
Why I Seldom Recommend Vitamins or Supplements
Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?
A Short Video For Patients Based on My Warfarin Post:
Three Challenges in the Art of Prescribing Warfarin
Serving is No Longer a Useful Term, Especially For Snack “Foods”
Working Too Hard Doesn’t Cause Burnout. Having to Do the Wrong Thing Does
Revisiting the Advantages of aSOAP Notes: The Best of the Paper Chart and Old School Photography
Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare
The Art of Medicine is Not an Algorithm
Food is a Hot Potato
New Book: SAMPLES – Recent Writings on the Art of Medicine. $2.99 on Amazon
Suboxone Saves, Builds and Rebuilds Lives
Morgellons? I Made the Diagnosis of DP. Now I Have to Figure Out How to Manage it.
“Tell Me More”
What Does Your Patient Need to Hear You Say Right Now?
Five Weight Loss Myths I am Constantly Fighting
Cholesterol Guidelines and the Bachelor With Platform Shoes – 13 Years Later
Screening for Depression: Then What?
Some People Don’t Think Like Doctors (!)
My Latest Post on A Country Doctor Talks:
New Symptoms With Old Explanations
Why I Don’t Order Fasting Bloodwork Anymore
My First VLOG: A Country Doctor Talks
THESE WERE NOT COMPUTER BOTS: My Patient Said he Had Bugs Crawling Under his Skin
Please Sign Below: Fraudsters Phishing for Physician Signatures
The Parallel Realities of Health Care: Ratio and Intellectus
Other Super Drugs in My Personal Black Bag of Tricks
THE PAIN IS IN YOUR BRAIN: Your Knees Know Next to Nothing
Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks
The Art of Clinical Decision Making: Friday Afternoon Dilemmas
Find me on Facebook
The Art of the Chart: Documenting the Timeline
An Uncommon Cause of Shortness of Breath
A Double Hit of Imperfect Technology and Massive Centralization
The Art of Diagnosis: Teasing Out the Timeline
Canada’s Buttergate: Invasion by a Trojan Cow
“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
The Art of Listening: When the Inner Voice Whispers
How I Write
It Pays to Play Dumb Sometimes
The Art of Asking: What Else is Going on?
Driverless Cars or Keyboardless EMRs? Which Do We Need Most?
Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
“I Don’t Cook” is an American Epidemic (But A Country Doctor Cooks)
The S-Word (Social) Suddenly Has a Place In American Medicine
Why We Need Good Primary Care Physicians
The Art of Asking: What’s Your Biggest Fear?
The Art of Prescribing (Or Not)
The Art of Explaining: Starting With the Big Idea
There Are Three Kinds of Primary Care, Not to Be Confused With Each Other
The Art of Asking: Show Me Where it Hurts
This is Not Health Care
The Art of Triage: What’s the Worst Thing This Could Be?
The General Public is Meant to be Deceived: The American Food Conspiracy
The Art of Tinkering: The Man With Cold Fingers
Quality in Healthcare: Cultural Competence, Diagnostic Accuracy or Patronizing Insensitivity?
A Country Doctor’s New Year’s Resolution
I Can’t Stop Blogging
Stop Bashing Nurse Practitioners: The Dunning-Kruger Effect is Everywhere
A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine
The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine
Featured Again in Sweden’s Journal of General Medicine
The Art of Listening: A Not-So-Simple UTI
The Art of Listening: Cause and Effect
The Art of Listening: Beyond the Chief Complaint
Stewardship: We Worry More About the Environment than Our Own Bodies
CRAZY AMERICA: Health Insurance Covers Testing When You Are Well But Not When You Are Sick
PATIENTS: Sufferers, Consumers or Something In Between?
I Still Love Being a Doctor – KevinMD
Swedish Analysis: Dark Triad Personality and Denying the Dangers of Covid-19
Courts Interpret Laws Differently – Even the Supreme Court, Depending on Individual Justices. Compare that with Interpreting Medical Science!
Physicians’ Communication Skills are Overlooked and Undervalued – Today’s Exclusive on The Health Care Blog
Where’s Waldo: Finding What’s Important in the Medical Record – KevinMD
