Archive for the 'Progress Notes' Category



Don’t Be Insulted If I Prescribe Narcan Along With Your Pain Medication

The Intrusive, Insensitive Nature of Primary Care

I had to get a PCR test for Covid today (I was negative) and before I had the pleasure of getting the swab inserted in my nasal passages I was subjected to a whole series of even more intrusive probings.

The questions on the multipage form included sex at birth and presently (just like our new EMR prompts us to document in every visit), sexual orientation, income bracket, ethnicity, food insecurity and living situation.

And this was just for a ten second nasal swab by a medical assistant.

If I had come for a primary care appointment with a medical provider, I would have received questionnaires about depression, anxiety, alcohol use, smoking, domestic abuse and maybe more.

I have several concerns about this barrage of questions before you even meet the provider. As clinicians we know that patients don’t always tell us the whole story. That is why we do pregnancy tests on nuns with abdominal pain, for example. We are supposed to use all our professional interviewing and communication skills to establish trust with our patients. That can be extra hard after they are first bombarded by the support staff with extremely personal questions.

This well intended systematic inquisitiveness is extremely insensitive and I seriously question its reliability. It seems odd to me that medical students and other staff categories have to take classes in cultural sensitivity and at the same time have a requirement to probe for personal secrets early in their interaction regardless of the age or cultural background of our patients.

I believe the statisticians are given too much power over how the clinicians work.

Understanding a CBC (Complete Blood Count)

Another video post about a common medical topic. (This one with a cameo appearance at the end of a blonde who keeps following me around.)

Abnormal Lab Tests: Not Always a Sign of Disease


I just realized none of the posts show on an iPad or a computer, but they do show on an iPhone. WordPress is working on this. In the meantime, please visit my Substack.

 

 

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

CONDITIONS, Chapter 1: An Old, New Diagnosis

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