How we Deliver Medication Information – a Reblog on KevinMD
“It’s the Interface, Stupid” Revisited: If X-Box Can, Why Can’t our EMRs?
My Latest on KevinMD – 7/26/20 on ACDW
A Country Doctor Writes: IN PRACTICE : Starting, Growing and Staying in the Medical Profession – eBook and Paperback
If We Can’t Have a Universal Electronic Health Record, We at Least Need a Single, Universal, Medication List Plug-In
Local TV Story on First Book in “A Country Doctor Writes” Series
Book Update: Labor Day Release Will Have New Title
CONDITIONS Paperback Bulk Orders
More Profit in Treating Chronic than Acute Diseases – Today’s Post on KevinMD.
One of My Burnout Posts on Today’s KevinMD
Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback – My Latest Post on The Health Care Blog
Driving With James Taylor
Take the Poll: Should I Narrate My Book for Audible?
A Country Doctor is in Australia – Medical Observer
I Cured My Patient, But What Was His Diagnosis?
Aren’t We All Somewhere On the Spectrum of Disease? – The Deductible
A Country Doctor Writes: CONDITIONS – Now Also in Paperback
Oats: Junk Food or Health Food? Ingredients are Only the Beginning
July 4 Book Release Update
When a diagnosis leads to sadness instead of triumph – KevinMD
A Country Doctor Talks – KevinMD
Participating in the greatest miracle a physician is privileged to be part of – KevinMD
There’s a code for pain, but what’s the code for suffering? – KevinMD
First Book Available for Pre-Order
Will Telemedicine Make Us Better Diagnosticians? – KevinMD
The New Normal is Still Unknown, on Earth as it is in Healthcare – The Health Care Blog
Post Scriptum
A Dozen Years of Writing About Doctoring
Meaningful U’s
A Country Doctor Reads: Why Walking Matters – The Wall Street Journal
My Patients with Anxiety and PTSD are Handling Covid-19 Better than Most
Will the Covid-Induced Telemedicine Scramble Change Primary Care Forever?
Covid-19 is Bringing Out the Worst Dishonesty in Some Patients
A Country Doctor Reads: Why Sweden isn’t Restricting Personal Freedom During the Covid-19 Pandemic – Svenska Dagbladet
Why Do Patients Trust their Doctor? Because He or She is a Competent Mensch
A Country Doctor Reads: How South Korea Flattened the Curve – The New York Times
A Country Doctor Reads: Job Crafting for Character – Harvard Business Review
American Telemedicine Has Gone Viral
Depression in Modern Times: We Have Many Friends and Followers, But Low Perceived Social Support Scores Can Make Us Sick
Black Box Warnings: Time to Reconsider Our Disease=Drug Reflex?
Hope is a Contagious Force of Healing
As Physicians Today, We Must Both Represent the “System” and Disregard it
American Primary Care and My Soviet Era Class Trip: Sensing the Inevitable Collapse of a Top Down Bureaucracy
The Science of Placebo and Nocebo Effects Puts the Doctor-Patient Relationship on Par With the Effectiveness of the Pharmaceuticals We Prescribe
Medicine is Child’s Play: Where’s Waldo, Spot the Difference and Whack-a-Mole
“The Four Horsemen of the Medical Apocalypse”: It’s All About Inflammation
Atherosclerosis and Nonstick Frying Pans: Newfangled Medications or Time Tested Lifestyle?
My Favorite Visit: “25 Minutes with More than 50% Spent on Counseling and Education”
Medical Records in Primary Care: Keeping the Story of Phone Calls and Medication Changes with Less than Perfect Tools
Asinine, Backasswards Colonoscopy Insurance Rules Make Patients Decline Medically Necessary Testing
Ad Usum Proprium: Physician, Treat Thyself!
“I Want Complete Labs Ordered Before My Physical”
Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway?
As a Doctor, I Should be a Keener Observer and Notice the Pathology All Around Me
Chronic Disease Drugs are Big Business, Antibiotics are Not
Tell Me Again Why We Should Screen for Early Alzheimer’s?
Doctoring at Christmas
The Public Health To-Do List is Choking Doctors and Jeopardizing Patients’ Lives
Thou Shalt Not Try to Outsmart Me
The Liability of Outside Provider Orders and What Could be Done About It
The Polyvagal Theory: The Science Behind Therapeutic Relationships, Stress Related Illness and Long Term Effects of Trauma
Changing EMR – Seamless Continuation, Dreaded Chore or Fresh Start?
Ten Building Blocks of Therapeutic Relationships
Screen Sharing With Patients
If Nothing Else Works, Try a Horse
Clinical Depth: The Power of Knowing More than the Minimum
Revisiting the Concept of Burnout Skills
Leveraging Time by Doing Less in Each Chronic Care Visit
More and More Pills for 25-30% Better Odds of This, That and The Other – Some Patients Want That, and Some Will Run the Other Way
Let Patients Lead – Explaining Addiction and Recovery to Families
We Have Lost Track of the Natural History of Disease
Patients Are the Real Healers
Sickle Cell Disease and Phenylketonuria (PKU): You May Have the Genes, But Your Diet Determines Your Symptoms
Ordering Tests Without Using Words: Are ICD-10 and CPT Codes Bringing Precision or Dumbing Us Down?
A Country Doctor Reads: September 20, 2019 – Full Circle With Sertraline, Airmanship and Mastery in Medicine, EMR Notes Exaggerate Comprehensiveness
Despair and Happiness in America and in Medicine
A Country Doctor Reads: September 14, 2019 – Life Forms Inside Us are Controlling Our Behavior
I Have a Strong Relationship with my Bank but I Almost Never Go There. How Could this Translate to Primary Care?
A Country Doctor Reads: September 7, 2019 – Workarounds in Healthcare, Empathy in he Age of the EMR, US vs Swedish Postoperative Pain Management
When Was the Last Time You Saved Somebody’s Life?
Magnesium Deficiency: An Undiagnosed Epidemic Behind the Epidemics of Heart Disease and Diabetes
A Country Doctor Reads: August 31, 2019 – Polypill for CVD risk reduction; Assisted living is a money-making fantasy; Why doctors should read business journals
Vertigo is a Symptom, Not a Diagnosis, and it’s Sometimes Caused by Loose Rocks Inside Your Head
Cultivating Charisma in the Clinical Encounter (and emulating Marcus Welby, M.D.)
A Country Doctor Reads: August 17, 2019
Whom Does the EMR Serve? Who Owns and Who Needs THE STORY?
Passed a Stress Test With Flying Colors and Had a Heart Attack on the Way Home, How Could That Happen?
A Country Doctor Reads: August 10, 2019 – High Blood Pressure is High Blood Pressure, No Matter Where or When
A Day of Practicing Medicine Without the Computer
A Country Doctor Reads: July 28, 2019
How Much Should Physicians Touch?
“Thanks for Your Time”: Einstein’s Relativity in the Clinical Encounter
A Country Doctor Reads: July 21, 2019 – Big Data
Everybody Seems to be an Expert, Except Your Family Doctor?
A Patient in the Lobby Refuses to Leave: Medical Emergency, Unhappy Customer or Active Shooter?
A Country Doctor Reads: July 12, 2019
The Stages of a Man’s Life
A Country Doctor Reads: July 6, 2019
Medicare PSA Screening Reversal: Yesterday’s Quality Measure is Today’s Rejected Claim
I Wish My Clinical Hunches Were Wrong More Often
My New Life
Psychiatrist: My Medicine Raised Our Patient’s Blood Sugar, Can You Help? PCP: That’s a Dump!
Our Profession is Deprived of its Language
A Country Doctor Reads: June 1, 2019
Is Hate Ever Therapeutic?
Beyond the Other Viagra: Curiosities in Off-Label Prescribing
A Country Doctor Reads: May 19, 2019
The Folly of Self Referral
A Country Doctor Reads: May 11, 2019
Brief is Good
A Country Doctor Reads: May 4, 2019
Today’s Doctors: Colleagues or Free Agents?
The ABCs of Beginning a Clinical Encounter
A Country Doctor Reads: April 27, 2019
Drug Rehab, Life Hab (ilitation)
A Country Doctor Reads: April 20, 2019
If You Are a Doctor, Act Like One
I Am Not an InstaDoc*; This Is Not InstaMedicine*
A Country Doctor Reads: April 13, 2019
Treatment of Peritendinitis Crepitans: Heparin or Prednisone?
A Country Doctor Reads: March 30, 2019
PDSA for Dummies
A Wonder Drug of Ill Repute
A Country Doctor Reads: March 23, 2019
The Power of Focus
No Information Exchange, Major Diagnostic Delay
A Country Doctor Reads: March 16, 2019
An Accidental Cure
The Cruelty of Managed Medicare
A Country Doctor Reads: March 9, 2019
A Science of Uncertainty and an Art of Probability
A Country Doctor Reads: March 2, 2019
Almost All We Do is Treat Symptoms
A Country Doctor Reads: February 23, 2019
A New Word for Discharge Summaries?
“Let Food Be Thy Medicine and Medicine Be Thy Food”
A Country Doctor Reads: February 16, 2019
Medicine is Not Like Math
Paralyzed by Insurance Drug Formularies? Don’t Forget Cash!
A Country Doctor Reads: February 9, 2019
The Dangers of Practicing Medicine Without Context
The Man with Brown Fingernails
A Country Doctor Reads: February 2, 2019
Checking Boxes
Unavailable Antidotes
A Country Doctor Reads: January 26, 2019
A Spot-On Analogy
Outlook and EMRs: Culture Clash in the Medical Office
A Country Doctor Reads: January 19, 2019
Inhaler Cures GERD?(!)
The Perfect Office Note? SOAP, APSO or aSOAP?
A Country Doctor Reads: January 13, 2019
How I Will Work Smarter in 2019
Stop Trying to Hijack Medical Huddles! Haven’t You Heard of Constant Contact?
Blogging While Driving
There Are Few Shortcuts to Health
Physicians are Influencers
Curiosity, Antidote to Burnout
Touching the Mezuzah – Revisited
The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers
Don’t Do Chronic Care in December
I Love Calling Patients – And I Don’t
Ask the Professor
Sometimes You Just Gotta Treat It
Reruns
HELP ME!
Distance, an American Health Disparity
The Elfins Return
Medicalization and Demedicalization in US Healthcare
Will Technology Keep Us From Thinking?
A Country Doctor Reads is Moving
Teflon Doctors and Velcro Patients
Suboxone for Pain? Not in Maine
Flirting With Functional Medicine
How Often Should Doctors Check Labwork?
What is a Dose of Psychotherapy?
Where is Relationship, Authority and Trust in Healthcare Today?
Helping Patients Accept Their “Imperfections”
Transdiagnostic Treatment Approaches in Primary Care
When the Patient Can’t Tell You
You Are What You Eat – Revisited
Be the Doctor Each Patient Needs
Fundamentals of Medicine: Diagnosis and Guidance (Not Just Treatment)
Dear [CEO]: The Letter I Gave My Boss This Week
M3DICINE: A Word With 3 Meanings
Endocarditis or Not? A Saturday Triage Decision
Two Cases of Bubbly Urine
Only Pain and Fear Bring Patients to the Doctor
Instant Relief
Lists of Three: Unforgettable Lessons from Medical School
If Not a Doctor, Then What?
A Rare Form of Deafness or a Trivial Case of Congestion?
Medicare Knows Everything About My Patients, But Hopes I Will Forget
Guidelines: When Satan Reads the Bible
Be the Guide, Not the Hero
Comprehensiveness is Killing Primary Care
Myopic Versus Hyperopic Views on Physicians’ Work
The Art of the Message
Too Many Chest Pains
The Art of Covering
Demonic Dreams and Irreversible Psychosis from Commonly Prescribed Big Gun Medications
What is Healthcare and Who Deserves it?
My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients
Doctors and CEOs Need Time to Think
Saturday Clinic
Self-Driving Cars are Like Most EMRs
Getting it Right
Primary Care Needs a New Business Model
My Neurology Professor’s Migraines
Facial Recognition in My Own Practice?
The Case For Professional, Not Just Personal, Resilience
Bread and Butter Medicine
Upselling in Medicine: Would You Like a Pap Smear with that Ankle Brace, Ma’am?
Progress in Weekly Increments
On a Personal Note
Brilinta or Clopidogrel, Maximum Benefit or Social Responsibility?
From EMR to Paper to EMR
Triage at the Front Desk
My Suboxone License is Capped at 100 Patients, Should My Opioid License Also Be?
One More Question
Doceo, Ergo Sum
Thou Shalt Do More Physicals
Hanging Up the Stethoscope
Pneumonia is a Disease. Is High Cholesterol or Osteoporosis?
A G.O.M.O.
Talk, Think, Listen and Type
How I Will Work Smarter in 2018
The Other Opioid Epidemic
Routine Physicals, Routine Labs
A Christmas Wish
Reengineering Primary Care (Again)
A Lousy Diagnostician
Between Patients: The Myth of Multitasking
Appendagitis – Not a Typo
Another Thanksgiving Reflection
Always Ask
Wasted Education
A Blackmail Attempt
The Codes that Disappeared
Too Early or Timely Diagnosis
How to Write Like a Dockter
Give Specialist Doctors a Break!
A Boomerang Patient
Annual Evaluations
The “Patient Centered” Medical Appointment: You Know the Drill
Cave: Ignoring the NNT
A Physician’s Lack of Self Awareness
A Flex Fuel Man
Caught Between two Paradigms
Driving my Mini (iPad)
An Old, New Diagnosis
A Dream Job
Thank Goodness(?) for Technology
From Group Practice to Herding Cats
The Dunning-Kruger Effect
Patients from Away
A Week with no Lab Coat
Alarm Fatigue
Medical Records for Amnesiacs
A Lesson Learned
A Moving Target
Quality Medicine: Showing the Math
Acts of Kindness
A Pearl From Medical School
The Real Reason Behind EPCS?
Horse Medicine
EMRs: It’s the Interface, Stupid*
Where Does it Hurt?
There but for the Grace
Everybody is Special
A Bug in His Ear
Imagining a Doctor Shortage
The Power of ACT
Peer to Peer
All or Nothing
Stop Excessive Measurement
Why Can’t We Speak Our Own Language?
Remembering the Inpatient Workup: All the Tests to the Patient’s Bedside
Medicine is a Love that Finds Us
EMRs Should Be Like Rental Cars
“Did You Read My Chart?”
A Day in the Life of Sir William Osler
Dropping the SOAP Note
Friday’s Lessons
Not On Call
Diagnoses Right Under My Nose
Doctors Should Be Paid Like Athletes
Everything Goes Through Me
The Illusion of “Other People’s Money”
Don’t Ask Me to Work for the Other Side
The Meaningful Use Paradox
An Anniversary of Sorts
One Shot Medicine: The Stilted Pseudo-comprehensiveness of American Primary Care
A Thanksgiving Reflection
Primary Care Has a Dirty Little Secret
“When I Was Your Age…”
If 911 Worked Like a Medical Office Phone System
Today’s Medicine has no Credibility
Double-Booking the Doctor is Half-Booking the Patient
Something Extra
Return visit: A Samurai Physician’s Teachings
The Art of Asking
Three Dutchmen Walked Into an Eye Clinic
Return Visit: Changing the Subject
Doctoring, In Simple Terms
Return Visit: A Shot in the Arm
Opiates, Pain and Integration
A Motherless Child Without a Father
A Failed Transition of Care
“Just in Time” Information – Lessons from Manufacturing
No Better
The Intricacies of Antidepressant Interactions
A Fifteen Minute Man
EMRs, PCMH and OCD are Limiting Access to Care
Role Play
A Country Doctor, Duped
A Transformative Visit
Don’t Squeeze, Tie, Slap or Bite the Hand that Feeds You
A Day of Real Doctoring
From Learned Professionals to Skilled Workers: The Dangerous De-professionalization of Medicine
35 Years of Burnout
A Really Bad Bruise
Inside and Out
An Outsider’s View of Cardiology
Cave: The Patient Who Suggests a Diagnosis Before Telling You His Symptoms
Specialists in Diagnostics
An Invitation
A Straight Face Test for Health Care: Would Patients Pay for This?
The Interview
All I Want For Christmas: Seven Things I Wish My EMR Could Do
Night Call
“This is America, You Don’t Have to Do Anything!”
Not on a Silver Platter
Art and Archetypes in Medicine
Husbands and Wives
The Reinvented Wheel, Now Square
A Sore Thumb
It’s Time We Stop Comparing Health Care to Manufacturing
Absolution
The Legend of the Avoidable Hospital Readmission
A Black Hole
A Very Careful Driver
“And Stay Away From Doctors”
Missing the Old A&P
The Man With the Shrinking Lung
Humming Jeopardy
Normal Blood Pressure
Medical Anamnestics
Border Doc
Does Lightning Strike Twice?
A Near Miss, Technology Notwithstanding
The Sick Game of Medicare D Formularies
When a Housecall is Worth a Thousand Tests
Outdated Equipment
All the President’s Mail
The Man with the Up and Down Blood Pressure
The Art of Antibiotic Selection
It’s Time We Talk: A Doctor is a Doctor is a Doctor, Right?
Three Dimensional Doctoring
Equanimity and the 25% Rule
It’s Time We Talk: Why Should Doctors Treat the Well and Nurses the Sick? – Part Two
It’s Time We Talk: Why Should Doctors Treat the Well and Nurses the Sick? – Part One
Nailing the Diagnosis, Failing the Patient
Checklist or choke list?
Requests Denied
It’s Time We Talk About Who Should Do What in Healthcare Teams
A Swedish Patient
It’s Time We Talk About What Healthcare Really Is: Public Versus Personal Health
And Then, What Happened?
A Rash of Rashes
Where is the Mind?
Cave! Ultracrepidarianism
Doctors Speaking Accountanese
Angry Docs
Suddenly Expensive Generics
“I Also Tame Wild Horses”
The Great Imposter
Less is More, More or Less
Calling Mrs. Kafka
Is it the Devil or God in the Detail?
Neither Doctor nor Priest
A Country Doctor in his Sixties
Context, Always
Med School, Day One (1974)
Medicine is Easy, but Metamedicine is Hard
Primary Care is Personal and Passionate
Primary Care is not General Motors
Primary Care is Messy
Incentive, Bribe or Kickback?
Primary Care isn’t Brain Surgery
Exit Diagnosis
The Art of Diagnosis
Recapturing Abundance
Be Prepared
The Ghosts in the Exam Room – Part 2
The Ghosts in the Exam Room – Part 1
The Red Blues
What’s in America’s Medicine Cabinets?
Free Blood Pressure Check
Treating Symptoms
A Tight Squeeze
How Should Doctors Get Paid? – Part 5
How Should Doctors Get Paid? – Part 4
How Should Doctors Get Paid? – Part 3
A Fire In the Belly
“I Hate Coming Here”
Let Doctors be Doctors
The Illusion of Electronic Prescribing
An Act to Eliminate Constipation
How Should Doctors Get Paid? – Part 2
Never Assume – Indeed!
How Should Doctors Get Paid? – Part 1
Never Assume
Bedside Manner and the Pendulum Effect
Aequanimitas – Doctors Stirred, not Shaken
Monocular Vision in Horses and Physicians
Epicrisis
The Art of Being Sick
Wrestling the Rooster
From Scribbles to Scribes: Newspeak and Foma in the Medical Record
Good, Strong Heart Beat – 140 and Regular
Children Who Never Grew
One Visit, One Problem?
Signed, Harvey Cushing
Pain and Suffering
Twenty Questions
When the Doctor is the Treatment
Doctors Without Heroes
A Country Doctor Acquitted
Hippocrates’ First Aphorism
“I am here, Doctor”
Low Tech Medicine
Albert Schweitzer, Action Hero
Practicing Medicine Requires a Patient Relationship
“Aaah, it’s Good to be Back!”
Saturday’s Child: A Country Doctor Reads Hillman and Chopra
What is Osteoporosis?
“Examine Thoroughly, Explain Simply”
Morbus Propedeuticus
Avoiding Retirement
The Night Before Surgery
Fifty-Fifty Propositions
What a Country Doctor Should Write
Quality or Conformity Revisited
What if Physicians Worked for Free?
A Samurai Physician’s Teachings
Doctoring in the Here and Now
Absolute Risk
Controlling Physician Behavior: From Socialized Medicine to Social Marketing
Sharing Territory
A Country Doctor’s Unlived Life
A Minute of My Time
The Art of Prognosis
Touching the Mezuzah
The Secret Of Life
A Country Doctor Watches Marcus Welby, M.D.
Blood – The Doctor Giveth and the Doctor Taketh: Myths, Beliefs and Evidence
Rural Medicine – Not Just Runny Noses
Journey’s End
QS, Ad Lib and PRN
Art, Science and Charity in Medicine
The Art of the Referral Letter
When To Take Medication
Negative Expectations
Cell Phones Welcome
A Doctor By Any Other Name?
Life and Death
A Country Doctor Practices Telemedicine
The Art of Listening: Narrative, Hermeneutics and the Electronic Medical Record
The Gift of Healing: Pastor Graf and Henri Nouwen
Jumping to Conclusions
Today’s Masterpiece
“I’m Sorry Mrs. Jones, But You Have Albuminurophobia”
How to Clicker Train Your Doc
Morbus Iatrogenicus
Squandered Jing
A Part-Time Healer
Never Mind
A Christmas Message to All Physicians from Sir William Osler
A Far Too Typical Visit
An Amended Diagnosis
Off Course
The Gift of One Day
The Virtues of Oligopharmacy
Whom Does the Medical Record Serve?
In Manu Medici: The Art of Administering and Prescribing Medications
Following the Path of the Soul
Patient Centered or Evidence Based Medicine – Can we really have both?
A Cleansing
Lifetime Nutritional Balance
A Drug Launch Lunch
“I Know Your Type”; Doppelgänger and Archetypes in Everyday Medicine
Dear Patient,
The Counterintuitive Concept of Burnout Skills
A Memorial Day Memento
An Angry Diabetic
Calling It Quits
A Snowbird’s Return
A Reluctant Interventionist
A Sore Spot
The Art of Scheduling: Air Traffic Control in the Medical Office
Intuiting Alexithymia
Clinical Instinct
A Letter from the Board of Medicine
An Embarrassing Allergy
Regrets
Useless Medicine
A Judgment Call
The Dance (2011)
“Why Am I So Dizzy?”
An Incomplete Workup
Two Red Herrings
A Red Herring
“I Need A Doctor When I’m Sick!”
“Will You Be My Doctor?”
The Art of Measuring Blood Pressure: Pseudohypertension, Oscillations and the Silent Gap
A Deadly Interaction
Welcome Stranger
Changing the Subject
Night Flight
B.C.
Holiday Cheers
Brand Name Drugs and Generic Prescribers
Guy Talk
Signing Off
“Mommy, I’m Going to Die!”
No Refill
The Oldest Disease
One Track Minds
Amy Laughs With The Angels
All is Well; Over and Out
Finding the Way
The Long Journey
The Call
Fearing the Worst
Playing the Odds
Mechanical Voices
Fecal Occult Blood Tests Illustrate What’s Wrong With Health Care Today
Dinner With A Homeopath
Bitter Medicine
Doing Nothing
A Walking Time Bomb
“Cure Sometimes, Treat Often, Comfort Always”
Shooting From The Hip
The Minimum Effective Dose
“Would You Take Me Back?”
“You Give Me Hope”
Too Good to be True
Why Not to be an Early Adopter
“Dog Ain’t Right”
Happy Birthday, Country Doctor
Meals on Wheels
“Treating to Target”
“That Doctor Is A Nurse!”
Continuity of Care
A Bad Case of Congestion
“Needs Prior Auth”
The Last Supper
Feeling Like A Doctor
The 15-Minute Hour
Beyond the Male Menopause
One-Liners
Abnormal Chemistries
Switching Places
The Emperor’s New Bones
A Quick Listen
Time, Money and Midlevels
“But I Still Have Chest Pain!”
Invisible Ties
A Work Excuse
Decision Support, Professionalism and the Lost Art of Healing
Off The Record
What Are We Doing?
Problem List Problems
A Negative Stress Test
“You Don’t Know Me!”
A Cancelled Appointment
A Terminal Case
Noah’s Journey
The Jig Is Up
Snap Diagnosis
A Bad Case of Nerves
Face-to-Face
“Choices, Gentlemen”
Scrubs, Ties and Stethoscopes
Attitude!
A Posthumous Blessing
The Art of the Intramuscular Injection
Quality or Conformity?
Saying No
Thanksgiving Potpourri
See You Next Time
Starting Over
Who Needs a Physical?
A Hero’s Pain
A Real Pain
The Shadow of the Object
If You Find It, You Own It
Trouble at 6 O’clock
The Power of Words
“Thank You, Father”
A Thirty Year Anniversary, And I Missed It
Basic Knowledge
Who Wants To Know?
Dear Doctor D,
An Empty Stall
Yesterday’s Children
A Tale of Two Sisters
My Most Expensive Instrument
Thicker Than Water
An Imaginary Mentor
One Strike, You’re Out!
Proof of Chickenpox
Oh, By the Way, Doc
The Apostolic Nature of Our Profession
A Shot in the Arm
My Annual Checkup
A Physician’s Funeral
Clinical Pneumonia or Virtual Health?
A Negative Workup
Instant Feedback
Our Last Visit
All My Children
An Easy Keeper
Local Firefighter Gives Doctor Thanksgiving Pie
Loss of Power
When I’m Sixty-Five
What Do I Call You, Doc?
A Change of Heart
A Nice, Clean Doublewide
A Train Wreck* With Two Car Wrecks
The Concept of Risk
All God’s Children
No More Headaches!
A Day Without a Diagnosis
The Good Mother
“Doctor, What Would You Do?”
An Innocent Looking Rash
Twinkle’s Back!
It’s Only Pressure
You Are What You Eat
Happy Hour
One Last Signature
Left Behind (In the Dust)
Playing Doctor
My Father’s Eyes – The Photographs
Visions of Little People
A Concurring Second Opinion
The Dreaded Visit with Priscilla Pye
My Father’s Eyes – The Song
An Anxious Daughter
My Senior Colleague
A Little Man
Another Young Man
Orthorexia Nervosa – Too Much of a Good Thing
Altered Vision
Choices in Swedish Health Care
Is There a Doctor On Board?
Friday’s Child
Doctor Fix-It
Tuesday Evening House Call
Shadow Syndromes
Physicians and Chiropractors – Like Priests and Rabbis
Catch-up Time
A Doctor’s Parting Words
A Doctor’s Advice
The Doctor’s Doctor
Clara’s Sinus Headaches
Physician, Heal Thyself!
The Correct Diagnosis – Ten Years Later
Adverse Effects
Thoughts on My In-Room Cup of Coffee
Losing a Patient Twice
A Country Doctor Stops In Brookline
Sally’s Dilemma
Caleb Didn’t Limp Yesterday!
Time’s Up!
Chocolate – Good or Bad?
Caleb, Our Horse with a Limp
My Nurse’s Mother
A Cobbler’s Mistake
New Doctors: Too Few, Too Many or Too Late?
Cholesterol Guidelines and the Bachelor with Platform Shoes

Share this:

Print
Twitter
Reddit
Email
Facebook
LinkedIn
Tumblr
Pinterest
Pocket

Like this:

Like Loading...

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

BOOKS BY HANS DUVEFELT, MD

Tweets

Error: Please make sure the Twitter account is public.

Top 25 Doctor Blogs Award

Email Subscription

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Email Address:

Follow

Facebook
Twitter
Instagram

Read my VERY FIRST blog post:

Cholesterol Guidelines and the Bachelor with Platform Shoes

Most Read This Week

Sickle Cell Disease and Phenylketonuria (PKU): You May Have the Genes, But Your Diet Determines Your Symptoms
Primary Care Has a Dirty Little Secret
THESE WERE NOT COMPUTER BOTS: My Patient Said he Had Bugs Crawling Under his Skin
Doctors Working for Free
Another Thanksgiving Reflection

Blogroll (remodeling in progress)

A Country Doctor Reads (Archive, Retired Blog)
Barnstorming
Common Sense MD
MD Whistleblower
Peter Elias, M.D.
Refined Medicine
Reidbord's Reflections
Status Iatrogenicus
The Blog That Ate Manhattan
The Heart is a Lonely Hunter

Holiday Reflections

A Christmas Message to all Physicians from Sir William Osler
A Christmas Wish
Touching the Mezuzah

Older Favorite Posts

A Doctor's Advice
A Doctor's Parting Words
Adverse Effects
Doctor Fix-It
It's Only Pressure
Losing a Patient Twice
Physician, Heal Thyself!
Physicians and Chiropractors…
The Doctor's Doctor

Posts That Went Unnoticed

A Quick Listen
Mechanical Voices
The Dance
Treating to Target

Recent posts

Doctors Working for Free
Be Thankful for Ordinary Days
My First Case of Restless Chest Syndrome?
More Pictures From the Life of a Country Doctor
The Dangers of EMR-Defaulted Prescription Stop Dates
The Broken Promise of Computers in Healthcare: A Doctor From the B.C. Era Explains
A Country Doctor’s Life
How Much Time Should Doctors Spend With Their Patients?
From Warrior to Wise Man: Former Coast Guard Reflecting on the Healthcare Workplace
A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)
My Fibromyalgia Patient With Chronic Back Pain and Gout Swears That Colchicine is a Miracle For All Three of Her Painful Conditions
Award Day
Acceptance Speech (long version): 2022 Carol Eckert, MD Memorial Award, Maine Primary Care Association
Awarded by the Maine Primary Care Association:
Delivering Health Care is Like Practicing a Religion
Make it So
Your Doctor Remembers Most Things About Medicine, But Not Everything About You
Five Plain Truths About Gout
I Do Fewer Elective Procedures Now Than When I Started Out. This is Why:
A Renaissance For Phrenology? (A Country Doctor Reads 8/24/22)

Mailbox

contact @ acountrydoctorwrites.com

© A Country Doctor Writes, LLC 2008-2022 Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.

Blog at WordPress.com.
RSS Entries and RSS Comments

Follow Following
- A Country Doctor Writes:
- Already have a WordPress.com account? Log in now.

%d bloggers like this: